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ALZHEIMER’S DISEASE ( 1999 )

• Pinpointing changes
• Types of incontinence
• Identifying the cause of incontinence
• Seeking treatment

http://mayohealth.org

Incontinence — it’s one of the most embarrassing aspects of Alzheimer’s disease. As many as 5 percent to 15 percent of people with Alzheimer’s are unable to maintain control of urine, stool, or both. As many as 50 percent of people with Alzheimer’s in long-term care facilities have this problem. Incontinence leads to further loss of independence, self-esteem and personal dignity.
Incontinence also substantially increases the burden of the person who is caring for a loved one with dementia. More time must be spent monitoring the loved one, and on hygiene and laundry. Caregivers and loved ones also may become socially isolated as a result. It’s not surprising that incontinence can become the deciding factor in transferring a person with Alzheimer’s disease from home to a long-term care facility.
The impact of incontinence is also economic. In the United States, more than $8 billion is spent each year on incontinence treatment and products.
Pinpointing changes
Incontinence is not an inevitable part of normal aging. However, there are changes that come with age that increase the risk of incontinence. The muscles and ligaments involved in the control of urine and stool may become somewhat less efficient. The tone of bladder and bowel sphincter muscles may lessen.
In addition to these physical changes, people with Alzheimer’s disease experience memory loss, decreased ability to reason, loss of interest in their surroundings, and eventually even the inability to communicate. All of these factors contribute to the likelihood of becoming incontinent.
“Incontinence is more common as Alzheimer’s disease progresses,” says Dr. Janet L. Vittone, a community internal medicine specialist and geriatrician at Mayo Clinic, Rochester, Minn. “However, some patients never become incontinent. For those who do, the condition often comes on slowly. People using a walker can’t get to the bathroom fast enough or there may be leakage between trips to the bathroom.”
When a loved one with Alzheimer’s disease begins to lose urine, it’s important for caregivers to monitor the incidents. Did the incontinence begin suddenly? Is it intermittent or ongoing? Has anything recently changed about the person’s environment, routine medications or diet? Have other behaviors changed? Are accidents occurring on the way to the bathroom? Is the person growing more confused? This information can be helpful in pinpointing a cause.
• Alzheimer’s and communication - Finding the words
Types of incontinence
• Urge incontinence — People with urge incontinence have a strong urge to urinate and they go to the bathroom frequently and often not quickly enough. Leakage is typically a problem.
• Stress incontinence — Urine may be lost with certain movements, exercise or even sneezing or laughing vigorously. “Getting up out of a chair may cause leakage,” says Dr. Vittone. “Even coughing from a cold may worsen the condition.”
• Overflow incontinence — People with this type don’t experience the sensation of completely emptying their bladder. This condition may prompt multiple trips to the bathroom day and night, and frequent to constant dribbling of urine. People may spend a long time in the bathroom, but only produce a weak stream of urine.
Identifying the cause of incontinence
Incontinence may be brought on by any one — or combination of — the following factors:
• Urinary tract infection (UTI).
• Constipation (especially likely when the person is confined to bed or a wheelchair).
• Hormonal imbalances in post-menopausal women, which may cause such conditions such as vaginitis.
• Medications. With age, the body handles drugs in ways that may either delay or prolong their effectiveness. The kidney’s ability to clear drugs from the body also is decreased.
• Confusion. People may not remember when or if they’ve gone to the bathroom. They may not be able to find the bathroom or they may urinate in improper places or at inappropriate times.
• Depression. This may cause people with Alzheimer’s disease to lose interest in their own needs.
• Weakness in the bladder itself or in the muscles that hold it in place.
• Chronic or acute disease. Uncontrolled diabetes, an enlarged prostate, or dehydration may account for the onset.
Some causes of incontinence are temporary and treatable; many are not. It is important to consult a physician so that the cause(s) of incontinence may be identified and steps taken to ease its effects or remedy it altogether when possible.
• Complications from a UTI
Seeking treatment
A medical evaluation includes a review of the person’s medical history and current medications. A physician may recommend that the caregiver keep a diary of the person’s fluid intake as well as their toilet habits, including the onset, frequency and severity of incidents of incontinence. Urinalysis can check for signs of infection or blood. The physical examination can search for physical changes in the bladder, urethra and prostate. It also may include diagnostic tests to pinpoint potentially treatable conditions that could cause incontinence, such as impaired mobility or heart failure.
“The goal of the evaluation is to determine the cause and a way to treat or manage the condition,” says Dr. Vittone. “Depending upon the cause, medications may be used to treat an infection. A change in routine may help ease the effects of incontinence. This could mean establishing a toileting routine, changing a medication schedule, or placing a commode next to the bed. In some cases, surgery may be needed.”
Never ignore incontinence. Consult a physician whenever losing urine becomes a problem for the loved one in your care.