Dementia is a general term describing a group of symptoms that negatively affect memory, thinking, and social abilities, interfering with daily functioning. This condition is progressive, meaning symptoms gradually worsen over time as cognitive decline continues. For individuals and their caregivers, addressing the topic of bowel control is a necessary part of managing the disease. Understanding the potential for loss of bowel control is important for maintaining the comfort and dignity of the person living with dementia.
The Direct Answer: Dementia and Bowel Control
Yes, people living with dementia can lose control of their bowels, a condition known as fecal incontinence. While this is not an inevitable outcome for every individual, it is a common issue, especially as the disease advances into the later stages. Individuals with dementia are approximately four times more likely to be diagnosed with fecal incontinence compared to older adults who do not have the condition.
It is important to differentiate between true incontinence and other bowel issues, such as occasional diarrhea or constipation. Severe constipation can often lead to overflow incontinence. In this scenario, liquid stool leaks around a hard blockage in the rectum. Dementia itself directly impacts the brain’s ability to correctly process and respond to the signals related to elimination.
Neurological and Physical Contributors to Incontinence
The primary neurological mechanism involves the progressive damage to brain cells that are responsible for cognitive and motor control. Areas governing executive function, which include planning and sequence recall, become impaired. This impairment means the person may no longer recognize the physical urge to defecate or remember the complex steps required to safely reach and use a toilet.
The brain’s signals to the external anal sphincter, the muscle responsible for voluntary control over stool release, are interrupted. This loss of communication prevents the patient from consciously keeping the sphincter closed until an appropriate time. Without this voluntary control, the involuntary passing of stool is more likely to occur.
Physical and environmental factors also contribute. Reduced mobility, often a co-occurring issue with advancing dementia, can prevent the person from getting to the bathroom quickly enough. Difficulties like struggling to find the toilet, difficulty recognizing it, or being unable to manage clothing fasteners can lead to accidents. Certain medications frequently prescribed to older adults or those with dementia, such as some anxiety-reducing drugs, can also affect bowel regularity or muscle control.
Progression and Timing of Bowel Incontinence
Bowel incontinence is typically associated with the moderate to severe stages of dementia, rather than an early indicator. The timing of onset varies widely, but it rarely appears in the mild phase of the disease. In many cases, urinary incontinence tends to manifest earlier in the disease trajectory than fecal incontinence.
Caregivers must promptly investigate any new or sudden onset of incontinence, as it may not be directly caused by dementia progression. Treatable medical issues, such as a urinary tract infection (UTI) or severe constipation, often present with an abrupt change in continence. Changes in medication or the development of other chronic conditions like diabetes or Parkinson’s disease can also influence bowel function.
Practical Strategies for Managing Incontinence
One of the most effective strategies involves implementing a fixed toileting schedule, often referred to as prompted voiding. This routine involves offering the toilet at regular intervals, such as every two to three hours, rather than waiting for the person to communicate the need. Scheduling a trip to the toilet shortly after a meal, particularly breakfast, can capitalize on the natural gastrocolic reflex that stimulates a bowel movement.
Caregivers should pay attention to non-verbal cues indicating the need to eliminate, especially as verbal communication declines. Responding to these cues with patience and understanding helps maintain the person’s dignity and reduces the likelihood of an accident.
Recognizing Non-Verbal Cues
- Fidgeting
- Pacing
- Pulling at clothing
- Sudden restlessness
Dietary interventions play a role in regulating bowel function and preventing the overflow incontinence caused by constipation. Ensuring a daily intake of high-fiber foods, such as whole grains, fruits, and vegetables, helps create soft, well-formed stools that are easier to pass. Adequate hydration, typically six to eight glasses of water daily, is important to keep the digestive tract moving and prevent dehydration.
Environmental adjustments can make the toilet more accessible and intuitive to use. Keeping the path to the bathroom clear of clutter and obstacles is important, and using good lighting or clear signage can help the person find the location. Choosing clothing with easy-to-manage closures, like elastic waistbands or hook-and-loop fasteners, reduces the time and frustration involved in undressing. When incontinence products are necessary, utilizing appropriate absorbent briefs or pads, along with diligent skin care, helps prevent irritation and maintain hygiene.