When People With Dementia Experience Problems Related To Using The Toilet
A person with advanced dementia may lose complete control over their bladder and bowels. However, there are many other reasons why a person with dementia may experience difficulties related to using the toilet. We should never assume that the person has become incontinent until these possible reasons have been explored fully.
If problems do occur, we need to be very sensitive and understanding towards the person.
What Can You Do About It
Communication techniques
- Be supportive, patient and offer reassurance, if helpful. They may be embarrassed or uncomfortable. They might not realise they have been incontinent and may feel embarrassed or upset when they notice what has happened
- If possible, ask the person how you can help them manage their continence. Find out about previous routines or habits, eg, frequency of bowel movements
- Look for non-verbal signs that the person might need the toilet, such as fidgeting, pacing, holding their crotch or their stomach, or going to the corner of the room
- Pay attention to the language the person uses, such as saying phrases like they need to go out
- Some people respond when reminded to go to the toilet regularly. Try prompting every two hours
- The person may hide wet or soiled clothing or cover a wet bed due to embarrassment. Instead of pointing this out, quietly remove soiled linen and replace it
Eating and drinking advice
- Dont stop the person from drinking as this can cause dehydration and constipation which may make incontinence worse
- Aim for at least six to eight glasses of fluid per day
- But do discourage drinking lots of fluid just before bed time
- Encourage a balanced diet with plenty of fibre to encourage regular bowel movements
Practical tips for the home
Helping the person use the toilet
Products and care
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Are There Any Treatment Options For Dementia Patients Suffering From Incontinence
The first thing to do would be to determine as best you can the type of incontinence that is being experienced.
Your doctor should be able to help assist with any underlying medical issues that might be a factor.
This could translate to a change in medications or even addressing a possible urinary tract infection.
An example of possible medical interventions could be as simple as recommending pelvic floor exercises to undergo corrective surgery.
You may also find that you or your loved one qualifies for use of a medical device or procedure designed to strengthen pelvic floor muscles and to retrain the bladder.
These represent some of the more modern methods of managing bladder control. These and other treatment options are best explored with the help of your personal physician.
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Dementia And Incontinence: 10 Tips For Caregivers
As Alzheimers disease and other forms of dementia progress, seniors experience more than just memory issues. Dementia patients functional abilities begin to decline, affecting their health, quality of life and ability to live independently.
Basic activities of daily living are used to measure functionality across six different tasks that are necessary for proper self-care. Although continence and toileting are two ADLs that are affected by the natural aging process, the skills needed to safely and independently complete these intimate skills is significantly impacted by dementia. Occasional incontinence events or accidents commonly progress into chronic incontinence issues during the middle to late stages of Alzheimers and other dementias.
How To Minimize Urinary Incontinence
There are many ways to minimize urinary incontinence. The solution for each individual will depend on the cause, or causes, in their unique case.
A multi-pronged approach, tailor-fit to their situation, will likely be most effective.
Locate the Toilet
Placing signs, or a trail of masking tape on the floor, to help the person find the toilet may help.
Sometimes pictures are easier for the person to understand than written words.
Keep the light on in the bathroom, or place a portable commode, or urinal, at the bedside to help someone who has trouble finding the bathroom during the night.
Replace Troublesome Clothing
Elastic waistbands can make toileting easier for those who have difficulty managing buttons or zippers.
Watch for Non-Verbal Clues
Pay attention to the persons non-verbal communication. Even if they cant always articulate that they need the bathroom, people often show outward behavioral signs.
Common signs of needing the restroom include:
- Fidgeting with or removing clothing
- Pacing, wandering or going in and out of different rooms
- Peering around frantically
Toileting Plan
One of the best ways to minimize incontinence is to develop a personalized toileting plan based on the persons needs.
Initially, the plan may be as simple and informal as reminding the person to use the bathroom before leaving the house.
Over time, the frequency and amount of oversight or assistance may increase.
Remind or assist them regularly just before they are likely to need it.
Example:
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Behaviour And Personality Changes
Many people with frontotemporal dementia develop a number of unusual behaviours they’re not aware of.
These can include:
- losing interest in people and things
- losing drive and motivation
- inability to empathise with others, seeming cold and selfish
- repetitive behaviours, such as humming, hand-rubbing and foot-tapping, or routines such as walking exactly the same route repetitively
- a change in food preferences, such as suddenly liking sweet foods, and poor table manners
- compulsive eating, alcohol drinking and/or smoking
- neglecting personal hygiene
As the condition progresses, people with frontotemporal dementia may become socially isolated and withdrawn.
Why Might Someone With Dementia Become Incontinent
There are many reasons why someone may become incontinent some are age-related and others are related specifically to dementia. These include:
Age:
Urinary tract infections Prostate gland problems common in older men Constipation although you may assume this would reduce the chance of faecal incontinence, what can actually happen is that liquid faeces slips round the hard impacted stool. Pre-existing bowel-conditions such as irritable bowel syndrome Side effects of medication
Damage to nerve pathways in the brain that are involved in bladder and bowel control. Not being able to communicate that you need the toilet Forgetting that you need the toilet until its too late Mobility problems which mean you cant get to the toilet in time, or having difficulty undoing clothing or getting onto the toilet. Struggling to recognise or remember where the toilet is
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Incontinence In Older People
In some cases, older people have a higher risk of incontinence because of a medical condition, which may be treatable. Medical causes of incontinence in older people include:
- urinary tract infection this is where bacteria get into the tube that empties pee from the bladder out of the body. This can lead to infection of the bladder or kidneys. Symptoms can include a sudden urge to pee, pain or a burning feeling when peeing, a fever and urinary incontinence. A urinary tract infection can usually be treated with antibiotics
- constipation this is uncomfortable and makes both emptying and controlling the bladder more difficult. Constipation is also a very common cause of faecal incontinence. When the bowel gets full of very hard poo which cannot be passed, liquid poo can leak out from around the edges of the blockage. It is easy to confuse this with diarrhoea
- prostate gland problems these affect men, and may be treatable
- side effects of medication the GP may be able to address these by changing the persons prescription or altering the dose
- other gut conditions such as irritable bowel syndrome .
Many people find it embarrassing to talk about these problems, and this can stop them from seeking help from health professionals. GPs and specialists deal with issues like these frequently and its important to get advice and support from them. Medical causes can often be treated or managed.
In What Stage Of Dementia Is Incontinence A Problem
In the middle stage of dementia, patients often experience increasing disorientationeven in familiar settingsand tend to get confused more easily while carrying out multi-step processes. A senior with Alzheimers may forget where the bathroom is located in their own home, what the toilet is for, and the steps needed for proper toileting. This can result in a dementia patient failing to locate and get to the bathroom in time, struggling to remove and put on their clothes, urinating and/or defecating in places other than the toilet, and neglecting personal hygiene. Cognitive and functional declines cause toileting problems to worsen throughout the middle stage of the disease, even with increased assistance and supervision.
As a dementia patients impairment becomes more severe, occasional accidents eventually progress into a full loss of bladder and bowel control that is not related to toileting difficulties. Late stage Alzheimers is marked by an inability to respond to ones environment, identify bodily urges, control movements and communicate needs. In the final stages of dementia, patients become completely dependent on others for their personal care.
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Alzheimers And Incontinence: Answers To Caregiver Questions
Caring for someone with Alzheimers disease can be a very trying experience, especially for someone who is not formally trained to do so. We have prepared some frequently asked questions and answers regarding Alzheimers and incontinence that we hope will be helpful. For more information on Alzheimers disease and Incontinence, visit our Alzheimers and Incontinence web page.
Q: Typically at what stage of Alzheimers does incontinence occur?
A: Inevitably in the final stage of Alzheimers, a person will experience a loss of control over their movements, including their bowel and bladder muscles. Though, it is important to remember that every person living with Alzheimers experiences different symptoms, so it is not uncommon for someone in the middle stages to be incontinent.
Q: What are the causes of incontinence in people living with Alzheimers Disease?
A: The causes of incontinence vary depending on the person with Alzheimers. It could be temporary incontinence because of the medicine that was prescribed, or it could be a urinary tract infection . It could be due to the signals that are normally sent to the brain to let a person know they need to use the bathroom are no longer functioning. Also, it may be that your loved one is not able to recognize the need to use the bathroom anymore. Incontinence could be caused by the inability to locate the bathroom or they may not be able to remove their clothes in time.
Q: Could it be a Urinary Tract Infection ?
The Seven Stages Of Dementia
One of the most difficult things to hear about dementia is that, in most cases, dementia is irreversible and incurable. However, with an early diagnosis and proper care, the progression of some forms of dementia can be managed and slowed down. The cognitive decline that accompanies dementia conditions does not happen all at once the progression of dementia can be divided into seven distinct, identifiable stages.
Learning about the stages of dementia can help with identifying signs and symptoms early on, as well as assisting sufferers and caretakers in knowing what to expect in further stages. The earlier dementia is diagnosed, the sooner treatment can start.
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Toilet Problems Continence And Dementia
Read our guide to toilet problems and incontinence, including causes, solutions and how this might affect a person with dementia.
Continence and using the toilet
Its common for people to have more difficulties using the toilet as they get older, particularly if they have dementia.
Accidents and incontinence can cause problems, especially as a persons condition progresses. This can be upsetting for the person with dementia and difficult when youre supporting them.
Many people find it difficult to talk about these issues. However, support is available. With the right help and advice, incontinence and toilet problems can be managed or sometimes prevented.
Progression And Later Stages Of Vascular Dementia
Vascular dementia will generally get worse, although the speed and pattern of this decline vary.
Stroke-related dementia often progresses in a ‘stepped’ way, with long periods when symptoms are stable and periods when symptoms rapidly get worse. This is because each additional stroke causes further damage to the brain. Subcortical vascular dementia may occasionally follow this stepped progression, but more often symptoms get worse gradually, as the area of affected white matter slowly expands.
Over time a person with vascular dementia is likely to develop more severe confusion or disorientation, and further problems with reasoning and communication. Memory loss, for example for recent events or names, will also become worse. The person is likely to need more support with day-to-day activities such as cooking or cleaning.
As vascular dementia progresses, many people also develop behaviours that seem unusual or out of character. The most common include irritability, agitation, aggressive behaviour and a disturbed sleep pattern. Someone may also act in socially inappropriate ways.
Occasionally a person with vascular dementia will strongly believe things that are not true or – less often – see things that are not really there . These behaviours can be distressing and a challenge for all involved.
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Is There A Cure For Dementia
Researchers are searching for answers for cures, new treatment options, and more advanced knowledge of these conditions and more.
To date, there are many clinical trials underway and progress is being made. We have seen many advancements in the way of diagnostic and imaging technology in addition to identifying important biomarkers.
Gastrointestinal Issues In Advanced Parkinsons Disease
Problems with motility of the gut can be a major source of difficulty throughout the disease course and can be particularly problematic in advanced PD as well. . Constipation, which can be one of the earliest symptoms of PD is a very common problem throughout the disease course. Two gut issues that tend to be particularly problematic in people with advanced PD are abdominal pain and fecal incontinence.
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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 theyre experiencing urinary incontinence, fecal incontinence, or both
- whether its a trickle or a flood
- if incontinence is more pronounced at certain times of the day or night
- physical or mental barriers youve 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.
Improving Continence In The Toilet
- running the tap or giving the person a drink of water if they are having trouble urinating
- allowing them to get up and down a few times if they are restless or hyperactive, and will not sit on the toilet
- giving something to distract them while they are on the toilet music may have a calming effect.
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Loss Of Bladder And Bowel Control
Bowel incontinence means you lose control over passing stool, whereas urinary incontinence refers to a condition that involves unwanted passage of urine. When you have bowel or bladder dysfunction, you are likely to experience other problems as well with voluntary urination and bowel movements. Not only can these problems cause pain and discomfort, they can be a source of embarrassment as well. While you may not feel comfortable with the idea of seeking medical help, you should not waste time and talk to your healthcare provider to find a treatment option to deal with loss of bladder or bowel control.
What Is Vascular Dementia
Vascular Dementia is caused by reduced blood flow to brain. This often results from a serious of tiny strokes, also known as infarcts. These strokes damage and destroy some brain cells. The condition can also be caused by a single stroke, in which the blood supply to part of the brain is suddenly cut off. In addition to this, it can also occur to the narrowing of small blood vessels in the brain. This is also called Subcortical Vascular Dementia.
Vascular Dementia affects an estimated 150,000 people in the UK. The condition does gradually get worse over time, although on some occasions it can be slowed down. Vascular Dementia can impair an individual’s memory, language and motor skills.
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How To Protect Yourself
Since bacteria and viruses cause most cases of diarrhea, make sure you donât get sick either. Wash your hands with soap and water often, especially before cooking and meals, and after youâre around anyone whoâs sick. Wear rubber gloves when you help your loved one around the toilet, clean them, or put any creams around their anus. Clean the toilet and sink with disinfectant cleaners, like bleach wipes. Donât let these cleaners touch your eyes and skin, as they can cause irritation.
Show Sources
The American Journal of Gastroenterology: âFunctional Bowel Disorders in the Geriatric Patient: Constipation, Fecal Impaction, and Fecal Incontinence,â âGuidelines on Acute Infectious Diarrhea in Adults.â
Gastroenterology: âAGA Technical Review on the Evaluation and Management of Chronic Diarrhea.â
Journal of Nutritional Health and Aging: âPreventing and Treating Dehydration in the Elderly During Periods of Illness and Warm Weather.â
National Institute of Diabetes and Digestive and Kidney Diseases: âBleeding in the Digestive Tract.â
UpToDate: âApproach to the Adult with Acute Diarrhea in Developed Countries.â