Managing The Elderly With Urinary Incontinence And Dementia
Si Ching LIM
Senior Consultant, Department of Geriatric Medicine, Changi General Hospital, Singapore
*Corresponding author: Si Ching LIM, Senior Consultant, Department of Geriatric Medicine, Changi General Hospital, Singapore, E-mail:
Received: April 14, 2017 | Accepted: June 03, 2017 | Published: June 05, 2017
Citation: Si Ching LIM Managing the Elderly with Urinary Incontinence and Dementia. Int Arch Urol Complic 3:027. doi.org/10.23937/2469-5742/1510027
What Are The Signs Of End Stage Dementia
Experts suggest that signs of the final stage of Alzheimers disease include some of the following:Being unable to move around on ones own.Being unable to speak or make oneself understood.Needing help with most, if not all, daily activities, such as eating and self-care.Eating problems such as difficulty swallowing.5 days ago
Why Do People With Dementia Become Incontinent
People with dementia may become incontinent for a variety of reasons and often, for several at once.
Many older women experience stress incontinence.
When the weakened bladder muscles are stressed by a sneeze or a laugh, they may leak small amounts of urine.
Urge incontinence is a common condition among elders, characterized by a sudden and intense need to urinate, followed by the loss of a large amount of urine.
Mobility challenges can make it hard to get to the toilet on time.
Difficulty Managing Clothing
Unzipping or unbuttoning pants can become a challenge due to various reasons, including arthritis or cognitive changes.
People with dementia may be unable to communicate the need to use the restroom.
A person may forget how to complete the sequence of events needed to successfully remove clothing and use the toilet.
The brain may become less able to recognize the signal from the body that it needs the bathroom.
Difficulty finding the bathroom, recognizing the toilet, or comprehending how to use it can present a major barrier.
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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.
Alzheimers Disease And Incontinence
Alzheimers Disease is the most common form of dementia, which is caused by a physical disease of the brain. It is a progressive illness, which causes loss of memory, judgment and language. Between 60 70% of those with Alzheimers will go on to suffer from incontinence issues. Incontinence should not be considered an inevitable part of this illness treatments are available to help with this condition and any issues should be investigated by your GP to rule out any separate conditions that may be affecting this.
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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.
Tips For Caregivers: Reducing Accidents
Incontinence often happens due to timing. It may help to recognize potential signs that a person needs to go, such as straining, turning red in the face, and tugging at their clothing. If you help them get dressed, use clothing thats easy to remove such as pants with elastic waistbands instead of buttons and belts.
One successful technique is prompted voiding. This is a type of bladder retraining that helps people to maintain a regular bathroom schedule. For example, every two hours, ask if theyve had an accident, have the person use the toilet, and praise successes.
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What Is The Relationship Between The Brain And Bowel Function
It is the muscles within the rectum and anus that help to control your bowels. The sphincter muscles are responsible for the release of stool. The relationship between the brain and bowel is more important than you may think. Just like how our bladder becomes full and sends signals to the brain to let it know, our digestive system becomes full and sends signals about its fullness to the brain. The brain then sends signals via the nerves to keep the external sphincter closed. These signals begin in the brain and go to the spinal cord and continue to the nerves located in the sacral area of the back. They then go down to the rectum and external sphincter muscles. The brain’s signals are important to ensure the muscles only release stool when it is appropriate.
Stage : Moderately Severe Dementia
When the patient begins to forget the names of their children, spouse, or primary caregivers, they are most likely entering stage 6 of dementia and will need full time care. In the sixth stage, patients are generally unaware of their surroundings, cannot recall recent events, and have skewed memories of their personal past. Caregivers and loved ones should watch for:
- Delusional behavior
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Do Dementia Patients Know What They Are Saying
These communication hiccups happen all the time to most people, but dementia affects the brain so that language problems become more noticeable. Someone with Alzheimers, for instance, wont remember phrases, or be able to learn new phrases. Slang and common expressions become hard or even impossible to remember.
Signs Of Dying In The Elderly With Dementia
Dementia is a general term for a chronic or persistent decline in mental processes including memory loss, impaired reasoning, and personality changes. Alzheimers disease is the most common form of dementia, accounting for 60-80% of all cases of dementia. It is also the 6th leading cause of death in the United States, and over 5 million Americans are currently living with Alzheimers disease.
Alzheimers disease and most progressive dementias do not have a cure. While the disease inevitably worsens over time, that timeline can vary greatly from one patient to the next.
Caring for a loved one can be challenging and stressful, as the individuals personality changes and cognitive function declines. They may even stop recognizing their nearest and dearest friends and relatives. As dementia progresses, the individual will require more and more care. As a family caregiver, its important to be able to recognize the signs of dying in elderly with dementia. Hospice can help by offering care wherever the individual resides, providing physical, emotional and spiritual care to the patient and support their family.
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What You Can Do For Your Loved One
As an individual with dementia declines, you can help them by providing a loving and supportive presence. Sit with them. Hold their hand. Play music they enjoy.
One of the greatest gifts you can give your loved one is helping to get their affairs in order. Ensure that financial and healthcare powers of attorney are put in place, so you can make decisions when your loved one is no longer able. Look into funeral arrangements before you need them, so you dont need to make important decisions in a time of crisis.
Talk to your loved ones physician about the possibility of palliative care support in the home and hospice care when your loved one is ready.
Stage : Mild Dementia
At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:
- Difficulty remembering things about one’s personal history
- Difficulty recognizing faces and people
In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.
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What Causes Incontinence In People With Dementia
In the later stages of dementia, a persons ability to react quickly and remember things is reduced. They may no longer recognize when they experience the urge to urinate or have a bowel movement. Reasons for incontinence in someone with dementia include:
- not recognizing the bathroom
- mental status changes or abrupt worsening of confusion, including significant changes in behavior
UTIs can worsen without proper treatment.
Causes Of Bowel Incontinence
There can be many causes for incontinence in someone with Alzheimerâs disease. It can be related to the dementia itself. The person may not recognize the urge to go or may have trouble finding the bathroom or taking off clothing.
Other reasons for bowel incontinence include:
- Medical reasons including chronic bowel disease, diabetes, Parkinsonâs disease, and urinary tract infections
- Weakness from surgery
- Diarrhea from a virus or bacterial infection
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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.
Toilet Problems And Continence In The Later Stages
As dementia progresses people may find it harder to use the toilet and may experience accidents or incontinence.
The later stages of dementia
This could be urinary incontinence , faecal incontinence or both. Incontinence may be an occasional leak or a total loss of control.
Having dementia doesnt mean a person will definitely become incontinent, but there are a number of reasons why they could be, or have problems using the toilet. These include various medical conditions, many of which can be treated. Possible causes include:
- urinary tract infection
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How Dementia Progresses: The 7 Stages Of Dementia
Written byDr. Victor MarchionePublished onNovember 25, 2016
Forgetfulness and memory lapses are part of both normal aging and dementia, but there are key differences between the two, which set them apart.
Dementia is quite different from normal age-related memory loss because it doesnt affect just memory. In fact, dementia can involve many aspects of health and well-being, including communication ability, behavioral changes, and much more. Symptoms of dementia negatively impact a persons everyday life, impairing their ability to live independently. Whereas in the case of normal aging, although one may have bouts of memory loss, they can still live on their own and perform daily tasks.
As a caregiver, its important to understand the different stages of dementia in order to be prepared and make appropriate changes to the patients care, ensuring they are kept safe and healthy.
Tips To Manage Activity Of Toileting Or Pad Changes
- Sign or picture of toilet on door keep toilet light on and door open always to flag location
- Provide a safe environment for toileting/pad changes- safe footwear, dried floors after showers & toileting, motion sensor alarms on chair, bed, floor, beside bed
- Learn behaviours that may indicate signs of wanting to void or open bowels: agitated, restless, increased anxiety, trying to move or stand up unassisted, wandering
- Clothing should be easy to remove/undo to make pad/pant removal easy and quick
- Contrasting objects in the bathroom- black hand wash & black towel dispensers, black toilet seats, black hand rails, and coloured toilet paper will make these key objects easier to recognise
- Establish toileting times to minimise accidents
- Allow proper time for toileting as rushing activity could trigger aggression or paranoia
- Establish a bowel management plan to avoid constipation or faecal incontinence
- Encourage mobility/exercise if feasible, as this may reduce constipation & improve sleep
- Choose products that do not disturb sleep – dementia can cause difficulty falling asleep, repeated awakenings, confusion between night or day
- Limit drinks two hours before sleeping to minimise disruption with pad change/toileting overnight
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Can Anything Be Done For People With Dementia Who Have Trouble With Bladder And Bowel Control
Dementia may rule out some treatments but there are still ways to provide comfort and dignity.
- Watch the persons bladder and bowel habits for a while. This may show a pattern of toileting habits.
- Watch for signs that they want to go to the toilet. For example, they may become restless, walk a certain way or pull at their clothing. The person can then be taken to the toilet in time.
- People with dementia or confusion may not notice the urge to empty their bladder or bowels. This can lead to wetting of pants or leaking of normal bowel actions. A common time for bowel motions to happen is soon after a meal, often after breakfast.
- Listen with care and respond to the person
- Get rid of clutter in the living areas. This may make it easier for them to find their way to the toilet.
- Keep the space around them simple and well known to them.
- Show respect and sincere care.
Check bladder and bowel control
Seek help from their doctor, continence nurse advisor or continence physiotherapist.
A bladder and bowel control check-up will include a physical check. The health professional will ask about when, where and why problems happen.
The carer is often the best person to give the details needed. The carer might be asked to give details about:
- the time the person goes to the toilet and/or leaks
- how much leakage there is
- when and how often they open their bowels.
Understanding Dementia And Toileting Issues
Toileting refers to an individuals ability to independently get to the toilet, use it properly and clean themselves effectively. Although this is second nature for most people, dementia patients face a variety of challenges that interfere with their ability to use the toilet.
There are several types of incontinence that have different underlying causes. Dementia patients typically experience functional incontinence their urinary system and/or digestive system works normally, but they experience a loss of bladder and/or bowel control due to an inability to get to the bathroom or use it properly. Cognitive deficits cause toileting difficulties because the individual doesn’t recognize the urge to go, can’t communicate their needs, has difficulty accessing the restroom and can’t remember the toileting process.
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Healthy Bladder And Bowels
Some causes of incontinence are treatable, for example a urinary tract infection or constipation, so it is important to get any incontinence checked out by a GP.
There are some things that can be done to help keep the bladder and bowels healthy, and reduce the impact that incontinence can have.
- Drinking plenty of water helps to reduce the risk of becoming constipated and also reduces the risk of developing a urinary tract infection. Try to drink between 6 – 8 glasses of water per day.
- Eating a balanced diet with at least 5 portions of fruit or vegetables per day, and incorporating at least 30g of fibre per day. Good sources of fibre include wholewheat cereals, wholewheat bread, pulses , nuts and seeds, and potatoes with the skin on.
How To Prevent And Respond
One of the challenges as Alzheimers disease progresses is urinary and fecal incontinence. Incontinence can be a difficult topic to discuss with others, but it’s an important aspect of caring for your loved one.
Incontinence is the loss of the ability to control urination or bowel movements. In a medical setting, this may be referred to as being incontinent of bowel or bladder, or fecal or urinary incontinence.
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What Can You Do About It
- 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