Incontinence, Urinary Tract Infections, and Constipation

Urinary incontinence is the same thing as having a loss of bladder control.  It can be an embarrassing issue, but it is very common¹.  It can be a minor problem, in which the person occasionally leaks urine during coughing and sneezing.  It can be as severe as having the urge to go that comes on so strong and suddenly that you can’t get to the bathroom in time.

• Nearly one in ten elderly people over the age of 65 are affected by incontinence and urinary tract infections
• 25-million American adults (200 million worldwide)² suffer from incontinence. Of this number, 27- to 80-percent are women
• Approximately 23% of women over the age of 60 deal with incontinence
• More than 50 percent of nearly 1.5 million nursing home residents suffer from incontinence, urinary tract infections, and/or constipation

CNA’s and HHA’s caring for the elderly at home, or while working in a nursing home or a long-term care facility will no doubt attend to people with minor and severe urinary or bowel conditions.  And although common, the impact these conditions have on a person’s life is annoying, embarrassing, inconvenient, and discouraging.  These problems can result in:

• A loss of self-esteem
• Increased depression
• Decreased ability to maintain an independent lifestyle
• Dependence on caregivers
• Avoidance of social activities and interactions with other people

Treating patients with respect and dignity can help reverse the impact these conditions may have on a resident’s wellbeing.

Complications of Urinary Incontinence

Typical complications³ of incontinence that does not go away include the following:

• Negative impacts on your personal life. Urinary incontinence can affect your personal relationships, work abilities, and social activities.
• Urinary tract infections (UTIs). Having urinary incontinence can result in repeated infections of the urinary tract.
• Skin issues. You can get skin infections, rashes, and sores due to having skin that is continually wet.

Treatments for Incontinence

Incontinence is a common problem faced by adults and elderly patients. This condition can be humiliating and upsetting, and can interfere with the activities of daily living. There are a number of treatments you can recommend to your patients, including scheduled toilet trips, bladder training, and fluid management.  You might also suggest adult diapers, which can provide the protection you patient(s) need to better manage this condition.

But, How Do I Get My Patients To Wear Diapers?

• First, don’t call them diapers. After all, diapers are for babies.  The word diaper can be insulting and demeaning to the elderly who may already feel they are losing control of their lives.  Call them “adult briefs” or “adult protective undergarments” instead, or whatever term your team decides on.
• If you suspect a problem, replace their regular underwear in their dresser with adult briefs. After you notice the “adult briefs” are being used, simply replace them, and don’t say a word.
• Have samples of several different types of adult briefs available. Clients may not know adult briefs have gotten thinner over the years, so they may not be so abhorred to using them if they see they are not as bulky and “baby-like.”
• Tell them – with compassion and kindness – that they smell like urine. Many elderly residents would rather be embarrassed about wearing adult briefs then about having other’s notice they smell.
• If a client starts wearing adult briefs, encourage their family and friends to treat the subject with sensitivity. This is not a joking matter.  There is nothing like a good laugh to change your client’s mind back to wearing underwear.

Remedies and Lifestyle Changes To Recommend To Your Patients

Difficulties with incontinence may mean that you have to take special care to prevent irritation of the skin.  CNA’s and HHA’s can talk to their clients about remedies, including:

• Suggest they allow the skin to air dry
• Recommend they use a washcloth instead of toilet paper to clean up
• Tell them to avoid frequent washing because overdoing it can cause bladder infections
• Recommend they use a barrier cream, such as cocoa butter or petroleum jelly
• Help your patients get on a bathroom schedule
• Move furniture or rugs that might be tripped over or run into on the way to the bathroom
• Use a nightlight to light a path to the bathroom, therefore reducing the chances of falling
• Suggest they use an elevated toilet seat
• Place a bedpan or commode in the bedroom

Prevention of Urinary Incontinence

Although it’s not always possible to prevent urinary incontinence, you might be able to lessen the risk in your clients by suggesting the following:

• Eat more fiber, in order to prevent constipation as a cause of incontinence
• Avoid irritants to the bladder, like acidic foods and caffeine
• Keep to a healthy weight

Constipation

Reports show that constipation affects about 42 million people or 15 percent of the population in North America.⁴   Defined as a condition where a person has fewer than three bowel movements each week, constipation can be acute (sudden and lasting a short time) or chronic (lasting a long time, or even years).

Common factors that can lead to constipation, include:

• Little physical activity
• Diets low in fiber
• Many medications
• Change in routine
• Ignoring or putting-off having a bowel movement
• Certain diseases, such as stroke, diabetes, or lupus
• Intestinal problems, such as irritable bowel syndrome

Many people in nursing homes and long-term residential care facilities, as well as elderly persons living at home, have constipation at least some of the time.  Many elderly patients are on medications that cause constipation, such as pain medications and antacids.  Many elderly people also do not get enough exercise, they are bedridden, or because it may be difficult to get to the bathroom, they may put off having a bowel movement.  CNA’s and HHA’s can help their patients and their patient’s family members understand the mental and physical health risks⁵ that come with constipation, including:

• Fecal incontinence (the second most common cause for nursing home admissions)
• Hemorrhoids
• Anal fissures
• Urologic disorders
• Stress
• Embarrassment

There are a number of things to do, and advice you can give your patients to ensure they stay regular, or get regular – Help them understand the need to eat lots of fruits and vegetables, beans, breads high in fiber, and cereals; apple and prune juice can help; stool softeners and laxatives (taken responsibly) can help;  or enemas (in more severe cases).

Voiding diary⁶ – Because the elderly often have issues with soiling themselves or can have skin rashes and sores from sitting in wet diapers, it is recommended that HHAs, and CNAs keep a “voiding diary” on each patient with incontinence, UTI or constipation issues.  A voiding diary is just that  – a diary of each time the resident soils him- or herself, how many times they get up at night, how often they are constipated, etc.  That way if a patient, for instance, usually wets himself at supper, a CNA can make sure to take him to the bathroom before he goes to the dining room to eat.  Or, if a resident is complaining she’s constipated, a CNA can look back in the diary and see when was the last time she had a movement.  A voiding diary not only saves time cleaning up messes but saves residents from embarrassment and health-related issues that can arise.

As a CNA or HHA, it is also very important to be observant and document a client’s problems with incontinence, UTI, or constipation to ensure an unknown or undiagnosed health issue is not the problem. Above all, consistently practice proper infection control techniques, answer the call button quickly, provide easy access to a toilet, commode or bedpan, provide gentle skin care, and…. always be compassionate and supportive.

References

1. Diseases and Conditions; Urinary incontinence; Definition. Mayo Clinic Staff
2. Urinary Incontinence in Women Statistics; Phoenix Physical Therapy, PLC; National Association for Incontinence, Facts and Statistics; WomensHealth.gov, Urinary incontinence fact sheet; American Medical Systems, Urinary incontinence
3. Mayo Clinic; Incontinence; Complications; Mayo Staff, Aug. 2014
4. Diseases and Conditions; Urinary incontinence; Risk factors; Mayo Clinic Staff, Aug. 07, 2014
5. Constipation, pdf. National Digestive Diseases Information Clearinghouse. Sept. 2013.
6. Constipation | Causes and Risk Factors; FamilyDoctor.org; Aug. 08, 2012

Using a Bladder Diary for Incontinence; National Incontinence; Aug. 02, 2013; Nancy