Dementia and Incontinence

Over the last few weeks, my mom’s incontinence has gotten MUCH worse. I would classify her as almost completely incontinent of bladder and about 50% incontinent of bowel. While these issues have been creeping up and steadily getting worse, they’ve been fairly well managed because she’s been willing and capable of changing her own briefs. When we’d notice she’d had an accident, we would ask her to change her pants and she would.

incontinenceOver time, the “passive” assistance she’s needed with this has increased. We used to keep the briefs in a drawer in the bathroom. Then we kept the package on the floor in the bathroom. But, she started hoarding the briefs by taking a handful at a time and putting them in her bedroom. The problem came in when she’d go into the bathroom with a full brief and no clean ones in sight. Lacking the ability to solve that problem, the dirty brief was left on and leaks and accidents occurred. We are now vigilant in making sure there is always one, and only one, brief sitting right on the sink next to the toilet.

Now, she needs “active” assistance. She has a hard time figuring out how to get the brief off and a new one on. That goes hand-in-hand with the job of care-giving. No surprises, it’s part of the job.

BUT, often, she flat-out refuses to take it off. The other day, my husband and I spent the better part of 6 hours trying to get her to change it.

Pause for just a moment and think about that smell. If you’ve never encountered it, you’re blessed. If you have, you know it’s a gagging, hold-your-breath-as-long-as-you-can smell. It permeates the house. Forget the job of cleaning her up, that’s nothing compared with enduring the smell while trying to convince her to change.

Maybe you’ve never cared for an incontinent elderly person, but if you’ve cared for a baby, you know diapers only hold so much. If they aren’t changed, eventually they leak. Through the clothes. Into the bedding. Into the upholstery.

Adjusting to this is rough. I don’t cry very often about this whole caregiving thing. I’m not always happy about it, but it’s my job and I do it. I’ve had complete hysterical melt-downs twice in the last three weeks.

She’s been averaging 3 pair of slacks a day. Changing the sheets is about an every other day job now. I clean the toilet and bathroom floor as many as 4 times a day.¬†Twice in the last two weeks she’s fallen down in the bathroom. Thankfully, she hasn’t been hurt. In both instances, her pants were half up–or down. We aren’t sure, but we think she has lost her balance trying to get the pants up after she goes.

There are so many factors that could be at play and it’s so frustrating that she can’t really communicate what they are. Here’s just a few thoughts and possible solutions. Even if they’re strategies that aren’t working for us, maybe they’ll work for you and your loved one.

  • She’s afraid of falling. We’ve installed a raised toilet seat with grab bars on the side. She seems to not really know what to do with it, but I’m working with her to teach her to use the grab bars.
  • Her pants might be too difficult to get up and down. She wears only elastic waist pants, so I’m not sure what else we can do here, but if your loved one is still wearing pants with zippers and buttons and snaps, it might be time to change.
  • Her brain might not be receiving the signal that she needs to go. Not a thing in the world we can do to fix that, but encouraging her to go to the bathroom on a regular schedule might help. We just have to figure out how often that will need to be.
  • She’s lost the ability to solve the problem of cleaning herself up and attending to the details of putting on a new brief when it is wet. We accompany her to the bathroom when necessary and stand outside the door to listen other times to see if we need to intervene.

As always, I encourage you to do your own research. Both Alz.org and Caring.com have great resources on the topic of incontinence and Alzheimer’s. Of course, you should also talk with your loved one’s doctor. There are medications to help; however, like any medication, they involve pros and cons, risks and benefits and there is no single solution for every patient.

One final and important note…if the onset of incontinence is sudden, it probably isn’t a result of the dementia, but rather a symptom of an infection. Please get your loved one into ¬†the doctor promptly!

If you have some tried and true strategies for caring for an incontinent person with dementia, please share in the comments!

 

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