Dear Carol: My dad has Alzheimer’s and was still living independently until COVID-19 became a threat. The original plan was to move him to an assisted living memory unit, but we didn’t feel that it was a safe option anymore because of the virus. Since I've received support and training from the Alzheimer's Association for how to deal with his Alzheimer’s I’m doing a fair job with that, so far. My problem is that he’s incontinent and that part is driving me nuts. Can you give me any information to help make things better? I’d like to stop the house from smelling like pee. – GH
Dear GH: You have my sympathy. Managing your dad’s Alzheimer's at home is enough of a challenge without the distraction of incontinence, but incontinence is part of most types of dementia. While I can't change that, I can give you some suggestions that might help make life easier for you.
Try to normalize the situation. It’s easy to become frustrated and even angry over all of the work that can be involved when someone has incontinence, but remember that your dad might be embarrassed about not being able to control his bladder and/or bowels. Putting yourself in his place will help you adjust your own mentality which in turn will help you develop a more compassionate approach. Let him know that incontinence is an entirely normal side effect of many health issues. Because of this even young people must sometimes deal with incontinence.
Humor can help with some personalities, so joking that their stylist said that it was time to change their clothes to something spiffier could work for some. Caution, though. If you choose to try humor, do it knowing that it could backfire. Much depends on your dad's personality.
Often the best approach is just being matter-of-fact about incontinence by treating it like any normal health realted condition.
- It might be helpful to know that some foods can be a trigger because they irritate the bladder. Coffee, tea, and carbonated drinks, acidic fruits and juices like citrus drinks, alcohol, spicy foods, tomatoes, as well as chocolate and other sweet foods can all irritate the bladder. I’d like to make a point that most people with dementia have so many challenges that adding restrictions on what they eat may not be practical – or kind. Still, knowing possible triggers might be helpful in overall planning.
- Fluid management is often mentioned on lists of things to consider with incontinence. Too much water can contribute to a constant need to urinate, but too little water can cause serious issues for someone who is living with dementia, so be careful about limiting fluids. Having said that, if he does drink a lot of fluid, limiting drinks somewhat late in the day might help.
- Unless your dad has reached the stage where he can't use the bathroom on his own at all, it’s good to work at keeping him on a schedule of bathroom visits. Doing so can help retain what bladder control he is capable of. Every hour or two can be good, but if he fights your efforts make the attempts less frequent. Like fluid management, this schedule can help reduce the times when you might need to clean up after him.
- Keep wipes and other supplies handy (you probably already do this).
- Transition to simple clothing and eliminate belts and complicated fastenings as soon as possible. There are tear-away pants available online in adaptive clothing stores that work for some situaitons.
- Use the best quality protection possible. This not only can save you work but it can help protect your dad's skin as well as your home. Also, using pads to protect furniture and bedding is a must. Egosan has these pads available to purchase right along with the proper size and absorbency of protection.
- For a variety of reasons, a caregiver might not be able to provide incontinence care by themselves in a home setting. In fact, incontinence is one of the leading causes for facility placement. If this is where you are, consider hiring an in-home caregiver to help with personal hygiene and toileting, or revisit your idea of moving your dad to memory care. With the vaccine, this is becoming a much safer option.
We're thinking of you and others in your position because we know how hard dementia care can be.
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