Personal Care Issues - Toileting and Incontinence

The need for assistance with this very private matter is often the most difficult for the caregiver and the memory impaired. Although toileting and incontinence issues are expected as a memory-impairing illness progresses, many caregivers are unprepared and upset when these issues begin to occur. Using some of the following tips and guidelines may assist in this very difficult care routine

> Follow structure and routine. This sets an expectation and helps to re-train bladder and bowels. Encourage the use of the toilet every two hours when the person is awake. Even if they make the statement that they don't have to go right now, encourage them to try anyway - maybe state that you are going to wash the floor so they'd better use it now before the floor is wet.

> Remove all barriers to using the bathroom. Keep the lights on in the bathroom. This may help draw them into the bathroom when they begin searching for the place to relieve themselves. You may need to put up signs on the door to help direct them. Never assume that just because they've lived in the house 20 years means that they know where the bathroom is. The disease is making normal memory change and fade - they cannot help becomming lost and disoriented - even in their own home.

> Watch for signs and indicators that they need to use the bathroom. Some signs may be restlessness, wandering, short tempered, undressing, pulling on clothing, moaning, whining...

> Keep them well hydrated. Offer fluids continually throughout the day (up until 6pm). Hydration is the first step in bladder retraining. A person cannot work to strengthen bladder muscles if they cannot feel the sensation of a full bladder.

> When assisting them with toileting - go slowly and explain each step. Never rush them. Be sure they understand your intentions.

> Never scold or embarrass them. They are not doing this to upset you, get even with you, or to get attention. If they were capable of controlling themselves, they would. They may become very angry if they are incontinent - even to the point of yelling at you as if it were your fault. This is simply an expression of their humiliation and fear. Do not react to the words they may say. Offer empathy and support. Try something like "That's OK - We can fix this with no problem." or "No problem - let's fix this and then we can go for coffee."

> If they begin using items other than the toilet to void in, remove those items. Again, this behavior is clearly an expression of the level of confusion they are experiencing. It is not uncommon for caregivers to complain that their family member is using a waste paper basket, floor plant or dresser drawer to void in. If this should begin to happen, move the item into the bathroom (if able - like the waste paper basket or plant) Often, once they see the toilet, it becomes clear to them to use it.If they are using furniture, try turning it toward the wall so they are unable to use it or remove it from their sight.

> Consider the use of disposable incontinence products. Adult wipes for the bathroom and disposable adult incontinence products will simplify things for you and help them maintain their dignity.

> Sometimes incontinence is an indication of infection or illness. Be sure to notify their doctor of any changes in their behavior, routines and conditions. The doctor may be able to offer additional assistance.

> Seek assistance from your circle of support. Use neighbors, family, friends, physicians and area support groups.

> The WNY Chapter of the Alzheimer's Association offers caregiver seminars at various times throughout the year. Please contact them for more information - (716)626-0600.

> For information regarding ElderWood Senior Care's Memory Care Programs, contact us at (716) 633-3900.