How Do You Care For An Incontinent Patient?

Incontinence is an involuntary loss of urine. You take care of an incontinent patient by using home care, medications, alternative therapies, medication and surgery.

Incontinence affects almost 13 million Americans and is especially common in older people. About 50% of elderly people living in a care facility or at home experience incontinence. Yet, not much is said about this deeply personal issue and those it affects: the patients and the caregivers. 

If you’re caring for a parent or relative with incontinence, it’s important to approach the problem with sensitivity and help manage the condition while preserving dignity, comfort, and hygiene.

Incontinence is when you cannot control your bladder or bowel movements. You may become incontinent following a surgery, childbirth, or it can happen as you advance in age. In America, more than 85% of people who suffer from incontinence are women. Men can also experience incontinence. 

This condition can often cause embarrassment, withdrawal from social gatherings, isolation, discomfort, and even cause you to stop going to work. Due to the nature of the issue, it’s important to tread lightly while discussing this sensitive topic with your patient or the person in your care.  

Symptoms of incontinence 

Common symptoms of incontinence include:

• Leaking urine or feces without feeling an urge
• Leaking urine or feces when you lift, bend, cough, exercise, or laugh 
• Sudden, uncontrollable urge to use the bathroom, followed immediately by urination 
• Wetting the bed at night

Causes of incontinence

There are many reasons why someone can become incontinent. It could be a relatively simple issue like side effects of a new medication. Or it could be a more serious and permanent reason. 

Common reasons why people become incontinent are: 

• Recent surgery
• Multiple sclerosis (MS)
• Urinary tract infection (UTI)
• Irritable bowel syndrome (IBS)
• Pelvic floor organ prolapse 
• Issues with the prostate 
• Constipation
• Weakening of the pelvic floor 
• Food allergies
• Alzheimer’s disease or dementia

Types of incontinence

There are several basic types of incontinence, such as: 

• Stress urinary incontinence: This is caused by an external stressor, such as lifting a heavy object or a sneeze, which suddenly causes urine to exit the body.
• Overactive bladder (OAB): Caused by a spasm in the bladder, and a sudden urge to urinate with little or no warning. 
• Neurogenic bladder: This happens when the nerves that control the bladder are damaged. This often creates spasms in the bladder, causing the bladder to not empty completely. 
• Urge incontinence: This is a sudden, uncontrollable urge to urinate, resulting in incontinence or leakage.
• Bowel incontinence (fecal): This refers to Feces or gas unexpectedly leaking from the rectum. 
• Overflow incontinence: This type is usually caused by weak or non-functional bladder muscles. The bladder never fully empties and the person feels no urge to urinate. 
• Functional incontinence: This occurs when inability to move impairs you from reaching the bathroom in time or at all. 

People can also suffer from a combination of these types of incontinence.

Incontinence can happen for many different reasons. That’s why it’s important to talk to your doctor about what’s causing it as soon as you notice it’s a problem. They will ask you questions about recent surgery, medication, or new symptoms you may have noticed. 

They will collect a urine sample to analyze at a laboratory (urinalysis) to see if there are any clues to what’s causing the incontinence. The doctor may also suggest other diagnostic methods to determine the cause, such as: 

• X-ray
• Blood chemistry test
• Cystoscopic exam

Once the cause is identified, they can diagnose the type of incontinence and tell you if it’s reversible or chronic. 

Your healthcare provider may prescribe a combination of medication, behavioral techniques, and certain exercises to help strengthen the pelvic floor muscles. They will typically try the least invasive treatments first before moving on to other options. 

Medications

Medications typically used for incontinence care are: 

• Alpha blockers
• Anticholinergics
• Topical estrogen creams or patches
• Mirabegron

Your doctor will be able to tell you what type of medication and therapy will work best for you. 

Home care

There are plenty of products available to make your life easier at home:

• Disposable underwear
• Protective bed sheets and furniture covers
• Incontinence pants 
• A small commode in the bedroom

Skin care while experiencing incontinence is important too. People who sit with urine or feces for any amount of time are prone to skin irritation, rashes, and other skin problems. Clean up any bouts of incontinence immediately. Urine and feces can break down the skin over time, causing infection.

• Use these skin tips when caring for someone with incontinence: 
• Use gentle soap and water when cleaning. 
• Avoid antibacterial soaps as they can be harsh on sensitive skin. 
• Don’t use talc powders or products with fragrance, as they can hold moisture against the skin. 
• Air dry the skin when possible. 
• Gently wash the area morning and night, even if no incontinence has occurred. 

Your doctor may recommend performing exercises to strengthen your pelvic floor. These can be extremely useful over time in preventing bouts of incontinence.  

Alternative therapies

There are devices available to help control incontinence. They can be categorized as: 

• Devices that prevent incontinence: These can be urethral inserts, anal plugs, or intravaginal devices such as a pessary. 
• Devices that collect or contain incontinence: Catheters and urinary or anal pouches collect and store waste until the receptacle is changed. 

Surgery

Surgery is available to treat people with incontinence. Your health care provider may recommend one of these surgeries as a last resort if other therapies haven’t worked:

• Colposuspension: A small incision is made in the lower abdomen to lift the neck of the bladder. The bladder is then stitched into a lifted position. 
• Sling surgery: Tissue taken from yourself or a donor is placed around the neck of the bladder or urethral bulb to support the bladder. 
• Artificial urinary sphincter: Your sphincter is a muscular ring that prevents urine from leaving the bladder through the urethra. If your sphincter muscle isn’t working properly, surgery to position an artificial sphincter muscle around your bladder is possible. 
• Prolapse surgery: Prolapse surgery repositions the pelvic floor organs so they function properly again. It’s sometimes done at the same time as sling surgery. 

There are many alternative options available for people who suffer from incontinence. Whether your incontinence is reversible or chronic, your doctor will discuss the proper form of treatment and its potential risks.

Talk to your doctor about any potential side effects from medication they may prescribe for incontinence.