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What Stage Of Dementia Is Bowel Incontinence

Stage : Moderate Dementia

What Are the Stages of Dementia?

Patients in stage 5 need some assistance in order to carry out their daily lives. The main sign for stage 5 dementia is the inability to remember major details such as the name of a close family member or a home address. Patients may become disoriented about the time and place, have trouble making decisions, and forget basic information about themselves, such as a telephone number or address.

While moderate dementia can interfere with basic functioning, patients at this stage do not need assistance with basic functions such as using the bathroom or eating. Patients also still have the ability to remember their own names and generally the names of spouses and children.

Symptoms Specific To Vascular Dementia

Vascular dementia is the second most common cause of dementia, after Alzheimer’s. Some people have both vascular dementia and Alzheimer’s disease, often called “mixed dementia”.

Symptoms of vascular dementia are similar to Alzheimer’s disease, although memory loss may not be as obvious in the early stages.

Symptoms can sometimes develop suddenly and quickly get worse, but they can also develop gradually over many months or years.

Specific symptoms can include:

  • stroke-like symptoms: including muscle weakness or temporary paralysis on one side of the body
  • movement problems difficulty walking or a change in the way a person walks
  • thinking problems having difficulty with attention, planning and reasoning
  • mood changes depression and a tendency to become more emotional

Read more about vascular dementia.

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

Skin care

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Symptoms Specific To Frontotemporal Dementia

Although Alzheimer’s disease is still the most common type of dementia in people under 65, a higher percentage of people in this age group may develop frontotemporal dementia than older people. Most cases are diagnosed in people aged 45-65.

Early symptoms of frontotemporal dementia may include:

  • personality changes reduced sensitivity to others’ feelings, making people seem cold and unfeeling
  • lack of social awareness making inappropriate jokes or showing a lack of tact, though some people may become very withdrawn and apathetic
  • language problems difficulty finding the right words or understanding them
  • becoming obsessive such as developing fads for unusual foods, overeating and drinking

Read more about frontotemporal dementia.

Fecal Incontinence In Elderly Adults: What You Need To Know

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Fecal incontinence affects up to 17 million people in the United States, according to the International Foundation for Functional Gastrointestinal Disorders. Its also the second most common reason older adults make the decision to go into assisted living or long-term care facilities. Even though fecal incontinence is common, it can be embarrassing or upsetting for seniors to talk about, and often goes unchecked.

The good news is that, in most situations, elderly fecal incontinence is treatable or manageable. Learn about common bowel incontinence causes and treatment plans, and how to talk to a doctor about your elderly loved ones FI.

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What Type Of Incontinence Do Persons With Dementia Have

In the early to mid stages of dementia, persons with dementia have a functional incontinence. Their barriers to speech, language, understanding, and dexterity can lead them to have accidents, not because they have a weakened pelvic floor or physiological or neurological changes to their bladder, bowel or sphincters. But as the dementia progresses, and significant damage to the brain occurs due to the disease process, it leads to a true incontinence, where the person with dementia will have no knowledge their bladder is filling or is full, or have no control over passing urine or faeces.

Suggestions For Managing Incontinence

  • Make sure the person is drinking adequate fluids, preferably five to eight glasses of water daily . Many people with dementia forget to drink or no longer recognise the sensation of thirst.
  • Consider reducing the persons caffeine intake by using decaffeinated coffee and tea.
  • Observe the persons toileting patterns and suggest they use the toilet at regular times that follow their pattern.
  • Try toileting before and after meals, and before bed.
  • Try to establish a regular routine for the person to have something to drink with and between meals.
  • There are many aids and appliances available to help in managing incontinence.

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At What Stage Of Dementia Does Incontinence Occur

Tips for managing incontinence.

Although incontinence typically occurs in the middle or late stages of Alzheimers, every situation is unique.

The following tips can help caregivers of people living with Alzheimers who are experiencing incontinence.

Bladder and bowel accidents can be embarrassing..

Tips For Caregivers: Reducing Accidents

Part 5 of 6: Dementia – incontinence products

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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Incontinence In Dementia Can Be Due To Many Different Problems

Incontinence is common in old age by itself and occurs in the majority of patients with dementia at some point. Although not as problematic as anger, aggression, agitation, or falls, incontinence is upsetting both to you and your loved one and is a major reason individuals with dementia end up leaving home and going into a facility.

There are many different types of incontinence that older adults may experience. Some types are related to anatomical and medical causes these types are best evaluated and treated by a urologist or other physician. For this reason, if these recommendations fail to significantly address the incontinence, it is important to discuss the problem with a physician.

Bowel incontinence may be due to problems that anyone can have, such as diarrhea, but it is common in dementia in the moderate and severe stages for the same reasons that urinary incontinence is common. The control of the bowels is impaired and individuals with dementia are less able to hold in their feces. They may forget to use the toilet to move their bowels prior to going on a trip. Due to frontal lobe dysfunction, they may not care if they soil their clothes. And again, if their walking is impaired, they will be less likely to make it to the toilet in time.

Key Question:

I dont mind cleaning up when she doesnt make it to the bathroom in time and soils herself, but now shes fighting me when I try to get her washed up.

Information For The Doctor

It is useful if you can provide the doctor with the following information:

  • How often is the person incontinent?
  • Is it urinary and/or faecal incontinence?
  • When did the problem start?
  • Is the person saturated or is it just a dribble?
  • Has there been an increase in confusion or any change in behaviour?
  • Has there been any fever or does the person appear to find it painful to go to the toilet?
  • Is the person taking any medication?
  • Does the person pass urine in strange places?

If medical assessment does not indicate that there are any other medical reasons for the incontinence, then the cause is most likely to be the persons dementia.

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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.

Urinary Issues In Advanced Parkinsons Disease

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Urinary dysfunction and symptoms in PD are most commonly caused by overactivity of the detrusor muscle, or the muscle of the bladder, which contracts excessively despite the fact that it is not filled with urine. This causes an increased urge to urinate and/or an increased frequency of urination, which can be especially prominent at night. In advanced PD, this could culminate in urinary incontinence, or involuntary release of urine. Mobility issues which make getting to the bathroom slower and more cumbersome, compound the problem.

Always remember that people with advanced PD may have other medical problems that affect their urination such as an enlarged prostate. Make sure to have a complete evaluation before assuming that the problem is only related to PD. It is also essential to keep in mind that if changes in urination occur suddenly, there could be a urinary tract infection present.

Once other medical issues and urinary tract infection are ruled out, there are a number of approaches to the issue of urinary incontinence in a person with advanced PD:

Unfortunately, for some, the above available options may not be sufficient to effectively treat urinary incontinence in advanced PD. If this is the reality, it becomes extremely important to keep the skin dry with frequent changes of incontinence products to prevent skin breakdown and the potential development of skin infection.

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Talk With A Senior Living Advisor

Our advisors help 300,000 families each year find the right senior care for their loved ones.

  • Types of food and drinks consumed
  • How many times, and when, they defecated throughout the day
  • Documentation of irregular stools
  • Notes about their accidents, including frequency

After gathering information, the doctor may do a physical examination of the anus and perineum, the area between the anus and the genitals, to check for hemorrhoids or infection. They may also schedule one or more of these common tests:

Treatment And Management Of Fecal Incontinence And Bowel Leakage

Fecal incontinence may have severe emotional effects, which can contribute to anxiety, depression, and even social isolation. This is one reason management of FI is so important for seniors, who are already at increased risk of isolation and mental illness.

Minor incontinence may be managed at home, while more severe incontinence can benefit from biofeedback training, prescription medication, or surgery.

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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

What Stage Of Alzheimers Is Sundowning

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Sundowning is a distressing symptom that affects people in mid- to late-stage Alzheimers and other forms of dementia, and as the condition progresses, the symptoms tend to worsen. Those with dementia can become hyperactive, agitated and confused, and these symptoms can extend into the night, causing sleep disruption.

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Caring For Someone With Incontinence

When caring for someone with dementia, incontinence may seem like the last straw. But there are measures that can be taken to alleviate the problem itself or to make it less stressful. It is important for you to seek professional help at an early stage and not struggle on your own. Incontinence can be very distressing for the person with dementia. It helps if you remain calm, gentle, firm and patient and try to accept and get over your own embarrassment in having to help the person in such an intimate way. Sometimes a little humour can help.

Why Do People With Dementia Become Incontinent

People with dementia may become incontinent for a variety of reasons and often, for several at once.

Stress Incontinence

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

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.

Functional Incontinence

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.

Communication Deficits

People with dementia may be unable to communicate the need to use the restroom.

Cognitive Changes

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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Diagnosing Senior Fecal Incontinence

If you or an elderly loved one is experiencing FI, talk to a doctor. Usually, a general practitioner will refer you to a specialist, who may ask questions about living arrangements, diet, and current and past bowel function, according to Rao.

A patient may also be asked to bring a record of fecal incontinence to their first visit, or to create one between appointments.

In this journal, they will likely record:

Are There Any Treatment Options For Dementia Patients Suffering From Incontinence

At What Stage of Dementia Does Incontinence Occur ...

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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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.

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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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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