Affinity health care

Questions & Answers with Vadim Cherdak, PhD, CSA
Certified Senior Advisor

Q. Does Alzheimer's disease cause incontinence? What are some ways to cope with incontinence?

A. About 3 out of 10 older people have difficulty with urine control called urinary incontinence. Many people feel so embarrassed about it that they avoid social situations and become house bound. Incontinence may come with an illness, infection, exhaustion, or hospital admission and leave when the person heals.

There are three general types of urine incontinence:

1.Stress incontinence is leaking during exercise, coughing, sneezing, laughing, or lifting heavy objects

2.Urge incontinence results from being unable to wait long enough to reach a toilet. Usually people with a stroke, Parkinson's disease, or multiple sclerosis have this condition. People with late stages of a progressive memory disorder may develop urge incontinence. As health declines, the condition gets worse.

3.Overflow incontinence results from a full bladder "flowing over." Often it occurs in people with diabetes or men with an enlarged prostate.

A physician will identify treatable and untreatable causes of urine incontinence. Treatments include medicine, diet changes, minor surgery, muscle exercises (Kegel exercises), and biofeedback. In the past few years, behavioral training such as timed visits to the toilet has been a successful way to treat, or at least manage, urine incontinence.

Bladder Training

Bladder training or bladder reeducation is an easy way to manage urine urgency, frequency, or incontinence. For this reason it is useful for people with progressive dementia. The training involves trying to change the behavior step by step. With each step of success, the person is rewarded. Basically, toilet times occur frequently. Then gradually the time increases between toilet visits. Over time the bladder muscles work harder and become more able to hold back urine. The person who uses the toilet every hour at first may be able to work up to a three or four-hour wait.

First a one-week diary identifies the person's lifestyle and pattern of in-continence. Then for several days, the person should try to use the toilet every 30 to 60 minutes. When dryness is achieved (and rewarded), the interval is increased by 30 minutes. The person is encouraged to wait the full amount of time set. If 30 minutes more are too long, then a shorter interval increase, such as 15 minutes, may work. Shorter increases in waiting time expand the bladder training period some additional weeks. Many people with mid-stage Alzheimer's disease may be able to work up to a 2 1/2 hour wait between toilet times.

Training Tips

Increasing toilet intervals may require some work with distracters, rewards, or relaxation strategies. When urgency occurs, instead of rushing to the toilet, the person should try to relax, sit or stand quietly, breathe slowly and deeply, and focus elsewhere on the body. Important also are positive thoughts such as, "I CAN make it to the bathroom" or "I can do it." The person should walk slowly to the bathroom because fast activity may lead to urine leaking.

The dermatologist's general rule for skin care is good to follow:
"When the skin is too dry, moisten it with ointment or lotion."
"When the skin is too moist (chafed and red), dry it with powder or cornstarch."