Bowel & Bladder Problems

Incontinence-BriefIt is not uncommon for a nursing home patient to experience trouble controlling his/her bowel or bladder.  Such a patient is said to be “incontinent.”  When a patient is incontinent of bowel, he/she cannot control bowel movement.  When a patient is incontinent of bladder, he/she cannot control urination.   Incontinence is caused by a variety of conditions, including the following:

Lack of Toilet Access — Many patients need assistance to the toilet or need a bedside commode or urinal.

Immobility — Patients who cannot walk by themselves may have control of their bowel and bladder, but may not be able to reach the toilet.   Facility staff can decrease incontinence by improving the patient’s ability to walk, transfer, and toilet.

Dexterity — Some patients may be unable to adjust their clothing to use the toilet. Special clothing or staff assistance can overcome this problem.

Disorientation — Some patients are no longer aware of their surroundings or can no longer sense their need to evacuate.  Scheduled toileting and regular reminders may help.

Medications — Many medications can cause incontinence. Patients prescribed diuretics, for example, may need to toilet soon after taking the drug.  Scheduling the drug in the morning may help a patient remain continent throughout the night.

Diet — Foods that contain caffeine and alcohol can irritate the bladder. Reducing or eliminating these foods may be helpful.

Medical Problems — Conditions such as congestive heart failure, urinary tract infection, fecal impaction, and pedal edema may contribute to incontinence. Medical treatment may improve continence.

Urge Incontinence — Patients with this common condition may feel the need to urinate, but cannot suppress the need long enough to reach the toilet. A scheduled toileting routine may successfully address this problem.

Determining the cause of incontinence is necessary so that diet, medication or environment can be changed to increase continence.  By law, nursing homes are required to implement measures that reduce incontinence, including all of the following:Nurse

  • A licensed nurse (RN or LVN) must perform a written assessment to determine the patient’s ability to participate in a bowel and/or bladder management program.
  • If the patient can participate in such a program, an individualized care plan must be developed.
  • A licensed nurse must perform a weekly evaluation of the patient’s performance in the individualized care plan.

What kinds of neglect are involved in bowel and bladder incontinence?

Incontinence BriefAs with many other forms of nursing home neglect, staffing is the determining factor in bowel or bladder incontinence neglect.  For example, if a patient is in a bowel or bladder “retraining” program, he or she may need to be reminded of the schedule, or may need assistance to the toilet.  The staff will therefore need to spend more time with the patient.

If a facility is understaffed, it tends to encourage (or require) the patient to wear an incontinence brief (an adult diaper), even when it is not medically indicated.  This is because changing a brief requires significantly less time than assisting the patient to the toilet.

Not only does this practice violate a patient’s right to be treated with dignity and respect, it is also a form of neglect which may lead to the following complications:

  • Briefs encourage a patient to become dependent upon caregivers, when he/she should be encouraged to remain as independent as possible.
  • Patients are often left lying in their own waste for extended periods of time, until the staff has time to change the brief.
  • Because patients in briefs do not need to rise from their beds to reach the toilet, they may remain in their beds all day.  This will cause their muscles to weaken, and also increases the likelihood that they will develop a bedsore.  See more >>
  • If a patient develops an open bedsore in the tailbone or buttocks area, the wound can become infected with fecal bacteria voided into the brief.  See more >>

In a case handled by the attorneys at The Gebler Firm, a woman admitted her 80-year-old father to a nursing home to receive physical therapy while she visited her mother in another country.  At the time, her father was fully capable of walking independently and regularly walked throughout the neighborhood.  He was also able to toilet by himself.  When the daughter returned only a few weeks later, she expected to find that her father had completed physical therapy and was ready to return home.  Instead, she learned that his physical therapy was discontinued, he had been tied into a wheelchair, labeled incontinent and forced to wear a brief.  This was done for one reason only – staff convenience.

Briefs should never be used for staff convenience, and efforts to “retrain” the bowel or bladder should be attempted before resorting to briefs.  Nonetheless, many nursing homes encourage the use of briefs for all patients, and often begin using them without the family’s knowledge or consent.

What can I do if I think my loved one suffered unnecessary bowel or bladder problems?

If you believe your loved one has suffered unnecessary bowel or bladder problems in a long-term care facility, or that his or her right to dignity was disregarded, contact The Gebler Firm for a free consultation.  We are available to speak with you by phone at 1-800-871-6998, or you may submit an on-line consultation request. We don’t charge any attorney fees unless we obtain a recovery.

We know this is a difficult subject to discuss, but we encourage you to act quickly.  The law limits the amount of time you have to pursue legal action.  In some cases, this can be as short as six months.

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Disclaimer:  The information on this site is for informational and educational purposes only.  None of the medical information is intended to be a substitute for professional medical judgment.  A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions.

Injured Elder