27: Managing Incontinence

This program will present:

  • Help you to understand the different types of incontinence (ADLs).
  • Discuss various interventions and treatments.
  • There are no easy answer when its comes to the care of another
  • Our hope is to offer you useful information and guidelines for caring for someone with dementia
  • These guidelines will need to be adjusted to suit your own individual needs
  • Involuntary leakage of urine.
  • Types of Urinary Incontinence.
  • Stress.
  • Urge.
  • Overflow.
  • Functional.
  • Mixed.
  • Stress incontinence is the leakage of urine due to sudden pressure on the bladder from increased abdominal pressure.
  • Urge incontinence is sometimes referred to as reflex incontinence or an overactive bladder
  • Overflow incontinence is the leakage of urine that occurs when the urinary bladder’s capacity is exceeded
  • Mixed incontinence refers to the presence of two or more types incontinence at the same time
  • Inability to control bowel movements
  • Muscle damage is involved in most causes of incontinence
  • Poor diet can also contribute to fecal continence
  • Decreased muscle tone
  • Decreased bladder capacity
  • Decreased kidney function
  • Decreased urethra tone
  • Lower estrogen
  • Enlarged prostates

Click here to learn more about incontinence

What could be causing Robert’s incontinence?

  • A. Chronic illnesses.
  • B. Medications.
  • C. His environment.
  • D. Cognitive changes due to Alzheimer’s disease.
  • E. All of the above.

Choice A: Chronic illnesses, is a good possibility. Many medical conditions can cause incontinence, so it is important to have a healthcare professional investigate the cause

Choice B: Useful of medications,is another good choice. MEDICATIONS CAN:

  • Make it difficult to make it to to the bottom in time
  • Make it difficult to empty the bladder
  • Decrease a person’s awareness of the urge to urinate

Choice C: His environment ,is another possibility.

  • Environmental factors
  • Availability of bathrooms
  • Distance to bathrooms
  • Lighting
  • Obstructions along the pathway
  • Restrictive or complex clothing
  • Language

Choice D: Cognitive chances due to Alzheimer’s disease, is also another possibility People with Alzheimer’s may become confused about finding the toilet, manipulating clothing, or bathroom fixtures They might not recognize the physical urge to urinate Choice E: All of the above, is the best answer.

      • Medical
      • Skin infection and breakdown
      • Urinary tract infections and blood infections
      • Impaired mobility, falls and fractures
      • PSYCHOLOGICAL
      • Feelings of guilt, anger, embarrassment and uselessness
      • Poor self-image, depression and sexual difficulties
      • SOCIAL
      • Isolation
      • Placement in long term care
      • ADDITIONAL MEDICATIONS
      • Healthcare providers will need to complete a physical examination, take a medical history, and talk to the person and caregiver
      • Incontinence journal or diary
      • Keep track of severity, frequency, patterns, and causes for at least 1 week
      • When the person goes to the bathroom and the amount of output
      • Incontinent episodes, the times that they occur, the output amounts, and what the person was doing at the time
      • fluid and food intake and their time sto consumptions
      • The diary is an essential tool in helping people overcome incontinence
      • Incontinence Assessment
      • Causes
      • Mental state, dementia, illness, injury, or disease, dietary and fluid intake, drugs, toilet training
      • Functional Assessment
      • Physical Assessment
      • Mental status evaluation
      • Take a backpack or bag containing cleanup supplies and a change of clothing
      • before leaving home, have the person use the toilet
      • Locate public restrooms before they are needed
      • Schedule regular trips to the restrooms
      • Have the person wear disposable undergarments, adult diapers or pads
      • Consider the use of fecal deodorants
      • Habit Training or Scheduled Toileting
      • Toileting on a planned basis
      • Match trips to the bathroom to the persons’ natural voiding or expelling schedule
      • Prompted voiding or expelling
      • Monitoring, prompting and praising
      • Constant need for communication and support from caregivers
      • Pelvic muscle exercise
      • For stress, urge or mixed incontinence
      • Penile clamp/incontinence clamp
      • Intermittent catheterization to empty the bladder
      • Disposable pads
      • Medications
      • Talk to a healthcare professional
      • Change the diet
      • No spicy foods, fatty and grassy foods, cured or smoked meat, carbonated beverages, and dairy products, caffeine, alcohol, sugar-free gum and diet sodas
      • Eat several, smaller meals
      • 20-30 gm of fiber per day
      • Drink more water
      • KEEP AREA AROUND ANUS CLEAN AND DRY
      • Clean with wet toilet paper, incontinence wipes or other disposable wipes
      • Shower or soak in a bath
      • After drying, apply a barrier cream or powder
      • Provide cotton underwear and loose clothing
      • Change soiled clothing as soon as possible
      • Use adult pads, diapers and disposable underwear
      • Staff are responsible for the follow-through of a plan of care
      • Programs for restoring and rehabilitating bladder function
      • Staff members make initial assessment of severity and types of incontinence
      • Develop a plan of care
      • Gather data to evaluate the effectiveness of the plan and to modify it as needed
      • Observe and encourage the residents in the plan of care
      • 5 MAIN TYPES OF URINARY INCONTINENCE
      • FUNCTIONAL INCONTINENCE is caused by inability to reach the toilet in time
      • Most common type among those with Alzheimer’s disease
      • STRESS INCONTINENCE is caused by sudden pressure on the bladder
      • URGE INCONTINENCE is associated with a sudden, strong urge to urinate
      • OVERFLOW INCONTINENCE occurs when the urinary bladder’s capacity is exceeded:
      • MIXED INCONTINENCE refers to the presence of two types of incontinence at the same time
      • Aging, medival conditions, medications, diet, and Alzheimer’s disease can all increase the risk of incontinence
      • Keeping a diary of the person’s bladder and bowel habits and diet can help assess the problem and evaluate treatments
      • STRATEGIES FOR MANAGING INCONTINENCE
      • Habit training and prompted voiding
      • Modifying the diet
      • Medications
      • Surgical treatment is usually a last report
      • CAREGIVER TIPS
      • Carrying cleanup supplies and a change of clothing
      • Scheduling regular trips to the bathroom
      • Using pads or diapers
      • Keeping the pelvic region clean and dry

Written by:
Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:
Sasha Asdourian

www.LightBridgeHealthcare.com

26: Late Stages: Behavior & Sleep

Select the best answers from the list of choices following each question.

Click here to open Certificate of Completion
  • Urinary Incontinence. Mayo Clinic. Retrieved on Jan 15, 2009 from http://www.mayoclinic.org/urinary-incontinence/.
  • Fecal Incontinence. Mayo Clinic. Retrieved on Dec 19, 2008 fromhttp://www.mayoclinic.com/health/fecal-incontinence/DS00477.
  • Fecal incontinence. (2000). FamilyDoctor.org. Retrieved on Jan 15, 2009 from http://familydoctor.org/online/famdocen/home/seniors/commonolder/067.html.
  • Fecal Incontinence. (2007) National Digestive Diseases Information Clearinghouse. Retrieved on Dec 19, 2008 from http://www.digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/.
  • Fink HA, Taylor BC, Tacklind JW, Rutks IR, Wilt TJ. Treatment interventions in nursing home residents with urinary incontinence: a systematic review of randomized trials. Mayo Clin Proc. 2008;83(12):1332-43.
  • Incontinence. Ethicon Women’s Health & Urology. Retrieved on Jan 15, 2009 from http://www.gynecare.com/bgdisplay.jhtml?itemname=incontinence_basic_information.
  • Leung FW, Schnelle JF. Urinary and fecal incontinence in nursing home residents. Gastroenterol Clin North Am. 2008;37(3):697-707, x.
  • Potter J, Wagg A. Management of bowel problems in older people: an update. Clin Med. 2005;5(3):289-95.
  • Roach M, Christie JA. Fecal incontinence in the elderly. Geriatrics. 2008;63(2):13-22.
  • Shamlivan T, Wyman J, Bliss DZ, Kane RL, Wilt TJ. Prevention of urinary and fecal incontinence in adults. Evid Rep Technol Assess (Full Rep). 2007;(161):1-379.
  • Skelly J, Flint AJ. Urinary incontinence associated with dementia. J Am Geriatr Soc. 1995;43(3):286-94.
  • Tariq SH. Fecal incontinence in older adults. Clin Geriatr Med. 2007;23(4):857-69, vii.
  • Upton N, Reed V. The meaning of incontinence in dementia care. Int J Psychiatr Nurs Res. 2005;11(1):1200-10.
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