General Tips: Dementia and Incontinence

A study by the National Association for Continence concluded that a shocking one in five individuals over the age of 40 suffer from an overactive bladder. It is estimated that urinary incontinence is up to 4 times more common in those with Dementia than those without Dementia.

A diagnosis of Dementia should not exclude people from access to treatment, as knowing how to treat the person with incontinence can rapidly increase their quality of life. We have researched and put together the most efficient ways you can help a person with Dementia to deal with incontinence.

Why is Incontinence a common Symptom of Dementia?

Incontinence in Dementia is often due to the multifunctional breakdown in the integrity of compensating mechanisms for the physiological changes in the ageing urological system.

People are not simply born with the knowledge of how to manage continence. Continence is a skill that is acquired and retained during childhood. The main causes of incontinence in people with Dementia include functional difficulties, defined by cognitive or physical impairment, psychological conditions associated with the unwillingness to use the toilet, the presence of physical barriers, or simply the lack of available care. Complications such as the inability to recognise the need to use the restroom and forgetting where the bathroom is located are common problems that can make incontinence worse for people with Dementia.

How can you deliver effective continence care for someone with Dementia?

Looking after someone with Dementia and incontinence requires more than simply providing the person with the correct pads and pants. It is important to understand that every individual and their circumstances are different. As June Andrews, director of Dementia’s Services Development in Stirling states, “both the patient and the home environment need to be assessed.” In order to effectively improve the quality of life for someone suffering from Dementia and Incontinence, it is vital to consider everything from the ways you can improve the person’s living environment to how you can make the person affected feel accepted and supported. Independence, comfort and dignity are the three important priorities to maintain for a person with Dementia and Incontinence.

Making the Home Incontinence Friendly

Often, a person with Dementia can have trouble reaching the toilet due to awkwardly placed furniture or doors which can be difficult to open. The addition of helpful toilet aids and small changes in the home can go a long way in allowing the bathroom to be more easily accessible.

If a loved one or someone you know who has Dementia finds the process of going to the bathroom in their home a difficult process, you may want to try the following toilet aids and tips to improve this.

1. Invest in wall rail aids- Wall rail aids can increase the safety of going to the toilet and prevent the incontinent person from falling or sliding during a toilet visit. The addition of wall rail aids can provide a person with Dementia with more confidence and assurance if fear of danger or an accident is preventing them from going to the toilet successfully.
2. Leave the toilet doors open- Many people with Dementia can often struggle with opening doors and working locks. In order to prevent any accidents such as the person locking themselves in the bathroom, ensure all of the doors are kept open and are easily accessible. Remove any locks on doors which are not easy to use or are likely to cause problems for the incontinent person.
3. Use Bright Contrasting Toilet Aids - People with Dementia can often get confused and find it hard to remember where the toilet is. A dementia-friendly bathroom is one where simple yet careful consideration of design can reduce the barriers that people with Dementia can face in carrying out daily living activities, greatly improving their safety and preserving their independence for as long as possible. Bright contrasting coloured toilet seats can remind people with cognitive loss of the purpose of the toilet and bathroom. This change can lower confusion and distress when visiting the toilet. This can also lower the chance of "accidents" in the bathroom or around the home. Brightly coloured toilet aid frames are also useful in ensuring maximum safety, support and familiarity for people with Dementia. Consider choosing a colour such as white, blue or red for a toilet frame which can be easily remembered and located. We offer red and blue prominent toilet seats, toilet aid frames and seat risers which stand out in any bathroom. Visit our Toilet Aids Section on our website here.
4. Invest in Door Signs- Often people with Dementia do not know which door is the toilet door, or the route to the toilet is cluttered. Putting a sign on the toilet door which includes a clear symbol and the name of the room can be helpful to provide clear guidance.

Planning Ahead

Although making adjustments to the home can be effective, it is incredibly important to be pro-active and prepared for an accident. Incontinence accidents can be unexpected, therefore outlining a pattern of how often the incontinent person uses the bathroom can be extremely useful in reducing the number of accidents that occur.

Keeping a bladder diary for the incontinent person or allowing them to keep their own bladder diary can be a useful way to find a pattern in which accidents occur. For more information and an accessible template for bladder diaries, visit our blog post on bladder diaries.

Considering the emotional impact of incontinence

The World Alzheimer Report (Alzheimer’s Disease International, 2012) claims incontinence can be “embarrassing” to family members, who “isolate themselves and the relative with dementia to avoid having to expose themselves to the reactions they anticipate from those outside the family”. There are a number of things you can do to help someone suffering from Dementia to feel supported and accepted, reducing the risk of isolation.

Small changes can include praising your loved one for successful toilet visits. The charity organisation Dementia Care Central advise, “it is usually easier to encourage good toilet behaviour by praising loved ones after successful trips to the bathroom.”

Additional factors to consider

Although cognitive impairment is a contributing reason as to why people with Dementia develop incontinence, there are other factors you may want to consider which may be treated fairly easily.

Additional reasons the person with Dementia can develop incontinence may include:

• Urinary Tract Infections.Urinary Tract Infections are common infections that can affect the bladder, the kidneys and the tubes connected to them. Lower urinary tract symptoms (LUTS) are common in men and women as they get older.

Symptoms of a Urinary Tract Infection include:

• An urgent or frequent need to go to the toilet, or feeling like you need to go straight after you've just been.

• Problems with passing urine, such as a slow stream of urine, straining to pass urine, or stopping and starting as you pass urine.

• Problems after you've passed urine, such as feeling that you've not completely emptied your bladder or passing a few drops of urine after you think you've finished.

• Constipation: If the person with dementia has constipation, laxatives might be able to help. Laxatives are a type of medication designed to relieve constipation and are widely available over the counter. However, they should not be used for more than a week without seeking advice from a GP or pharmacist, as the symptoms may be masking another condition.

• Prolapse. Pelvic floor muscles hold up your pelvic organs from below. If the fascia or ligaments are torn or stretched for any reason, and if your pelvic floor muscles are weak, then your pelvic organs might not be held in their right place and they may bulge or sag down. This can cause someone’s bladder to become weak and result in a lack of control over the bladder.

• Medication effects. It is vital to stop and consider whether certain medication the person is taking may be worsening their incontinence. As physiotherapist Sue Croft states, “many medications can be the culprit of urinary incontinence, so it’s always important to record them and check if they are contributing to urinary leakage”.