We Put Our Faith in Caring
Helpful tips for family caregivers

Nonverbal signs of pain

Dementia itself does not cause physical pain. But people with dementia still encounter pain, just like anyone else: headaches, arthritis, tummy aches. They just can’t describe it. They might even deny having pain when you ask because they don’t understand the question.

Learn the nonverbal signs of pain so your loved one doesn’t suffer. (Your knowledge of their pains before their memory loss condition will be helpful in identifying pain now.) Nonverbal signs of pain include

• short, rapid breathing
• unexplained sweating
• grimacing, wincing, or frowning
• moaning, whimpering, crying, or shouting
• shielding a part of their body, curling up
• rocking or self-soothing movements
• tense or rigid body

Other signs include withdrawn behavior, increased confusion, trouble sleeping, inability to be comforted, restlessness or lashing out, refusal to eat. The more frequent these signs appear and the more intense they seem, the more likely there is a high degree of pain.

If you don’t see an obvious source of pain—a mouth sore, a reddened or sensitive area, a bleeding cut, or a fever—contact the doctor. Describe what you have been observing.

• Can you think of a likely cause?
• Are there patterns, such as time of day?
• Is there swelling somewhere? A particular location of the pain?
• Is your loved one constipated?
• Is he or she urinating frequently?
• What have you found that seems to help?

You and the doctor together can determine if there is a problem to be treated—and if not, what you can do to effectively manage your relative’s pain.

In the later stages of dementia, your loved one may not understand what’s happening, but he or she understands comfort. If a medical solution isn’t possible, do what you can to provide comforting doses of pleasure and kindness. Perhaps try a foot rub or a favorite song.

BPH: Weighing surgical options

Ever wondered why older men seem to need to urinate frequently? An enlarged prostate gland is likely to blame. The condition, benign prostatic hyperplasia, or BPH, is so common that it affects 90% of men by age 80.

The prostate gland is roughly donut shaped and is located below the bladder. The urethra, the “tube” that carries urine out from the bladder, passes through the prostate. As the prostate enlarges (swells), it squeezes the urethra, making it difficult for urine to flow through.

Symptoms of BPH include

• increased frequency and urgency of urination
• weak urine flow
• leakage, or inability to control urination

While BPH is not dangerous, it can have a powerful impact on quality of life. Affected men feel they cannot stray far from a bathroom. And they worry about the embarrassment of an accident. BPH also causes frequent nighttime urination, which can bring on insomnia, fatigue, and depression.

Surgery
Although medication and lifestyle changes can be effective, if symptoms become too imposing, the doctor will probably suggest surgery. There are many different types. Review these questions with the doctor as you help your loved one evaluate the options:

• What kind of improvement can be expected? How soon after the procedure will symptoms be relieved?
• How long will the benefits last? What is the likelihood of needing retreatment in five years?
• What is the recuperation like? Pain? Bleeding? Swelling?
• What are the risks or complications? How likely are they to happen?
• Can this procedure occur on an outpatient basis, or will hospitalization be required?

There is no one surgery that fits all. And new approaches are being developed all the time. The goal is to find the surgery that brings the greatest relief for the longest period of time with the lowest likelihood of complications.