Dementia and incontinence: Tips for carers

People with dementia may also develop incontinence. This can be very distressing for the person with dementia and their carer. There can be many causes of incontinence including other medical conditions, so it’s always best to seek support from your doctor.

What is incontinence?

Incontinence is the involuntary loss of bladder and bowel control. This means that you may lose urine or faeces without meaning to. More than 5 million Australians have some form of incontinence.
There are two main types of incontinence — urinary incontinence (of which there are four types) and faecal incontinence.

Urinary Incontinence

Urinary incontinence refers to the loss of bladder control which is a common but embarrassing problem. There are four types of urinary incontinence:

• stress incontinence — small amounts of urine leak when pressure is placed on the bladder

• urge incontinence— a sudden, urgent need to urinate followed by loss of urine. This is also called overactive bladder and is very common in people with dementia

• overflow incontinence — this is when the bladder doesn’t empty properly and continues to leak small amounts of urine

• functional incontinence — this is due to a person’s inability to get to the toilet in time due to a physical or intellectual disability

Unintentional bowel movements or faecal incontinence

Faecal incontinence refers to poor bowel control. This can cause people to fully or partially empty their bowels at the wrong time or in the wrong place.

Why do people with dementia become incontinent?

People with dementia are more likely to experience unintentional bowel movements and urinary incontinence than those without dementia. One of the main reasons is that dementia causes changes in the brain. Messages between our brains and bladder and bowel tell us when they are full and when we need to empty them. Being aware of our bodily sensations is key to being able to control our bowel and bladder. So is our ability to remember what to do when our bladder or bowel is full.

The decline in cognitive ability that occurs when someone has dementia means that they may become incontinent. Other factors that can contribute include:

• not getting to the toilet in time due to limited mobility

• not being able to communicate their need to go to the toilet or ask for help

• not understanding when someone reminds them to go to the toilet

• being confused and not remembering where the toilet is

• not remembering how to use the toilet

• forgetting what to do to use the toilet (e.g. remove their clothes)

• not wanting others to help them get to the toilet

• side effects of medication.

What stage of dementia does incontinence happen?

Everyone with dementia is different and the progression of the disease is different for everyone. However, most of the time (unless there is a medical condition that causes bowel or bladder problems), incontinence typically occurs in the middle or late stages of dementia.

During the middle stages, dementia can cause someone to be disoriented and confused which can impact their ability to get to the toilet. As dementia progresses, the person becomes increasingly unable to respond to their bodily cues, control their movements or communicate their needs.

How do caregivers deal with incontinence?

Caring for someone with dementia-related incontinence can be very hard. Incontinence can be very embarrassing and distressing for the person with dementia. They may be unwilling for you to help them or for you to know about their problem. Things you can do to help both you and the person you care for include:

• staying calm and patient, remembering that the person you’re caring for doesn’t have accidents on purpose

•  ensuring the person you care for drinks adequate fluids

• making the toilet a ‘safer’ place by removing tripping hazards such as mats and instal rails and bars to hold on to

• try to ensure the toilet is a different colour from the floor and that toilet paper is a different colour from the wall, to make it easier for the person you care for

• encouraging the person with dementia to wear clothing that is easy to get on and off (i.e. elasticised pants without buttons or zips)

• scheduling regular trips to the bathroom throughout the day

• providing verbal assistance by reminding them what to do when they use the toilet

• removing objects around the house that may be mistaken for the toilet (e.g. potted plants, bins, etc.)

using incontinence products such as:

• • disposable or reusable incontinence pants or pads
  •  absorbent bed pads and chair pads
  • urinary penile sheath for men

• It’s important to seek help at the first signs of incontinence, rather than try to manage it yourself. The first person you should speak to is your doctor.

Where to get help?

If the person you’re caring for is having toileting problems, speak to your doctor. It will be useful to tell them:

• what type of incontinence is it (e.g. urinary, fecal or both)?

•  when did the problem start?

• how often is the person incontinent?

• how severe is it (e.g. full or partial emptying of the bladder or bowel)?

• does the person have mobility issues?

•  are they taking any medication?

• do they relieve themselves in places other than a toilet?

• How are you managing the situation and do you need help?

Sometimes there may be a medical reason or condition contributing to the incontinence, which may be able to be addressed.

Remember, you don’t have to deal with incontinence on your own. There is lots of help and support available.

Disclaimer: General advice only – this information should not replace the information provided to you by your health care professional. If symptoms are severe or persist, please speak to your health care professional. You should also speak to your medical professional before taking any supplements or medication, including herbal remedies.