There are lots of reasons that people develop incontinence. This blog focuses on people with dementia: their care and ways to prevent urinary tract infections, a serious consequence of incontinence in the elderly.

People with Alzheimer’s disease and dementia often have problems with urinary incontinence. This can be a result of not realizing they need to urinate, forgetting to go to the bathroom, not being able to find the toilet, or limited mobility.

Ways a caregiver can help

• Avoid giving drinks like caffeinated coffee, tea, and sodas that may increase urination. It is important, however, that healthy liquids including water, smoothies, and fresh fruit juices are not restricted. Hydration is vital to overall health and to prevent urinary tract infections.
• Keep pathways clear and the bathroom clutter-free, with a light on at all times.
• Make sure you provide regular bathroom breaks–at least every 2-3 hours.
• Mark the bathroom door with a large sign that says “Bathroom.”
• Provide a portable commode or a toilet frame with handrails or grab bars to make getting on and off easier. Make sure it’s the right height.
• Supply underwear that is easy to get on and off.
• Use absorbent underclothes for trips away from home and/or adult diapers.
• When going to a restaurant or public place such as a movie theater, try to sit as close to the bathroom as possible.
• Limit liquid intake after dinner

Talking to the doctor

• Ask if it’s possible to cut back on prescribed medications such as water pills that increase urination
• Does the patient have undiagnosed diabetes? Diabetes increases urination.
• Is an enlarged prostate the problem? Rule out any medical issues that increase urination or block urination.

Preventing urinary tract infections

Urinary tract infections, commonly called UTIs, are more common in people who are elderly, bed-ridden and incontinent. Symptoms can include general weakness, confusion, nausea, dizziness, sudden incontinence or increased severity of incontinence. Often these symptoms seem connected to other conditions that are unrelated to a UTI, and can make it difficult to determine that the cause is an infection.

• The most important method of prevention is to keep the genital area clean and healthy. Wipe from front to back to avoid transferring bacteria to the urinary tract, especially in women.
• Remove used diapers from front to back.
• Dry the skin when changing or after bathing since bacteria grows better in moist areas.
• Use recommended hygienic products for washing that are not drying to the urogenital area.
• Keep the patient hydrated since urination can flush out unwanted bacteria from the urinary tract.
• Try to make sure your loved one gets help to empty their bladder entirely, since urine remaining in the bladder can help bacteria thrive and multiply.
• Help to prevent constipation by providing plenty of fruit (applesauce, apples, berries, prunes, figs) and other foods high in fiber, such as oatmeal, legumes, peas, chia seeds, carrots, beets, broccoli, Brussels sprouts, popcorn, nuts, and whole grains.

The dangers of UTIs

Urinary tract infections are notorious for causing delirium and delusional behavior in the elderly. When younger people get a urinary tract infection, they typically experience painful urination, an urgent need to urinate, lower abdominal pain, back pain on one side, and fever and chills. However, an older adult might not experience those symptoms. As we get older our immune system changes and it responds differently to infection. Instead of pain symptoms, seniors with a UTI may show increased signs of confusion, agitation or withdrawal. In older adults with dementia, these behavioral changes may come across as part of that condition or signs of advanced aging. If the underlying UTI goes unrecognized and untreated for too long, it can spread to the bloodstream and become life-threatening. In fact, I have a dear friend who died from a UTI that quickly became septic.

If you suspect a UTI

• Get medical help, especially if your loved one has fever or complains of nausea or back pain. An antibiotic will be prescribed. Make sure the entire prescription is taken even if the symptoms subside. Otherwise, the infection can come back with a vengeance.
• If it is appropriate, have the patient drink unsweetened cranberry juice on a regular basis, and/or take a cranberry/D-Mannose supplement to help stave off future infections.
• Give the patient plenty of water to flush out the harmful bacteria
• Apply a heating pad to the lower abdomen and/or back to help with discomfort
• A pain reliever such as Advil can help alleviate pain and fever

Urinary tract infections are nothing to mess around with. Please get your loved one medical help if you suspect an infection.

Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at Amazon, Barnes & Noble, Boulder Book Store, Tattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.