Continence and dementia

Loss of continence is loss of control of bladder or bowel function and is also known as incontinence. Incontinence may occur in people living with dementia for many reasons.

Our brains send messages to our bladder and bowel telling them when it is necessary to empty them. Being in control of these functions depends on an awareness of bodily sensations, such as the feeling of having a full bladder, and the memory of how, when and where to respond. When there is a decline of intellect and memory as a result of dementia, incontinence may occur. The changes in a person’s brain that happen with dementia can interfere with a person’s ability to:

• recognise the need to go to the toilet
• be able to wait until it is appropriate to go to the toilet
• find the toilet
• recognise the toilet
• use the toilet properly.

Causes of incontinence in people with dementia

Incontinence can be caused by infection, constipation, menopause and prostate enlargement. It’s possible to treat these conditions.

Your doctor will ask questions and do tests to find out the cause.

Your doctor might ask:

• Are you experiencing incontinence in your bladder or bowel, or both?
• How often does it happen?
• When did it start?
• Does it happen during the day or night, or both?
• Is it painful to go to the toilet?
• Have you experienced an increase in confusion or any behaviour change?
• Have you had a fever?
• What medications are you taking?

If your doctor rules out other causes, they might tell you dementia is the most likely cause of your incontinence.

What you can do

Incontinence can be stressful and embarrassing, but there are things you can do.

Drinking

• Drink enough water or other fluids. Try around five to eight glasses daily, but small amounts of jelly, custard or ice cream are also okay.
• Dementia can make you forget to drink. It can also stop you knowing when you’re thirsty. Set reminders and leave notes to remind yourself to drink.
• Reduce how much you drink before bedtime.
• Caffeine makes you urinate more. Drink less coffee, tea or cola. Try decaffeinated versions.
• Reduce alcohol and fizzy drinks, as these can irritate your bladder.

Setting up the toilet

• Put clear signs on both sides of the toilet door at eye level. They’ll help you understand where you are and what you’re there for.
• Make your toilet seat a different colour to the floor, so it’s easy to recognise.
• Choose a toilet paper that’s a different colour to the wall.
• Colour the water in the cistern with food dye or a cleaning tablet. This will help you identify the toilet bowl.
• Install a raised toilet seat and handrails to help you get on and off the toilet.
• Make sure the toilet seat is attached securely to reduce the risk of slipping.
• Remove floor mats to prevent tripping.

Creating a comfortable environment

• Ensure your mobility aids are always within reach.
• Is your bed too high or low? Do you have difficulty getting in and out? If so, consider replacing the bed.
• Use a night light or a motion sensor light so it’s easier to see at night.
• Leave the bedroom and toilet doors open so it’s easy to get from one place to the other.
• Use a waterproof bed sheet to keep your bed dry.

Clothes

• Buy clothes with elastic or velcro that are easy to get off and on.
• Buy machine-washable clothing.
• Try adult continence underwear or disposable pads.

Skin care

Clean and dry your skin to prevent rashes. Your doctor or local chemist can suggest soaps and skin creams.

• Wear a layer of fabric under protective plastic. Plastic can irritate your skin.

Caring for someone with dementia and incontinence

Caring for someone with dementia who is experiencing incontinence can be challenging. But there are things you can do to make the situation less stressful for them and yourself.

• Suggest toilet breaks at times that follow their usual bowel or bladder movement patterns.
• Watch for reactions that indicate they need to go to the toilet. They may pull on their clothes, get agitated or their face may become flushed. If they need to go, don’t rush.
• If they’re restless and don’t want to sit on the toilet, let them get up and down a few times. Music may calm them. Or try giving them something to hold, to distract them.
• Use short, simple words and give step-by-step instructions.
• Make the toilet area more private, if this is a concern for the person.
• Remove any objects that they may mistake for a toilet.

For more information and support, contact Continence Health Australia.

Management of Bowel and Bladder Symptoms

Bowel and bladder problems are common in Lewy body dementia and many other types of dementia. In this webinar, neurologist and sleep physician Dr Elie Matar discusses how the bladder and bowel can be affected by dementia. He will discuss treatment options that may be prescribed and how they work. Dr Matar will also identify some lifestyle factors that can help prevent bowel and bladder issues.

Where to get help

• Your GP (doctor)
• Dementia Australia continence webpage: expert information about continence and dementia
• Dementia Australia video: Management Bowel and Bladder Symptoms (14:31 minutes)
• National Continence Helpline: free and confidential, expert advice about continence problems, 1800 330 066.
• National Dementia Helpline: free, confidential, and expert telephone advice about dementia. Available 24/7, every day of the year, 1800 100 500.
• Dementia Australia hygiene webpage: information about hygiene and personal care.
• Dementia Australia Library Guides: a list of publications to help answer your questions about dementia, including incontinence and personal care.