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To Diaper or Not; Incontinence and Alzheimer’s

What do you do when your loved one uses every room of the house as a bathroom? Print Page

Incontinence is common with people suffering from Alzheimer's, especially in the later stages of the disease. As the disease progresses, the problem will change from simple accidental urination to some rather strange behavior, where the problem becomes an ongoing and challenging cleaning issue.

The Bathroom Routine Solution

When people with Alzheimer's first begin to have bowel and bladder accidents, the cause is often more related to forgetting where the bathroom is and what it is for than a physical or medical condition. The problem of occasional accidents often may be resolved by following a daily bathroom routine. Many organizations offer the following suggestions:

Make the bathroom obvious. Place a sign or a picture on the door. Add a colorful light and leave it on.
Be alert for signs. Restlessness, tugging on clothing and touching of genitals may signal the need to use the bathroom.
Establish a schedule. For example, schedule bathroom breaks every two hours, before and after meals and before bedtime.
Use Velcro. Sweat pants and other clothing with elastic at the waist are even easier to get on and off.
Don't be critical when accidents happen. Offer reassuring words to reduce any feelings of embarrassment. Remember to offer praise when your loved one uses the bathroom successfully.

When the Routine No Longer Works
Alzheimer’s is a disease of forgetting; sooner or later the person will forget the purpose and location of the bathroom. As the disease progresses, the loved one will forget what a bathroom is, the meaning of the picture on the door and the schedule of the bathroom routine. When the urge to urinate occurs, the potted fern will work just as well as the toilet and it won’t matter if it is part of the scheduled routine or not.

This will be a very frustrating time for many caregivers as successful potty breaks will no longer be the norm. Accidents will occur more frequently and unexpectedly throughout the house. As the accidents increase, so will the caregiver’s frustration and anger. In order to prevent accidents, the caregiver will have to be ever more vigilant or opt for a different solution.

The Difficult Solution: Adult Diapers

The solution to the problem is obvious--- dress the loved one in adult diapers. So why is this so difficult to do?

Diapers solve the problem. The caregiver no longer has to follow a rigid routine of “pee patrol,” worry about a surprise puddle or maintain constant watch for any signal of the possible need to go. Diapers not only solve the physical problem by containing accidents, but give the caregiver one less thing to worry about. And this is no small matter! As the caregiver’s day becomes more consumed with care giving, one less worry is as good as winning the lottery.

Emotionally, however, the very notion of dressing a loved one in diapers is one that the caregiver may not want to face. In many ways the use of diapers represents a transition point in the disease. Unfortunately, it is one that we may not want to recognize. We may not want to believe that the condition of our loved one is at a point where such measures are necessary. We also may dread the comments of family and others who question why such action had to be taken.

The challenge of care giving often involves finding a balance between the needs of the caregiver (who is too often the forgotten member of the team) and the loved one. This transition point, when the issues relating to incontinence requires constant care by the caregiver, is a time when many caregivers decide to place the loved one in a nursing home. The use of diapers offers a practical solution to a difficult problem and may postpone the difficult decision of out-of-home care.

Dealing with Diapers

Diapers help prevent accidents, but also create new problems, most of which are easily managed.

Solving Odor and Cleaning Problems

There are three possible odor issues: on the person, on the individual’s clothing and in the household.

            On the person: Clean the area with an antibacterial wash, such as Allsclean’s perineal wash. Apply a skin protectant (Provon Perineal Skin Protectant) after every changing to protect the skin.
            On clothing: Separate urine soaked clothes from general laundry. Add laundry detergent and fabric softener as needed. Add two ounces of Allsclean’s Urine Contamination Treatment (UTC) for normal load; for heavy contamination, add two to four ounces. Double rinse clothes. For best results, wash clothes as soon as possible.
           In household: Soak up urine by blotting with a paper towels. Don’t rub, especially on a carpet as it may damage carpet fibers. Blot from the outside of the mess and move inward. Once the mess is contained and removed, go back and clean the area surrounding the initial stain with Breakdown with Enzymes. This will help ensure that you remove sources of odor. Helpful hint: Wrap up soiled diapers in plastic grocery bags to help contain the smell.