How can I talk to my loved one about incontinence?
Realize it's normal to feel uncomfortable. There are some discussions between close relatives, especially a parent and child, that many of us would rather avoid: Talking to your own children about sex is probably not something many parents can glide through without some discomfort. Equally difficult, or perhaps even more so, is broaching the subject of incontinence with the very person who used to change your diapers when you were an infant.
Whether or not the person you're caring for has memory problems or dementia, the topic of incontinence is challenging. "Society has programmed us to view bodily functions as dirty and private, and when you're dealing with a parent, having such a discussion isn't a natural thing to do," says Carol Jones, a family consultant with the Mountain Caregiver Resource Center in Mount Shasta, California.
Avoid denying there's a problem. When talking to adult children who are caregivers, Jones found that they often have such a hard time dealing with incontinence that they pretend it's not happening. "Sometimes the biggest problem is that the caregiver is embarrassed and feels the need to cover up the accidents, even denying that the person is incontinent."
Don't assume the person is trying to punish you. Another pitfall, particularly if the person has dementia, is the misperception that he's having accidents "on purpose," as a way of gaining control, according to Jones, yet that's rarely the case.
Communicate about the problem.
To overcome these emotional obstacles, Jones recommends tackling the topic head on. "The best way to do it is to speak frankly and say, 'We're in this together. I know this is embarrassing for you, and it's hard to depend on someone else for bodily functions, but I want to work on this with you to make it easier.'" Of course, if the person you're caring for has dementia or Alzheimer's, you may need to use a different approach.
How can I help my incontinent loved one have fewer accidents?
Take him to
First, if the person you're caring for hasn't seen the doctor, he should make an appointment or you should make one for him. Incontinence isn't a normal part of aging; it could be a sign of, say, a urinary tract infection. Medications could also be the cause, or accidents could be a sign of another medical problem, such as an enlarged prostate in a man.
If the person has already seen his doctor and medical treatment hasn't solved his incontinence, you can try a number of things to make it less of a problem.
Make sure there's nothing to slow him down when he needs to urinate. One impediment to getting to the toilet on time could be the clothes he's wearing. Jones used to run an adult daycare center, and a big obstacle to reaching the toilet was the men's pants: "I live in cowboy country, and men would come in with button-front jeans, and by the time they got to the bathroom, there's no way they weren't going to wet themselves." An easy solution is to make sure your father wears pants with a large zipper fly or an elastic waistband.
Another option is to check with your local medical supply store to inquire about installing handrails and grab bars to make it easier for him to get to the toilet, or look into buying a bedside commode or urinal for him to use at night.
Help set up a toilet schedule. If the doctor hasn't told you how to set up a toilet schedule, it's easy enough to do. It tends to work best with stress incontinence (this is a result of weak pelvic floor muscles, and is often triggered by sneezing, laughing, coughing, or lifting; it's more common in women) and urge incontinence (when a person has a strong urge to urinate and leaks urine before reaching the toilet). Urge incontinence often occurs in people who have diabetes, stroke , dementia, or Parkinson's disease .
Try keeping a diary or have him log the times when he urinates for a period of two or three days. Once you've figured out when he typically needs to relieve himself, set up a schedule so that he heads to the toilet before he'd typically need to go.
Watch the fluids before bed.
Of course, how much fluid he drinks will affect how often he needs to urinate. People often assume that withholding fluids will help incontinence. However, barring a medical directive from the doctor, your parent should drink fluids throughout the day to avoid dehydration and cut down on fluids in the evening so he doesn't need to go as often at night.
Consider other possible triggers.
What the person drinks and eats can affect incontinence. Anything with caffeine, for example, may irritate the bladder and should be reduced or eliminated. "Coffee, colas, and chocolate will cause your parent to have to go much more often, as will alcohol -- though I'm not talking about an occasional glass of wine," says Jones. Spicy foods, carbonated beverages, and foods with high acidity like tomatoes, peppers, and citrus are also bladder irritants and are best avoided. "If he has orange juice in the morning, try switching to apple juice," suggests Jones.
Learn about incontinence products. Long gone are the days when wearers of incontinence products felt as though they were carrying around a log in their pants; today there are plenty of comfortable products to choose from. There are briefs of different sizes and shapes, male and female briefs, some that look like a classic diaper, and some that appear no different from underwear. A variety of cleansers, moisturizers, and skin barriers can protect your parent's skin against developing sores. To find out which type best meets your family's needs, see " 11 Questions to Ask When Selecting Incontinence Products ."
Chapter 20, "Incontinence," American Geriatrics Society.
Marion Karpinski. Quick Tips for Caregivers. Healing Arts Communication, Medford, Oregon, 2000.
Virginia Morris. How to Care for Aging Parents . Workman Publishing, New York, 1996.
"Urinary Incontinence." National Institute on Aging.