Dementia and Incontinence

  1. Why Do People With Dementia Develop Incontinence?
  2. Common Medical Causes of Incontinence
  3. Tips For Care Providers to Manage Incontinence
  4. Maintain a healthy bladder and bowel with diet and fluid intake
  5. Incontinence Pads and Pull-Up Pants

It is estimated that between 3 and 6 million people in the UK suffer from urinary incontinence.[1] Though less common, faecal incontinence affects approximately 3% of the adult population. While these issues affect people of any age and at any stage of life, incontinence is much more prevalent in older people.

Around 39% of women over the age of 60 and 10% of men over the age of 65 have some degree of urinary incontinence. This number increases dramatically after the age of 80. Dementia is an umbrella term for a host of memory loss symptoms and includes vascular, frontotemporal, and Lewy body dementia.[2] As dementia becomes more prevalent with age, many sufferers are also dealing with incontinence.


Why Do People With Dementia Develop Incontinence?

There are a number of reasons why someone with dementia might develop incontinence.[3]

  • Not recognising the bathroom – People with dementia can struggle to recognise common household objects. While they can visually ‘see’ the toilet in front of them, they might not be able to identify what it is, and what it is used for.[4]
  • Getting lost and wandering – People suffering with dementia tend to get lost very easily. The pathways responsible for spatial awareness can become muddled, and ‘wandering’ aimlessly becomes common.[5] While this might begin out in the world, it can progress to confusion and getting lost within one’s own home.
  • Communication issues – Dementia can cause communication to break down. A person with advanced dementia might not be able to alert their carer that they need to use the toilet before it is too late.
  • Mobility loss – Dementia is often accompanied by reduced mobility and other physical disabilities. Even if a person is conscious that they need to use the toilet, their physical condition might prevent them from doing so. This often results in an inability to get to the bathroom in time to prevent an accident.

stethoscope next to a laptop

Common Medical Causes of Incontinence

Many people with dementia are also dealing with co-morbid illnesses that can compound their distress, discomfort, and incontinence issues. Here are some of the most common medical causes of incontinence.

  • Enlarged prostate – Urinary incontinence is a common side effect for some men who have an enlarged prostate (also known as benign prostatic hyperplasia, or BPH). The BPH starts to cause the involuntary leakage of urine.
  • Constipation – While constipation seems to be the opposite problem of faecal incontinence, it can actually cause such incontinence. As hardened stool is painful and difficult to pass, it can become lodged high up in the bowel. Watery faecal matter can begin to flow around it, voiding without any warning. This is common in older people.
  • Neurological complications, often caused by a stroke – Complications caused by a stroke or other neurological illnesses can interfere with the mental signals to the bladder and bowel, causing incontinence.
  • Parkinson’s Disease, Multiple Sclerosis, and Prostate Cancer – These conditions can prevent the physical signals involved in bladder and bowel control. A person with Parkinson’s or MS may not feel any urgency, even when voiding is imminent.
  • Certain medication side effects – Certain medications can relax the muscles of the bladder and reduce overall awareness. This is most common with -the use of sleeping pills and tranquillizers.

tablet assortment

Tips For Care Providers to Manage Incontinence

Managing Incontinence

Here are some of the ways that you can help your patient or loved one manage their incontinence and avoid accidents:

  • Bladder Retraining

Bladder retraining involves delaying urination until just after the time a person feels the urge to void. Ideally, you will start by waiting around 10 minutes after they first report feeling the need to go, and then increase the duration over time. Eventually, they will only need to visit the toilet every 2 to 3 hours. This method might not be suitable for someone in the later stages of dementia, as they may not be able to communicate their needs.

  • Timed/Prompted Voiding

Similar to bladder retraining, timed voiding involves waiting between visits to the toilet. However, with this method, the person does not wait until they feel any urge to urinate or defecate. Instead, you will take them to visit the toilet every 2 to 4 hours, regardless of whether they feel any urge or not. Often just sitting on the toilet will trigger urination or a bowel movement.

  • Pharmaceutical Options

There is a wide range of pharmaceutical options that a GP or Continence Specialist Nurse might prescribe a person with incontinence and dementia. They include:[6]

  1. Anticholinergics – Anticholinergics can help to relax an overactive bladder, and are often prescribed for urge incontinence.
  2. Mirabegron (Myrbetriq) – Mirabegron is often prescribed for urge incontinence. It relaxes the bladder muscles, allows it to hold more urine, and allows it to empty completely.
  3. Alpha-blockers – Men who have urge or overflow incontinence can often benefit from taking alpha-blockers. They relax the muscle fibres in the prostate and bladder neck, making it easier to void completely.
  4. Topical oestrogen – Some women might benefit from applying topical oestrogen, sold as a vaginal cream, patch, or ring. It can help to rejuvenate and strengthen the urethral and vaginal tissue.

glass of water

Maintain a healthy bladder and bowel with diet and fluid intake

One of the best ways to manage your loved one’s incontinence is to help them to maintain a healthy bladder and bowel. This is accomplished through a  healthy diet and adequate fluid intake.[7]

  • Adequate fluid intake

Ensure those you care for are drinking an adequate amount of fluids, especially water. This can come in the form of sparkling and still water, fruit juice, fruit squash, tea and coffee, preferably decaffeinated.. Avoid fizzy drinks and heavily caffeinated teas and coffees, which can dehydrate, and lead to constipation, but can also cause bladder irritation

  • Limit alcohol consumption

Alcohol is one form of liquid that anyone should definitely limit if they are dealing with incontinence. It dehydrates the body, exacerbating IBS, urinary tract infections, and constipation. Alcohol can also cause bladder irritation.

  • Prepare and feed them a well-balanced diet

One of the best ways to improve overall health is by eating a well-balanced diet rich in fruits, vegetables, whole grains, healthy fats, and lean proteins.

  • Consider a FODMAP Diet

Many people with faecal incontinence could benefit from following a FODMAP (fermentable oligo, di-, monosaccharides and polyols) diet.[8] Many studies have shown that eliminating certain foods from a person’s diet is beneficial for treating IBS (irritable bowel syndrome). Removing the offending foods can reduce bloating, constipation, and diarrhoea, and in turn, prevent faecal incontinence.


Incontinence Pads and Pull-Up Pants

Incontinence Pads or pull up pants can give a person suffering from incontinence a sense of normality, whilst at the same time, maintaining their dignity. A wide range of Incontinence products are available from HARTMANN Direct, which provide containment for both urinary and faecal incontinence to help reduce the embarrassment that incontinence can cause.

One of the best things you can do to keep life as normal as possible for someone with dementia and incontinence is ensuring that they have the supplies they need to stay clean and dry, even in the wake of accidents. If they soil themselves, assist them to clean themselves (or do so for them) as soon as possible.

A common problem for both sufferers of dementia and their carers is broken sleep, due to accidents in the middle of the night. When a person isn’t getting enough high-quality sleep, their cognitive functions decline even further. This can exacerbate the dementia sufferer’s symptoms, and cause the carer to become exhausted and overwhelmed.

HARTMANN customer Adrienne recounts her experiences with husband Jeff. “Jeff’s problem was not remembering quickly enough that he needs to go to the toilet during the day and having frequent accidents during the night. We tried to manage it ourselves, to begin with by looking out for signs he needed the toilet and setting the alarm… but he was frequently soiling the bed.”

“This was upsetting and confusing for him and meant that I had to strip the bed, which resulted in very broken sleep for me… As a carer I was exhausted and had lots of additional washing to do in the morning.”

She found respite and relief with HARTMANN MoliCare® pull-up pants. Adrienne continued, “the MoliCare® pull-up pants are much better for Jeff as they look like normal underwear, so he doesn’t get upset wearing them. He can pull them up and down like normal pants, which helps him maintain his dignity.”

“We want him to keep his independence for as long as possible and minimise what is already a confusing world for him.”

Adrienne is just one of the thousands of customers around the UK who have benefitted from using HARTMANN pads and pull up pants for themselves and their loved ones. Dementia or not, no one deserves to have incontinence affect their quality of life.

Review for HARTMANN Direct left by Adrienne in October 2019


Reference list

Alzheimer’s Society (2019). Toilet problems and continence. [online] Alzheimer’s Society. Available at: https://www.alzheimers.org.uk/get-support/daily-living/toilet-problems-continence.

Bardsley, A. (2014). Understanding incontinence in people with dementia. [online] Independentnurse.co.uk. Available at: http://www.independentnurse.co.uk/clinical-article/understanding-incontinence-in-people-with-dementia/63430/ [Accessed 23 Jan. 2020].

Fillit, H. (2018). Types of Dementia (It’s Not Just Alzheimer’s) | Alzheimer’s Drug Discovery Foundation. [online] Alzdiscovery.org. Available at: https://www.alzdiscovery.org/news-room/blog/types-of-dementia-its-not-just-alzheimers [Accessed 27 Jan. 2020].

Harris, C. (2019a). Everything You Need to Know About FODMAP… [online] HARTMANN Advice Centre. Available at: https://hartmanndirect.co.uk/information-centre/fodmap-diet/ [Accessed 23 Jan. 2020].

Harris, C. (2019b). How to Maintain a Healthy Bladder and… [online] HARTMANN Advice Centre. Available at: https://hartmanndirect.co.uk/information-centre/how-to-maintain-a-healthy-bladder-and-bowel/ [Accessed 23 Jan. 2020].

Mayo Clinic (2018). Alzheimer’s: Understand wandering and how to address it. [online] Mayo Clinic. Available at: https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/alzheimers/art-20046222 [Accessed 27 Jan. 2020].

Mayo Clinic (2019). Urinary incontinence – Diagnosis and treatment – Mayo Clinic. [online] Mayoclinic.org. Available at: https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/diagnosis-treatment/drc-20352814.

Scie.org.uk. (2011). Problems related to using the toilet – Dementia – SCIE. [online] Available at: https://www.scie.org.uk/dementia/living-with-dementia/difficult-situations/using-the-toilet.asp [Accessed 27 Jan. 2020].

Telegraph.co.uk (2017). Why incontinence is more common than you might think. [online] The Telegraph. Available at: https://www.telegraph.co.uk/business/business-reporter/incontinence-more-common-than-you-might-think/ [Accessed 27 Jan. 2020].

Sources

[1] https://www.telegraph.co.uk/business/business-reporter/incontinence-more-common-than-you-might-think/

[2] https://www.alzdiscovery.org/news-room/blog/types-of-dementia-its-not-just-alzheimers

[3] https://www.alzheimers.org.uk/get-support/daily-living/toilet-problems-continence

[4] https://www.scie.org.uk/dementia/living-with-dementia/difficult-situations/using-the-toilet.asp

[5] https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/alzheimers/art-20046222

[6] https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/diagnosis-treatment/drc-20352814

[7] https://hartmanndirect.co.uk/information-centre/how-to-maintain-a-healthy-bladder-and-bowel/

[8] https://hartmanndirect.co.uk/information-centre/fodmap-diet/

Previous Post
How To Maintain Good Hygiene For Someone You Care For
Next Post
Adrienne’s Story: Dealing With My Husband’s Dementia and Incontinence

Related Posts

Leave a Reply

Your email address will not be published.

Fill out this field
Fill out this field
Please enter a valid email address.

Menu