Incontinence is a common problem in dementia. Understanding WHY the person you are caring for is experiencing incontinence is a necessary step for successful management. It will help you intervene early with an appropriate strategy. There are a number of factors to consider, including infections, comorbidities, environmental causes, and dementia itself.
Firstly, when dealing with issues of incontinence it is important to rule out health reasons that may have little or nothing to do with dementia. Many of the conditions listed below are reversible and treatable, so a full medical assessment by your doctor will help figure out why the incontinence is occurring. Talking with a continence nurse can also be helpful.
Urinary Tract Infection (UTI) and other infections of the bladder or kidney, cause a sudden need to urinate, pain or a ‘burning’ feeling when urinating, a fever and urinary incontinence.
Prostate problems in men (enlarged prostate) cause frequent and urgent urination, leading to accidental leaks of urine
Unstable Diabetes: The high blood sugar level causes nerve damage thereby increasing frequency of urination, inability to fully empty bladder, an overactive bladder, inability to ‘hold’ urine as you usually would do when you feel the urge to go and UTI.
Stroke, which can cause damage to the brain in controlling bladder and/or bowel movements or cause difficulty with walking and communicating the need to go to the bathroom.
Arthritis can lead to not reaching the bathroom in time, joint stiffness, overactive bladder and constipation
Weakened bladder and bowel muscles, which happens as a result of ageing, causes stress incontinence. These muscles are used to prevent and control urination.
Hormonal changes, for example after menopause or those who have had children, can affect the strength of the pelvic muscles and cause bladder control issues
Constipation and diarrhea, as a result of not eating a healthy diet, inability to digest food properly, and/or dehydration, can make both emptying the bladder and controlling it uncomfortable and difficult.
Sleeping pills and anxiety-reducing drugs can relax muscles of the bladder and reduce awareness or urination.
Diuretics (e.g. caffeine) could impact a person’s control over their bladder.
Sedatives impact their ability to get to the toilet.
Environment and Clothing
It is difficult to find the bathroom
The toilet seat is difficult to identify from its surroundings
The path to the bathroom is cluttered with objects and obstacles like furniture
Clothing is difficult to take off and put back on
Maintenance of continence requires mobility, dexterity, mental capacity and motivation. As the disease progresses, the person with dementia is vulnerable to developing problems in these areas. So while incontinence isn’t a result of dementia, incontinence episodes can increase as the disease progresses. Below is a list of dementia symptoms that lead to incontinence issues.
Memory loss – May not remember where the bathroom is
Difficult processing tasks – May not remember how to use the toilet properly, forgetting how to undress when they get there, or not knowing what to do with the toilet paper
Affected area of the brain controlling bladder – May not be able to hold their urine till they reach the bathroom as they can’t react quickly enough to the sensation of needing to use the toilet or even recognise the need to go the bathroom in the first place
Recognition problems – May not recognise that a toilet is a toilet or make it out as separate from its surroundings
Communication breakdown – May lose their ability to communicate the need to use the bathroom
Mobility problems – May not be able to get to the bathroom in time
Behavioural changes – May resist to use the bathroom or stay seated on the toilet till they finish
It is important to remember that incontinence is not a disease, but rather a symptom of an underlying issue that has developed during the course of dementia. There are many ways to manage incontinence and you can find these strategies in our blog on managing incontinence in dementia.