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by Sandra Ray, Staff Writer
Treatment Options
If the incontinence is due to an underlying
medical condition, such as a urinary tract infection
or a bowel obstruction, treatment can range from
antibiotics to surgical intervention. The decision,
of course, will be based on the severity of the
condition and the best course of action for the
patient. It is important to remember that
incontinence is not a disease, but rather a symptom
of an underlying issue that has developed with the
patient.
If a medical condition is readily ruled out, the
doctor may move on to other options like medications
that treat the bladder’s urge to urinate or the
frequency with which the bladder sends the “alarm”
to the body that urination is about to occur. These
medications are generally anticholinergics and have
the effect of reducing frequent urges to urinate
when the patient is unable to make it to a toilet
fast enough. These urges may be made worse by the
dementia since the signal that urination is about to
occur may be misunderstood or misinterpreted by the
patient.
Recently, however, researchers with the Wake
Forest University School of Medicine uncovered a
serious problem with older anticholinergic
medications and medicines that are used to lessen
the mental decline in cognitive functioning in some
dementia patients. In many patients, the
anticholinergic medications that treat incontinence
interfere or counteract the medications that are
also treating dementia. In other words, patients
with dementia may experience a more rapid decline in
mental functioning while taking anticholinergic
medications. For these patients, treating the
incontinence with medication is worse than finding
alternative solutions for working with the issue.
There are newer anticholinergic medications that
were developed since the study’s original test
results in 2003 and 2004 which may or may not have
this effect. This is perhaps the best reason to
discuss any medications that a dementia patient
takes with their primary doctor before starting a
new treatment course.
There are other non-medication or surgical
methods that can be used to treat incontinence at
home. Adaptive clothing may be able to help if
functional incontinence is an issue. Replacing
hard-to-manipulate buttons and snaps with Velcro and
zippers may be a quick fix if it appears that the
patient is aware of the incontinence and wants to
correct it without too much intervention on the part
of the caregiver. This approach gives the patient
more control over their environment and encourages
independence. It also affords the patient the most
privacy which is often a serious source of angst for
many patients. There are also incontinence products
for all ages and sizes that may be helpful, although
the patient may have difficulty understanding their
use and disposal. Communicating the need for these
products may be a challenge, and the caregiver may
need to explain their use more than one time in
order for the patient to understand.
Other methods may be home modifications or adding
a portable toilet chair to the room(s) where the
patient spends most of his or her time. This method
is relatively easy to implement, although it may
need some additional explanation since patients with
dementia wonder why the caregiver is altering the
living situation or the layout of a particular room.
Any approach that changes the daily routine of a
dementia patient drastically should be undertaken
thoughtfully and with as much input from the patient
as possible.
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