Elderly Incontinence - tips for carers

Incontinence means any involuntary leakage of urine or faeces. Incontinence can occur in men or women of
any age, but a person who is elderly, disabled or has a chronic health problem is at increased risk.
Continence assessment

There are different types and causes of incontinence. A continence assessment helps the doctor (or other health
professional such as a continence nurse) to work out an effective treatment program. The doctor will need to know
the persons medical history. In most cases, the doctor will also perform a physical examination, which may include
a vaginal or rectal examination.
The doctor will ask you for detailed information about the persons incontinence signs and symptoms, which may
include:

how often the person goes to the toilet to both urinate and defecate (poo)
a rough estimate of the amount of urine passed
visual description of the faeces
whether the leakage is urine or faeces
details of diet and fluid intake
list of medications including prescription, over-the-counter and herbal preparations
current health concerns
self-care abilities for example, whether the person can feed, dress and bathe on their own
whether or not the person recognises their need to go to the toilet or remembers the location of the toilet.

Treatment for incontinence

Medical treatment depends on the type and cause of the persons incontinence. Be guided by your doctor,
but treatment options may include:
increased fluid intake of up to two litres a day

high-fibre diet
pelvic floor exercises
bladder training
training in good toilet habits
medications, such as a short-term course of laxatives to treat constipation
aids such as incontinence pads.

General tips for carers

Medical treatment may take a while to work or it may manage the incontinence but not cure it. Be guided by your
doctor, but general suggestions for carers include:

The person you care for may be deeply distressed and ashamed about their incontinence. Aim to be calm
and patient. Talk openly together about the situation.
Try to accept your own discomfort and embarrassment. Humour can help.
Despite effective treatment, accidents may happen from time to time. Try to keep a relaxed attitude as much
as possible.

 Look after yourself too. Plan breaks from caring on a regular basis to give yourself time to recharge.
Practical suggestions for incontinence issues

Suggestions include:
Pads for urinary or bowel incontinence are available. Call the National Continence Helpline for advice
about pads and funding, or contact your pharmacist.
Change pads frequently and as required.
Clothing with velcro fasteners or elasticised waistbands may be easier to manage than clothing with zippers
or buttons.
Choose machine-washable garments that dont require ironing.
Protective garments (for example, plastic or rubber garments) may cause rashes if they contact the skin.
Check the fit of protective garments and adjust if necessary.
Toileting suggestions for carers

Suggestions include:

Consider aids such as a raised toilet or a wall-mounted grab bar if the person is unsteady on their feet.
Remove floor mats and make sure the seat is securely fastened to the toilet.
Dont rush the person while they are on the toilet. Music can help create a calm and unhurried atmosphere.
Run a tap or give the person water to sip if they have trouble urinating.
Take note of the persons toileting patterns and suggest they visit the toilet at times that are appropriate to
their pattern. Making notes on how often the person urinates and defecates can also help you and your
doctor to recognise and assess the severity of problems such as constipation.
Consider a portable commode, which is kept by the bed, if the toilet is too far away for the person to
reliably reach in time.
Use disabled toilets if they are available when you are out. A disabled toilet is usually unisex and has room
to fit two people.
Try to accommodate the persons need for privacy whenever possible. If privacy isnt possible, use a
relaxed demeanour to set the mood. Humour may help to dispel embarrassment or upset.
Hygiene suggestions for carers

Suggestions include:
Wear disposable latex gloves (available from most supermarkets and pharmacies) when you are helping the person
to clean up.
Wash the persons skin afterwards. Pat dry and apply a barrier cream sparingly to prevent irritation.
Wash your hands thoroughly with soap and water afterwards, even if you wore disposable gloves.
Dispose of used pads and gloves appropriately. Do not flush pads or gloves down the toilet.
When to see the doctor

Some events may need prompt medical attention including:

inability to urinate
sudden bedwetting or loss of urinary control

chronic constipation
diarrhoea that lasts longer than 24 hours
persistent skin rash that doesnt respond to scrupulous hygiene and barrier creams
strong negative emotions such as anger, stress or depression experienced by the person or the carer.

Treatments and Practical Management

Usually the first line of treatment is behavioral therapy, which will often cure the incontinence. Treatments can
include bladder training, scheduled bathroom trips, pelvic floor muscles exercises, and fluid and diet management.
"The nice thing about behavioral therapies is that there are no side effects and the response is proportional to the
work of the patient," Rosenberg says.
Bladder training can involve learning to delay urination by gradually lengthening the time between bathroom trips.
Or one can practice double voiding: after urinating, the patient waits a few minutes, and then urinates again. This
teaches the patient to drain the bladder more thoroughly.
Scheduled bathroom trips are effective for people with mobility issues or neurological disorders, even if this means
someone else is in charge of taking you to the restroom.
Pelvic floor muscle exercises, called Kegels, strengthen the muscles that help regulate urination. Usually one needs
to practice these a few times a day, every day, for the rest of one's life-stopping can mean the return of incontinence.
Learning how to contract the right muscles can be confusing, so a provider must check to see if the Kegels are
performed correctly by inserting a finger in the anus or vagina to check pressure. Or one can work out with the aid
of biofeedback. Transducers, connected to a computer, are placed on the body, and lines on a video monitor show
when one is doing the exercises correctly.
Medications are frequently used in combination with behavioral therapies:

Anticholinergic or antispasmodic drugs: These are usually prescribed for urge incontinence, and examples
include Vesicare, Detrol LA, Ditropan XL, Oxytrol skin patch, and Sanctura. The most common side effect
is dry mouth. Less common side effects include blurred vision, constipation, and mental confusion.

Hormone replacement: Estrogen therapy-with a vaginal cream, ring, or patch-is used to counteract the
atrophy of the skin lining of the urethra and vagina in post-menopausal women.

Antibiotics: These are prescribed when incontinence is caused by a urinary tract infection or an inflamed
prostate gland.

Others: For men with enlarged prostates, medications either relax the muscles used in urination or shrink
the prostate. Flomax, which relaxes the muscles, is commonly prescribed for this condition. If one's bladder
doesn't contract enough, a provider can prescribe a medication to help it contract more often.

Medical devices can be prescribed for women:

Urethral inserts: This is a tampon-like insert that a woman places in her urethra, usually during activities
related to her incontinence episodes, such as tennis. The woman removes it when she needs to urinate. These are
not as commonly prescribed, says nurse practitioner Smith, as they can be uncomfortable and can cause urinary
tract infections.

Pessary: This is an intra-vaginal device similar to a diaphragm that supports the bladder. A medical provider
places the pessary, which needs to be taken out, inspected, and cleaned by the provider every three months.

If your loved one suffers from elderly urinary incontinence, self care helps avoid complications such as skin rashes
and urine odors. For cleaning, use a mild soap such as Dove. Petroleum jelly or cocoa butter can protect skin. Make
sure to pat the skin dry after urinating. If he or she rushes to the restroom, slip-and-fall accidents can ensue, so try to
set up the home to make bathroom trips easier. Use pads and protective garments such as plastic or washable
underwear until you find a successful cure, or if his or her treatment isn't 100 percent effective.
Surgery
Surgery is an option that is usually only discussed after all other treatment options have been tried. Although more
than 150 surgical procedures exist, the following are the most common types:

For women, sling procedures support the urethra by placing abdominal tissue or synthetic materials under
the urethra. Complications include the inability to void temporarily after surgery.

Women can also have a doctor inject collagen around the urethra, which is a two to three minute procedure.
This fix typically lasts 3 months, so it must be repeated.

For men (and infrequently for women) with stress incontinence, an artificial urinary sphincter can be
implanted around the neck of the bladder. This fluid-filled, doughnut-shaped device holds the sphincter closed
and is attached to a valve implanted in the testicles or labia. To urinate, one presses the valve twice and the
bladder empties.

A sacral nerve stimulator, which is a device implanted in the abdomen with a wire connecting to a nerve
related to bladder function, is a fairly rare procedure, used in roughly .5 percent of the population, according to
Smith. Electrical impulses transmitted from the device prompt the nerve, helping the bladder function.

Of course, the most important step is to seek professional medical help. If elderly urinary incontinence is keeping
your loved one at home and away from his or her favorite pastimes, please realize that this is a highly treatable
condition. With the proper and appropriate treatment, your loved one will soon be enjoying that stroll in the park or
a night out at the movies again.