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Incontinence and incontinence care are two subjects of conversation that no one likes to talk about. These are both difficult and sensitive issues, but the results are clear. The painful proof is an obvious stain on your parent’s pants. Incontinence and incontinence care can lead to embarrassment, shame, and confusion for both you and your parent. It shouldn’t, however, result in public humiliation or ridicule. Incontinence is a common problem for seniors and there are ways to manage an embarrassing situation with advanced preparation.

What Causes Incontinence in the Elderly?

Incontinence is often caused by weakened bladder muscles. The bladder plays a key part in human urination. Picture your bladder as a sponge which stores urine. Going to the bathroom is like squeezing a wet sponge. The tightening bladder muscles force urine into a tube called the urethra to exit the body. A senior’s older muscles can weaken and don’t often work the best or even in the same way they did years before. When the bladder muscles fail, urine can leak out – often without a senior noticing. While both human genders are susceptible, incontinence occurs more often with women.

Other indications of incontinence include the following:

  • Physical inactivity
  • Certain chronic health problems
  • Previous removal of gall bladder
  • History of smoking

Types of Incontinence

To better manage incontinence care, you will need to know more about the cause for your loved one. Pinpoint the type of incontinence you are dealing with from this list:

Stress Incontinence: No, this is not related to any undue stress that a person may feel. Sudden movement (e.g. jumping, coughing, or laughing) can lead to incontinence. Usually, the following leakage is slight.

Urge Incontinence: Seniors with urge incontinence will often need to rush to the closest bathroom even when their bladder is not completely full. If the senior does not reach a bathroom in time or finds it already in use, accidents can frequently happen.

Mixed Incontinence: A combination of stress and urge incontinence leads to mixed incontinence.

Overflow Incontinence: Does your parent experience urine leakage without knowledge? Your parent may have overflow incontinence caused by a block in the urine flow. Compare this with a vacuum with a sock stuck in its hose. The machine will still want to work but lacks the ability to function correctly.

Functional Incontinence: This is often seen with seniors with dementia. When a senior may not realize the need to go to the bathroom incontinence care becomes more difficult. Even if seniors can reach a bathroom in time, they may not know what to do when they get there. If they don't remember or aren't able to pull down a pair of pants or transfer from a wheelchair to a toilet seat, accidents occur.

Reflex Incontinence: A senior’s bladder muscles may suddenly tighten resulting in larger urine leaks. This type of incontinence is more prevalent in seniors suffering from multiple sclerosis or spinal cord injury.

The Best Incontinence Care Products for Older Adults

There are incontinence products available to help manage this condition. These include:

Adult diapers: Diapers aren’t for young children anymore! Seniors can also wear these to absorb human waste. Don’t delay too long with changing diapers. As diapers are in direct contact with the skin, human waste can lead to painful rashes and dangerous infections. If a senior needs adult diapers, a caregiver should shop for pants one or two sizes larger than usually required. I did this with my father.

Condom catheters: These will be for men only and are a three-part system. The first part will slide over a man’s genitals. The second part is a plastic tube which can run down the leg. The third part is a plastic bag at the bottom of the leg which collects urine. As the device can be worn comfortably underneath a pair of pants, none of this will be noticeable.

Men’s Liberty: If a man prefers, this product can be placed over the tip of his genitals. This can provide a little more freedom and convenience to the wearer. The tight seal will prevent any risk of leakage. As with the external condom catheter, urine can flow down a plastic tube attached to a leg and into a bag.

Bedside urinals: Seniors may have limited mobility and cannot move quickly from a bed to a bathroom. In this case, a bedside urinal can be helpful. Bedside urinals often resemble a jug or a dish. Women will find this process more difficult than men. Women can use another product which resembles a funnel with a wider opening to better "aim" urine into the jug or dish.

Commodes: Commodes look like a standard toilet, can be placed at bedside, and folded when not in use. Commodes greatly reduce the length of the trip required to reach the bathroom. Urine is collected in a small bowl directly underneath the seat. Incontinence management requires regular emptying and washing of this bowl

Internal catheters: Internal catheters are inserted directly into the bladder via the urethra to drain the bladder. Users can enjoy more freedom and mobility but this does come with an increased risk for a urinary tract infection. Internal catheters can also be referred to as Foley Catheters.

6 Tips to Make Caring for Incontinence Easier for Caregivers

Incontinence care is easiest when you can prevent an accident before it happens. These six tips can help:

  1. Go Before Leaving the House. Family caregivers can ensure that incontinent seniors go to the bathroom before any road trip. Family caregivers may be reminded of previous family journeys when they were younger and were quizzed about going to the bathroom before getting in the car.
  2. Look Around. Locating the closest bathroom(s) prior to venturing out can also be a good idea. Is the public bathroom located up or down a flight of stairs? Stairs can prove to be difficult for seniors at any time. If the caregiver is trying to rush a senior up or down stairs, either person could fall and this could be dangerous. Public bathrooms may be pay-to-use so carry some pocket change with you.
  3. Limit Drinking. Reducing the amount of what goes in will reduce the amount of what comes out. Cut back on any drinks. Plenty of water is still encouraged to stay hydrated. Avoid caffeinated beverages as those can lead to incontinence quickly.
  4. Pack an Extra Layer. Family caregivers can carry a bag with an extra pair of pants and underwear. In the case of an accident, slip into the nearest public washroom and help your parent change clothes.
  5. Pack an Extra Roll of Toilet Paper. Reaching a bathroom in time is only half the battle won…there may be a limited amount of toilet paper on the roll. Plan for this and help clean up by carrying another roll of toilet paper with you. A washcloth can also be handy.
  6. Exercise. Seniors can add slower and faster pelvic muscle contractions to their routine. These are often referred to as Kegel exercises. If you are interested in adding these to your daily regimen, check with your family doctor. He or she can best recommend if these exercises could be appropriate and explain the movements required.

Read: Is it Time for 24 Hour In-Home Care?

How Do Incontinence and Alzheimer’s Disease Connect?

Incontinence and Alzheimer’s disease can occur hand-in-hand. A senior suffering from Alzheimer’s disease may not remember the sensations of needing to go to the bathroom. Even if these are recognized, the senior with Alzheimer’s can forget where the closest bathroom is located. Make sure to check in with your loved one frequently to avoid an accident.

Can You Treat Incontinence?

Incontinence care can begin with an honest discussion with your doctor. Often, a long-term family doctor is the best choice. He will be most familiar with your parent’s medical history, should not have to conduct an extensive number of tests, and can be trusted to provide the best solution. Seniors will undergo a complete physical exam and be asked to provide a urine sample. This sample will be thoroughly examined to check for any infections or diseases.

This may not point to anything conclusive. In this case, the doctor may require an x-ray or a urinalysis test. X-rays probably don't require an explanation, but a urinalysis test may be a foreign term. This involves the patient urinating into a modified toilet. This toilet will report the speed and strength of the senior’s urine stream. The doctor will check this supplied urine for any infection. If that doesn't clear things up, the doctor will insert a catheter into the senior’s bladder and a tube into the senior’s rectum. Granted, this may not sound very comfortable, but rest assured that the senior should not experience much pain. The doctor will slowly pour saline into the catheter, gauge response, and check for any urine leakage.

Depending on the findings, your family doctor may take any number of action steps. Medications (e.g. Ditropan XL, Detrol, Enablex, and Vesicare) may be prescribed, medical devices recommended, or surgery conducted. Caregivers can make the best decision by fully exploring all the options with the doctor and their loved one.

As a last word, with advancing age, incontinence can – and likely will – happen in some form. My advice? Deal with incontinence care the same way you do with other caregiving issues you face – with diplomacy, sensitivity, and tact.

Read: Home Care vs. Home Health Care & What Caregivers Do

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About the Author(s)

As a former co-caregiver, Rick Lauber helped and supported his own aging parents. His mother had Parkinson's and Leukemia and his father had Alzheimer's. Rick learned that caregiving is challenging and used writing to personally cope.

His stories became two books, Caregiver's Guide for Canadians and The Successful Caregiver's Guide.

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