Talking about continence issues can be a challenge for both you and the person you are caring for. We understand that probably neither of you had to describe such problems before and it can be an embarrassing and often stigmatised subject. However it is important that you speak about it, because incontinence can impact the health and wellbeing of both you and the person living with dementia. This article is here to help you identify continence issues so you can share them with your doctor and an intervention in place as early as possible.
What is incontinence?
Incontinence refers to any accidental or involuntary loss of urine from the bladder (urinary incontinence) or bowel movement (bowel incontinence).
1. Urinary incontinence
The severity of urinary continence ranges from a small occasional leak of urine to complete loss of one’s bladder contents. The severity is dependent on the stage of dementia and the symptoms the person is experiencing. For example, memory loss, confusion and mobility issues can contribute to incontinence. There are many different types of urinary incontinence, which also varies from person to person. One of the most common types associated with dementia is an overactive bladder. This causes people to feel a sudden and urgent need to urinate. It could also cause someone to urinate frequently. Another type, that women are more likely to experience, is called stress incontinence. This is when a cough, sneeze or laugh causes a small leak of urine.
2. Bowel incontinence
Bowel incontinence is the difficulty in controlling one’s bowel. The severity of this can range from passing wind and staining one’s underwear to complete loss of bowel movements. This type of incontinence is less common than urinary incontinence.
What are the signs of incontinence?
Someone experiencing incontinence may frequently change their clothes or bedding. They may start to hide or throw away dirty clothes or bedding. This could indicate they aren’t recognising the need to go to the bathroom or aren’t able to get to the toilet in time.
The person with dementia might start to refuse to shower and change clothes, which could indicate problems with personal hygiene.
They might go to the bathroom when they need to, but struggle to remember what to do once they reach the bathroom. You might find that they tried to clean up, indicated by dirty towels in the bathroom.
If they become confused when going to the bathroom, they may go to the toilet in inappropriate places like a wastepaper bin or the corner of the room.
The person with dementia might stop drinking liquids to avoid needing to go to the bathroom as they realise it’s too difficult or they aren’t doing it right.
They might experience skin irritation and damage. Dermatitis and pressure ulcers are common physical consequences of incontinence.
What is the impact of incontinence?
Change in relationship – Whether you are the spouse, child or relative, supporting the person with continence, care can be uncomfortable for both parties. The person with dementia starts to lose their privacy while carers may feel they are crossing a line they didn’t think they would have to.
Sleeping issues – Both the carer and the person being cared for can struggle with getting adequate sleep at night due to frequent continence issues
Social isolation – The person experiencing incontinence may be embarrassed and reluctant to go outside and meet family and friends or have them over in case they have an accident.
Financial cost – Continence care can be linked to increasing costs of laundry and cleaning, adaptations to the home, and/or incontinence products.
Institutionalisation – Severe incontinence issues can result in the person with dementia being transferred to a care home which is both an emotional and financial strain on the family.
All of this ultimately impacts the family’s quality of life. Therefore, as mentioned above, it is important to intervene as early as possible. To help you understand potential causes of incontinence, read our next blog. The more information you are able to share with your doctor or your team of healthcare professionals, the better they can support you.
Who can help?
Incontinence care can sometimes become overwhelming, but know that you are not alone. There are sources of support that are available to help you and the person you are caring for. They can help you better manage care. Here are a few starting points:
Your Doctor: They will conduct a continence assessment to determine an appropriate care plan. This includes answering questions like frequency and quantity of urination, number of accidents, bowel movements, fluid and diet intake, their level of independence, current medications, and comorbidities.
Community continence advisors or nurses: They have specialised training in continence care. They are able to do home visits, assess incontinence and advise on its treatment and management.
Continence physiotherapists: They have specialised training in pelvic floor rehabilitation. They work with the person being cared for and assist them to use their pelvic floor muscles correctly.
Occupational therapists: They can assess an individual’s abilities in a holistic manner, including mobility, brain functions, environment, clothing, and carer difficulties. Based on their assessment, they can recommend products and tips to support with continence care.
Find out more on how to manage incontinence in our blog.