Dementia can cause incontinence, a challenging symptom for individuals and caregivers. This often arises as cognitive functions decline, affecting the brain’s ability to manage bladder and bowel control. While not every person with dementia experiences incontinence, it is common, particularly in middle to late stages. Understanding this link is crucial for addressing incontinence in dementia.
How Dementia Impacts Bladder and Bowel Control
Dementia interferes with the brain’s ability to process bodily signals, leading to issues with bladder and bowel control. Cognitive impairment can cause individuals to forget the urge to urinate or defecate, or to lose awareness of a full bladder or bowel. This results in accidents when they cannot react quickly enough to use the toilet.
Memory loss, a hallmark of dementia, further complicates toileting by making it difficult for individuals to locate or recognize the bathroom. They might forget the steps involved in using the toilet, such as undoing clothing fasteners, or even mistake inappropriate places like a wastebasket for a toilet.
Mobility issues, such as difficulty moving quickly or navigating obstacles, can also prevent timely access to the bathroom, even if the urge is recognized. As dementia progresses, changes in social awareness and inhibitions can also contribute to incontinence, as the person may lose the ability to understand or communicate their needs appropriately.
Types of Incontinence Associated with Dementia
Functional incontinence is common in individuals with dementia, where bladder and bowel function may be intact, but cognitive or physical impairments prevent proper toileting. This means the person might recognize the need to go but cannot get to the toilet in time due to mobility issues, or they may simply forget where the bathroom is. Communication difficulties or disorientation also contribute to functional incontinence, as the individual may struggle to express their need or understand prompts.
Urge incontinence is another prevalent type, characterized by a sudden, strong need to urinate or defecate, often leading to involuntary leakage before reaching a toilet. This can be due to changes in the brain affecting bladder control signals, such as an overactive bladder, common in people with dementia.
Sometimes, individuals experience mixed incontinence, which is a combination of both functional and urge incontinence. Less common types like overflow incontinence, where the bladder doesn’t empty completely, can also occur.
Other Potential Causes of Incontinence
Incontinence in individuals with dementia is not always solely due to dementia; various other conditions can cause or worsen it.
Urinary tract infections (UTIs) are a frequent and treatable cause, especially in older adults, leading to a sudden urge to urinate, pain, or increased confusion. Constipation is another common culprit, as a full bowel can put pressure on the bladder and lead to leakage.
Certain medications, including diuretics, anxiety-reducing drugs, and sleeping pills, can also contribute to incontinence by relaxing bladder muscles or increasing urine output. Underlying medical conditions, such as diabetes, an enlarged prostate in men, or weakened pelvic floor muscles, can also affect bladder control.
Environmental factors, like inaccessible toilets or a lack of assistance, also play a role. Dehydration can also lead to concentrated urine that irritates the bladder, potentially worsening incontinence symptoms. A thorough medical evaluation is always recommended to identify and address these reversible or treatable causes.
Managing Incontinence for Individuals with Dementia
Managing incontinence involves a multifaceted approach, beginning with a medical consultation to rule out treatable causes. A healthcare professional can provide tailored guidance.
Implementing a routine of scheduled toileting or prompted voiding can be highly effective; this involves taking the person to the bathroom at regular intervals, such as every two hours during the day, or at their usual voiding times. Observing and noting the individual’s patterns can help establish the most effective schedule.
Environmental adjustments can significantly prevent accidents. This includes ensuring a clear, well-lit path to the bathroom, using contrasting colors for the bathroom door or toilet seat, and providing easy-to-remove clothing. Commodes or raised toilet seats can also make toileting more accessible.
While adequate fluid intake is important to prevent dehydration and UTIs, timing fluid consumption, such as limiting drinks before bedtime, can reduce nighttime accidents. Identifying and avoiding bladder irritants like caffeine or alcohol can also be beneficial.
Appropriate continence products, such as absorbent pads or briefs, can help manage leakage and maintain dignity, especially when out of the home or during the night. Meticulous skin care is also important to prevent irritation and skin breakdown from prolonged exposure to moisture.
A supportive and patient approach from caregivers is paramount, as incontinence can be embarrassing and distressing for the person with dementia.