Incontinence and dementia

Many people with dementia also experience urinary incontinence. In fact, a person who has dementia will almost always suffer from urinary incontinence as the dementia progresses.

Dementia can cause a noticeable decline of brain function, such as loss of memory, which can lead to urinary incontinence.

The number of people with urinary incontinence is known to be much higher among dementia sufferers. This is not unexpected because a decline in brain function can delay or confuse the messages that our brain sends to our bladder, telling us when it is necessary to go to the washroom. The loss of bladder control in dementia is often the result of being unaware of the sensations to urinate, lacking the memory of what do when these sensations are felt, not recognizing the toilet or when it is appropriate to urinate, or a combination of these factors.

Although dementia could be the underlying reason for urinary incontinence, people with dementia are also at risk for common causes of urinary incontinence that can affect all of us. If you are caring for someone who has dementia, make certain you tell their doctor about their urinary incontinence so all other causes can be ruled out. These include urinary tract infections, constipation, hormonal changes, and prostate enlargement to name a few. The underlying cause of the urinary incontinence may be easily treatable.

When talking to the doctor, be prepared to describe the behaviours associated with the incontinence of the person you're caring for. Use the following questions as a guide.

  • Do they make an attempt to go to a washroom, or do they wet themselves in strange places?
  • How often are they incontinent?
  • How much urine do they pass, just a trickle or are they soaked?
  • When did the problem start?
  • Are they constipated?
  • How much fluid are they drinking?
  • Are they taking any medication?
  • Have you noticed any changes in behaviour such as increased confusion, memory loss, or agitation?
  • What is their mobility? How fast can they get to a washroom if needed? How far is the nearest washroom in their home setting?

Once the doctor has done a full evaluation, if they can find no other cause, then urinary incontinence is most likely related to the person's dementia. Talk to the doctor about strategies that help you manage urinary incontinence in dementia. Some tips include:

  • Monitor what and how much they drink. People with dementia may not recognize the sensation of thirst, so make sure they don't get to much or too little fluids.
  • Reduce their caffeine intake.
  • Keep their diet rich with fibre to avoid constipation.
  • Try and keep a regular schedule of going to the toilet, especially after meals, when they wake up, and before they go to bed.
  • Use absorbent products if necessary to avoid accidents.
  • Learn if they are giving you clues when they need to go to the washroom, such as pulling at clothes, agitation, or a flushed face.

It is important to remember that incontinence can be very distressing and embarrassing for a person with dementia, so it is important to respect their privacy and dignity. Accept that there will be accidents, have patience, do not rush them, be reassuring, and stay calm.

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