Related topics: •  Alzheimer's and Bathing •  Caring for Someone With Alzheimer's

Most caregivers will do practically anything for a loved one with Alzheimer's disease. They'll give baths, help to dress the person, cut up food into manageable bites, and patiently answer the same question 20 times in a row.

But when a patient starts wetting or soiling himself, even the most dedicated caregivers can feel defeated. It's hard to face the prospect of constantly cleaning urine stains from the couch cushions or changing the sheets three times a night. Such accidents, in fact, drive some dedicated caregivers to look for nursing homes.

It doesn't necessarily have to be that way. Sometimes, with a few simple steps, you may be able to help your loved one regain control, or at least more comfort, while saving yourself some work and distress.

The first thing you should do is discuss the problem with the patient's doctor. Incontinence -- especially urinary incontinence -- is a very common condition among older people, and it may have nothing to do with Alzheimer's.

For instance, many older people have overactive bladders, which leads to a sudden and urgent need to urinate and causes frequent leaking. Others have trouble squeezing urine from the bladder, so the bladder overfills and produces a more or less constant dribble of urine. Due to weak pelvic muscles, many older women lose urine when they sneeze, laugh, or exert themselves. A person with bowel incontinence may be suffering from an infection, diarrhea, constipation, or a fecal impaction (an accumulation of waste lodged in the bowel).

Many of these problems are reversible. A doctor can prescribe medications to improve bladder and bowel control in some cases. For instance, several drugs are available to calm an overactive bladder, and a number of medications can help people empty a bladder that is overfull.

As the brain damage done by Alzheimer's progresses, you may need to take extra steps to prevent accidents. A confused person can forget to go to the bathroom, or he may not remember what to do once he gets there. You can help by taking your loved one to the bathroom every few hours and, if necessary, showing him the toilet. You should also watch for restlessness, such as tugging at clothes, or other subtle clues that he may need to relieve himself.

If the person you are caring for continues to have accidents, do your best to keep him comfortable. To prevent sores, wash the skin thoroughly and apply powder to keep it dry. "Adult briefs" or absorbent pads can be extremely useful in preventing accidents, as long as the patient doesn't find them too uncomfortable or demeaning. He may be more accepting of pads if he can pull underwear over them, or if they are built into the briefs themselves. (If your loved one suffers from fecal incontinence, he probably needs to wear adult briefs.)

Most of all, try not to scold a person for accidents. Your loved one isn't trying to make your life difficult. Rest assured, he dearly wishes he could take care of himself.

Here are some other tips that will help keep accidents and frustration at a minimum:

•If your loved one has trouble finding the bathroom in the early stages, put up clear signs with words and pictures.

•If walking is a struggle, buy a portable commode to shorten the trip. A commode next to the bed can be especially useful for preventing nighttime accidents.

•If a person often wets the bed, limit her fluids before bedtime. In later stages, use adult briefs and put a plastic cover under the sheets.

•Make sure a person has plenty to drink during the day. Without enough liquids, a person can become constipated and dehydrated.

•Provide clothes such as sweatpants, which are easy to take off quickly.

•Plan ahead for bathroom stops if you take a person with Alzheimer's on an outing. Take a change of clothing along just in case.

•If patterns of urination change dramatically, have the person evaluated for a possible urinary tract infection.

•If the person with Alzheimer's has diarrhea, consult with your doctor; the condition often needs to be treated aggressively.

•If an overstressed caregiver mistakes a urinary accident for a deliberate act, he or she may in rare instances lose control. If you ever find yourself becoming abusive or yelling after your loved one has an accident, seek counseling help immediately. You don't want to take out your anger on a bewildered, demented person, and your reaction is a sign that you need more help caring for him.

-- Chris Woolston, M.S., is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive, and was the staff writer at Hippocrates, a magazine for physicians. He has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education. His reporting on occupational health earned him an award from the northern California Society of Professional Journalists.

Further Resources

Alzheimer's Association 800/272-3900

http://www.alz.org

Michael Castleman et al. There's Still a Person in There: The Complete Guide to Treating and Coping with Alzheimer's. Putnam Publishers, 2000.

Howard Gruetzner, M.Ed. A Caregiver's Guide and Sourcebook. John Wiley &Sons, 1992.

Nancy L. Mace, M.A., and Peter V. Rabins, M.D., M.P.H. The 36-Hour Day. Johns Hopkins University Press, 1999.

Lela Knox Shanks. Your Name Is Hughes Hannibal Shanks: A Caregiver's Guide to Alzheimer's. The Penguin Group, 1999.

Carol Simpson. At the Heart of Alzheimer's. Manor HealthCare Corporation, 1996.

References

Last updated February 25, 2009
Copyright © 2000 Consumer Health Interactive

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