Incontinence is the  inability of the body to control the evacuative functions of urination or defecation. This occurs as the bladder and bowels relax toward the last stages of life.

With decreased eating and drinking body conserves the limited energy it has and blood circulation through kidneys decrease resulting in decreased and darker colored urine, at times with a strong odor.

On a daily basis, the body makes about 8 liters of gastric and intestinal juices most of which is re-absorbed by the body in the process of digestion and assimilation of food, some of it is still eliminated as the bowels empty– even in a person not on oral intake. Therefore, in spite of decreased eating and drinking in a terminally ill patient, the body continues to produce some stool almost until the last days. But this function also decreases as the individual’s body prepares for death so decreased amounts of urine and stool and at times no elimination at all closer to death are all normal variants.

What you may do to assist:

– Keep your patient very clean and dry at all times. This will prevent them from being embarrassed/ashamed (as it is beyond their active control).

– Keeping the skin clean and dry and applying a thick, protective moisture barrier cream will prevent rashes and other skin breakdown that can result from incontinence. Your hospice nurse can recommend the best kind for your patient.

Under pads to be placed over the bottom bed sheet for incontinence.

– Most Hospice organizations/services provide and teach the use of adult disposable diaper/briefs/under pads on the bed. He or she should show you how to apply these items.

– An indwelling catheter may be indicated in some situations to keep the surrounding skin from constant wetness in cases of urinary incontinence. This is a simple, non-surgical procedure performed at home by the nurse. A tube is inserted and led into the bladder. On the outside will be a thick, plastic bag attached to the end of the tube where the urine flows. The catheter is changed regularly to avoid infection. However, some people tolerate this catheter better than others. It does not always happen, but there is a risk of your patient getting a Urinary Tract Infection from the use of an indwelling catheter in the bladder. Your hospice nurse can demonstrate proper cleanliness of the tubing to help avoid infection.

Indwelling catheter. The end of the tubing is  inserted into the patient by the hospice nurse. It goes into the bladder so urine automatically is relieved into the bag and can be emptied by the caregivers on a regular basis. 

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