By Jennifer Beach, LSW, MA, C-SWCM
Sarah was looking forward to a special afternoon with her mother to celebrate their birthday month. Both were born in April and having lunch together has become a tradition. Sarah was a bit worried about her mother not having any “accidents” while they were out. Her mother has always been so particular about her hygiene, it is hard for Sarah to understand what exactly is going on with her mother. The last time they went out, her mom had an “accident” in her car right as they left the restaurant. Sarah had asked her mom two times prior to leaving the restaurant if she had to use the bathroom and her mom clearly said “no.” Sarah’s mother has recently been diagnosed with dementia and Sarah is struggling with this new incontinence situation.
Brain changes and incontinence are not uncommon, can be complex and depend on our abilities and systems. Systems include the digestive system, the nerve pathways between the brain and bladder and bowels, awareness of time, mobility, manual dexterity, senses and more. The process of elimination is individualized, with different patterns, frequency, and quantity.
When you eliminate your bladder or bowels, your brain sends messages telling you when it is “time to go.” Being in control of these functions depends on many things, including an awareness of bodily sensations, such as the feeling of having a full bladder, and the brain’s ability to tell you when, where and how to respond. When there is a change in cognitive function and memory because of dementia, incontinence may become a challenge.
A few common challenges may be:
- Recognizing the need to go to the bathroom
- Feeling the sensation of having to go to the bathroom
- Recognizing, planning and being able to wait or hold until getting to the bathroom
- Physically getting to the bathroom
- The height of the toilet and feeling comfortable getting on/off
- Difficulty with getting clothing up and down
- Vision and lightening issues
- Locating, recognizing and/or using the toilet properly
- Not being able to recognize when incontinence has occurred
Although the brain changes due to dementia can lead to incontinence, other medical conditions can also cause continence problems in individuals with dementia, such as infection, constipation, hormonal changes, and prostate enlargement, to name a few. It is important to be aware of routine patterns and recognize that changes in patterns may be a sign that something else could be going on.
Three tips to consider when assisting individuals in varying stages of dementia challenged with incontinence:
Remind & encourage trips to the bathroom
It is important to be aware of the way, tone and words being used for bathroom reminders. It typically is best to avoid asking, “Do you want to use the toilet? “or “Do you need to use the bathroom?” as often individuals with dementia may respond, “No, I don’t.” They may not recognize or feel the sensation to go. Instead, try phrases such as “Let’s stop in here and just try to go” or “I have to go, can you come with me?” Pointing out accidents or making statements like “Remember what happened last time we were out” often feel like shaming the individual, is typically ineffective and may lead to the person hiding soiled clothing for fear of being discovered, embarrassed or shamed.
Simplify clothing
Elastic waistbands or wraparound skirts are easy. Try using Velcro instead of zippers, select washable clothing that doesn’t need ironing or look wrinkled, if that is important to the individual. Use protective undergarments such as disposable briefs and pads.
Assisting in the bathroom
Helping someone when in the bathroom often takes patience. Rushing the person can add undue stress and frustration for all involved. Try running the tap water or giving the person a drink of water if they are having trouble urinating. Allow them to get up and down a few times if they are restless or hyperactive and will not sit on the toilet. Try something to distract them while they are on the toilet; music may have a calming effect.
Even though managing incontinence can be a challenging endeavor, it is an important aspect of supporting an individual living with dementia. Being aware and educating yourself about how brain changes are affecting even what we consider smaller tasks, such as going to the bathroom, can be incredibly helpful in offering effective support.
Original Article: https://www.northeastohioboomer.com/blogs/why-they-might-not-know-they-gotta-go/