Dementia and Incontinence

Dementia and incontinence

Urinary incontinence, or unintentional urination, is common in people who have dementia. It can range from mild leaking to unintentional urination. Less commonly, it also refers to unintentional bowel movements, or fecal incontinence. This includes the occasional leakage of stool before a bowel movement or a total loss of bowel control.

Incontinence is a symptom that develops in the later stages of dementia. About 60 to 70 percent of people with Alzheimer’s develop incontinence. But it’s not a defining trait. Not all people who have dementia have or will develop incontinence.

As a caregiver, knowing more about this condition can help. Learn why this happens, tips on managing incontinence and dementia, and what you can do.

What causes incontinence in people with dementia

In the later stages of dementia, a person’s ability to react quickly and remember things is reduced. They may no longer recognize when they experience the urge to urinate or have a bowel movement. Reasons for incontinence in someone with dementia include:

not recognizing the bathroom
communication issues
being unable to get to the bathroom in time
mobility loss

In some cases, accidents can lead to feelings of embarrassment, and possibly depression.

Medical causes

Incontinence is also common in people without dementia. About 25 million Americans experience incontinence. It also affects about 23 percent of women over 60 years old. Medical causes of incontinence in older adults include:

enlarged prostate
constipation
neurological complications, often caused by a stroke
diseases such as Parkinson’s disease, multiple sclerosis, and prostate cancer
side effects of medications that relax muscles of the bladder and reduce awareness, such as sleeping pills and tranquilizers

Urinary tract infection (UTI) is also common in people with dementia. Watch for signs of UTI, including:

burning or painful urination
cloudy or blood-tinged urine
constant urge to urinate
pain in the pelvis or back
fever, nausea, vomiting
mental status changes or abrupt worsening of confusion, including significant changes in behavior

UTIs can worsen without proper treatment.

What increases the risk for incontinence

Certain factors can also increase a person’s risk for incontinence. These factors include:

being overweight, as weight puts pressure on the bladder
age, as older adults tend to have weaker bladder muscles
pregnancy and childbirth, which can affect the pelvic floor and bladder muscles
menopause, as hormones affect the bladder
enlarged prostate or prostate surgery
certain medications
trauma that affects the nerves

Tips for caregivers: Management

Medications are available to calm an overactive bladder, if overactive bladder is the cause of the incontinence. But some have side effects that can make dementia worse. Talk with the doctor about options that apply to the person you’re caring for. In some cases, where incontinence is caused by an underlying medical condition, treating the condition may help.

If necessary, ask your health care provider for a referral to an occupational therapist. An occupational therapist can help you brainstorm other fall prevention strategies. Some solutions are easily installed and relatively inexpensive. Others may require professional help or a larger investment. If you’re concerned about the cost, remember that an investment in fall prevention is an investment in your independence.

How to maintain bladder health

When managing someone’s diet:

Make sure they

avoid carbonation or caffeine
limit liquids before bed
avoid spicy or acidic foods, which irritate the urinary tract
eat plenty of fiber to avoid constipation
exercise regularly

Fluid intake is also important, as it keeps the bladder and bowel healthy. Space out roughly six to eight glasses each day. Fiber-rich foods like bran, fruit, and vegetables can help with constipation.

Pads and pull-up pants

If the person you’re caring for needs to wear absorbent products such as pads, adult underwear, or liners, you may also need to wash their skin. Regular exposure to moisture can cause a number of skin problems, such as inflammation, and fungal and yeast infections.

Keep skin clean by washing it gently with a pH-balanced perineal cleanser, and then patting it dry. Creams and powders can be useful in protecting skin from moisture overexposure.

Tips for caregivers: Reducing accidents

Incontinence often happens due to timing. It may help to recognize potential signs that a person needs to go, such as straining, turning red in the face, and tugging at their clothing. If you help them get dressed, use clothing that’s easy to remove such as pants with elastic waistbands instead of buttons and belts.

One successful technique is prompted voiding. This is a type of bladder retraining that helps people to maintain a regular bathroom schedule. For example, every two hours, ask if they’ve had an accident, have the person use the toilet, and praise successes.

At home

The goal to reduce accidents at home is to help the person you’re caring for identify and use the toilet with ease. Here are some things you can do to achieve this goal:

Remove obstacles from paths taken most often to the toilet.
Leave the bathroom door open at all times or put a sign in front of the door. Avoid locking the door.
Make sure the toilet is at a good height and that lighting is good. Install grab bars next to the toilet, if possible.
Wait until they are next to the toilet to help remove their clothing.

At night, you can place a portable toilet chair near their bed. Installing motion sensor lights may also help avoid accidents. If they can’t get to the bathroom without help, consider getting a bed pad or a waterproof mattress protector.

Outside or in public

When going out, plan in advance. Time your travel stops around bathrooms, and be prepared for accidents by bringing a pad and extra clothes.

After accidents

Everyone reacts differently to incontinence. Some may find it upsetting, while others recognize it as part of their condition. The best way to approach the situation is with understanding and genuine interest for improvement.

If an accident occurs, try to:

be respectful of privacy
speak or address the issue in a calm manner
avoid scolding, or looking upset or frustrated

Wash your hands thoroughly in warm water before and after helping with toileting or changing adult undergarments or pads.

Information you can give the doctor

A doctor can help identify the underlying cause of incontinence for treatment. A doctor can help write up a treatment plan to help cure or manage this condition. Bring notes to the appointment to help the doctor identify the underlying cause. Here are some things you may want to take note of:

how long the person has been experiencing incontinence symptoms
if the person has had episodes of incontinence in the past
whether they’re experiencing urinary incontinence, fecal incontinence, or both
whether it’s a trickle or a flood
if incontinence is more pronounced at certain times of the day or night
physical or mental barriers you’ve observed
typical diet and how much fluid is consumed

You can also reach out to other health professionals for support. A nurse can provide advice on hygiene and management. A physical therapist can tell you more about equipment and adaptions. Talk to the doctor for recommendations.

The outlook for this condition

Caregiving is both rewarding and challenging. Many people find managing incontinence one of the more difficult aspects of care. But it’s important to know that you can help someone manage this condition. Techniques like prompted voiding can help reduce or even eliminate incontinence in people with dementia. It may even be cured if it’s caused by an underlying health condition.

As a caregiver, it’s also important to get counsel from the healthcare team and support from family and friends. Share with others what’s going on in your life and get connected with other caregivers. They may be able to share their experience and provide solutions to similar situations. Online resources for caregiving include Family Caregiver Alliance and Alzheimer’s Foundation of America.

Atlantic In-Home Care refers caregivers who provide at-home services for seniors in Port St. Lucie and the surrounding areas. The caregivers we refer are caring for seniors utilizing experience and integrity in their work. They can assist in creating care plans and daily schedules. If you need help establishing a daily routine or caring for seniors, Atlantic In-Home Care can facilitate help! Contact us online or call us at (772) 773-6994.

Content Credits: Healthline

Dementia and Incontinence

The outlook for this condition

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