Incontinence

What is incontinence?

Incontinence is when someone can no longer control their bladder and/or bowels. People with dementia may suffer from incontinence because the changes in their brains can stop them being able to:

  • recognise when they need to go to the toilet
  • wait until they reach the toilet
  • find the toilet
  • recognise the toilet and know what to do when they get there.

Or, just like any other adult, they might have other health problems, too, such as infections, constipation, hormonal changes and prostate issues, which might make them incontinent. If a person with dementia is starting to be incontinent, have them assessed by their doctor to find out why.

 

 information for the doctor

When you do see their doctor, it’s useful for them to know the following:

  • How often the person is incontinent?
  • Are they having trouble controlling their bowels, bladder, or both?
  • When did the problem start?
  • How bad is the problem – do their clothes become saturated or is there just a dribble?
  • Has there been an increase in confusion or any other change in behaviour?
  • Are they going to the toilet in strange places? Do they seem to be confused about where it’s appropriate to urinate?
  • Any other symptoms – has the person had a fever or appear to find going to the toilet painful?
  • Any other medication they are taking.  

If no other medical reason can be found for the incontinence, then the cause is most likely to be their dementia.

 caring for someone with incontinence

No-one likes dealing with incontinence and it’s already a tough job caring for someone with dementia. You don’t have to struggle on alone as there is help available for you – just ask your doctor or your local Alzheimers organisation who can help.  

But while you are dealing with these situations, it’s helpful if you can remain calm and patient and try to control any embarrassment about having to help them in such an intimate way. It’s embarrassing for them, too, and sometimes a little humour can help!

 suggestions for managing incontinence

  • Think about reducing their caffeine intake by using decaffeinated coffee and tea – remember that caffeine makes you go to the toilet more often.
  • Make a note of when they usually go to the toilet, then suggest they go at those times if they haven’t already gone.
  • Watch for non-verbal clues, such as pulling at their clothes, agitation, or a flushed face.
  • Use words that are familiar to the person, such as “pee” or “tinkle” to prompt them.
  • If they have forgotten how to go to the toilet, use short, simple words to give instructions step by step.
  • Using public toilets can be confusing and they will probably need help – disability toilets are usually for both sexes and there’s plenty of room for two.

Aids, appliances and good clothing choices can also help manage incontinence:

  • Install a raised toilet seat and grab-rails on the wall to help the person get on and off the toilet.
  • Make sure the seat is fastened securely to the toilet so it won’t slip around.
  • Floor mats can be a trip hazard, so don’t use them if you can avoid them.
  • Have them wear simple clothing – use Velcro tape instead of buttons or zippers.
  • Try elastic waistbands for trousers or wrap-around skirts.
  • Use washable clothing that doesn’t need ironing.
  • Using protective clothing, such as waterproof underwear, and disposable pads might also help.

 in the toilet

  • If the person is having trouble urinating, try giving them a drink of water or running the tap.
  • If they are restless or hyperactive and won’t sit on the toilet, let them get up and down a few times – you could also try playing calming music or doing something to distract them while they sit.

 skincare

It’s very important to care carefully for the skin of someone with incontinence to stop rashes or irritations.

Take care to:

  • wash the skin after any accidents
  • use special soaps or skin creams if needed – ask a pharmacist for help
  • make sure their skin isn’t next to protective plastics because this can cause soreness.

 constipation

Constipation can be another common problem for people with dementia.

To avoid constipation try:

  • making sure they are eating a high-fibre diet (plenty of vegetable, fruit and wholegrains) and drinking at least six to eight glasses of water a day
  • keeping them physically active
  • keeping track of when they go to the toilet – people with dementia might forget that they have gone.

See their doctor if the constipation is ongoing, as there’s plenty of treatment available.

Issues around toileting can be humiliating and embarrassing, and it’s not nice for anyone. Remember to respect their privacy and dignity and be sensitive to their feelings. Accidents are bound to happen, so try not to worry too much. Get help to manage if you need it and make sure you get a break.

 

There is help available for you as you care for someone with dementia, contact your local Alzheimers organisation for more information.