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When Nature calls too often: solving elder bladder and bowel incontinence problems

by Sue Lanza

Many older adults are struggling with caring for a loved one who has poor control over bowel and bladder function. Realize that you are not alone by reading some of the reasons behind the issues and preparing for an evaluation of the complications that come when nature calls too often.

Problems of the bladder (that expels urine) or the bowels (which push out feces) can be challenging for caregivers. The range of concerns you may be dealing with can be leakage, urgency, reactions, such as constipaton, to medications, assistance needed in voiding, fecal impaction and nighttime incontinence, to name a few. The issues are not always a cause for alarm but is definitely the body sending a message. If a change in the person's normal habits is sudden, it could be an indication of a temporary medical problem, such as a bacterial infection. If you are noticing more subtle alterations over time, a greater clinical change may be at work. Either way, you need to bring your loved one to a physician or other health care professional to take a look at what is going on.

Since bladder and bowel problems involve the entire body, your clinician will have lots of questions for you about your loved one. You can be proactive by starting to gather information about changes that you've noted. Then you will be ready for the visit. An easy way to begin is to record toileting routines and symptoms each day for a few days. This data will give you a starting point in identifying bowel and bladder concerns. Some of the areas the health professional will ask you or your loved one will include:

  • Current medical or surgical conditions. It will be important to know if there are problems with cognition such as dementia, movement challenges such as arthritis and even past urinary conditions such as frequent urinary tract infections, or bowel situations like hemorrhoids or irritable bowel syndrome.
  • Bowel and bladder history/symptoms. This is where your ""incontinence diary"" comes in handy. The physician will want to know current problems (what brought you in today), but also the historical viewpoint such as what prior bowel or bladder function problems have existed for your loved one and the immediate family. The more details you can provide, the easier it may be to solve the mystery.
  • Toileting patterns. Questions here will relate to what is ""normal"" toileting procedure. Valuable information would be the frequency and timing of bowel movements or urination. In addition, data concerning the consistency of the bowel movement is critical, along with whether diarrhea or constipation was noted. For bladder issues, observations about the amount seen (less or more than usual), and whether leakage was present, will help. Nighttime bathroom visits, or if elimination is triggered by meals, can also be useful to know. Usage of supportive devices like bedpans or commodes should be discussed as well.
  • Medication usage. Bringing a detailed list of prescribed medications, as well as over-the-counter drugs, is vital to understanding incontinence. Certain types of drugs, such as opioids, anti-depressants, anti-psychotics, laxatives and diuretics, have been shown to cause all types of incontinence problems.
  • Fluid and food intake. Dietary changes, such as taking in more or less fluids or foods, may contribute to bowel and bladder issues. Consuming certain foods, like coffee or citrus fruits, can also irritate bowel or bladder function.
  • Functional abilities. Questions will be asked about how well the person with incontinence can independently toilet themselves. Can they physically locate the toilet and manage all the tasks involved in voiding? Are they aware of the urge to visit the bathroom? Do they need assistance with toileting all the time, or only at night?
  • Urine/feces sample for analysis. Standard routine for an office visit to diagnosis incontinence issues would be providing a sample, so lab tests can be performed. For those with incontinence issues, it is often difficult to produce a sample ""on demand"". At the time you make the office appointment, inquire about the need for a urine or feces sample, as you may be able to bring a morning specimen with you. You must call ahead though, as you may need to pick up a container along with instructions on how the catch the sample properly. When samples are not collected in the right manner, it may lead to a false result and require another specimen. So, save time and follow the office instructions.

This topic is not popular with anyone except for those who are caregivers in the midst of changes in the bowel or bladder pattern of a family member. If you have read this far, you have to let go of any embarrassment and instead focus on the guidelines to help you and your physician solve the incontinence issues with your loved one. Congratulations for tackling this unpleasant task.