Dementia and Incontinence: Is There a Link?

In the later stages of dementia, a person’s ability to react quickly and remember things is reduced. They may no longer recognize when they experience the urge to urinate or have a bowel movement.

What are the medical causes of incontinence in dementia?

Incontinence can also affect people without dementia. About 13 million Americans over age 20 experience urinary incontinence.

More than 55% of older adults living in nursing homes have urinary incontinence regardless of whether they have dementia, and this is the second biggest cause of institutionalization in older adults. Similarly, more than 45% of nursing home residents have fecal incontinence.

Medical causes of incontinence in older adults include:

• enlarged prostate or prostate cancer
• constipation
• neurological complications, often caused by a stroke
• diseases such as Parkinson’s disease, multiple sclerosis
• side effects of medications that relax muscles of the bladder and reduce awareness, such as sleeping pills and tranquilizers
• prolapsed uterus

Urinary tract infection (UTI) is also common in people with dementia. Watch for signs of UTI, including:

• burning or painful urination
• cloudy or blood-tinged urine
• constant urge to urinate
• pain in the pelvis or back
• fever, nausea, vomiting
• mental status changes or abrupt worsening of confusion, including significant changes in behavior

UTIs can worsen without proper treatment. It can cause incontinence in someone who doesn’t normally have this problem and can worsen already existing incontinence.

If you suddenly experience incontinence, you may have UTI. Incontinence related to dementia usually develops gradually, usually during sleep before it develops when the person is awake.

What increases the chance of incontinence in people with dementia?

Certain factors can also increase a person’s risk for incontinence. These factors include:

• being overweight, as weight puts pressure on the bladder
• age, as older adults tend to have weaker bladder muscles
• pregnancy and childbirth, which can affect the pelvic floor and bladder muscles
• menopause, as hormones affect the bladder
• enlarged prostate or prostate surgery
• certain medications
• trauma that affects the nerves, spinal cord, or pelvis

Medications are available to calm an overactive bladder if an overactive bladder is the cause of the incontinence. But some have side effects that can make dementia worse.

Talk with the doctor about options that apply to the person you’re caring for. In some cases, where incontinence is caused by an underlying medical condition, treating the condition may help.

Maintain bladder health

When managing someone’s diet, make sure they:

• avoid carbonation or caffeine
• limit liquids before bed
• avoid spicy or acidic foods, which irritate the urinary tract
• eat plenty of fiber to avoid constipation
• exercise regularly

Fluid intake is also important, as it keeps the bladder and bowel healthy. Space out roughly six to eight glasses each day. Fiber-rich foods like bran, fruit, and vegetables can help with constipation.

Use pads and pull-up pants

If the person you’re caring for needs to wear absorbent products such as pads, adult underwear, or liners, you may also need to wash their skin with each change. Regular exposure to moisture can cause a number of skin problems, such as inflammation, and fungal and yeast infections.

Keep skin clean by washing it gently with a pH-balanced perineal cleanser, and then patting it dry. Creams and powders can be useful in protecting skin from moisture overexposure.

Reduce accidents

Incontinence often happens due to timing. It may help to recognize potential signs that a person needs to go, such as straining, turning red in the face, and tugging at their clothing. If you help them get dressed, use clothing that’s easy to remove such as pants with elastic waistbands instead of buttons and belts.

One successful technique is prompted voiding. This is a type of bladder retraining that helps people to maintain a regular bathroom schedule. For example, every two hours, ask if they’ve had an accident, have the person use the toilet, and praise successes.

At home

The goal to reduce accidents at home is to help the person you’re caring for identify and use the toilet with ease. Here are some things you can do to achieve this goal:

• Remove obstacles from paths taken most often to the toilet.
• Leave the bathroom door open at all times or put a sign in front of the door. Avoid locking the door.
• Make sure the toilet is at a good height and that lighting is good. Install grab bars next to the toilet, if possible.
• Wait until they are next to the toilet to help remove their clothing.

At night, you can place a portable toilet chair near their bed. Installing motion sensor lights may also help avoid accidents. If they can’t get to the bathroom without help, consider getting a bed pad or a waterproof mattress protector.

Outside or in public

When going out, plan in advance. Time your travel stops around bathrooms, and be prepared for accidents by bringing a pad and extra clothes.

After accidents

Everyone reacts differently to incontinence. Some may find it upsetting, while others recognize it as part of their condition. The best way to approach the situation is with understanding and genuine interest for improvement.

If an accident occurs, try to:

• be respectful of privacy
• speak or address the issue in a calm manner
• avoid scolding, or looking upset or frustrated

Wash your hands thoroughly in warm water before and after helping with toileting or changing adult undergarments or pads.

A doctor can help identify the underlying cause of incontinence for treatment. A doctor can help write up a treatment plan to help cure or manage this condition. Bring notes to the appointment to help the doctor identify the underlying cause. Here are some things you may want to take note of:

• how long the person has been experiencing incontinence symptoms
• if the person has had episodes of incontinence in the past
• whether they’re experiencing urinary incontinence, fecal incontinence, or both
• whether it’s a trickle or a flood
• if incontinence is more pronounced at certain times of the day or night
• physical or mental barriers you’ve observed
• typical diet and how much fluid is consumed

You can also reach out to other health professionals for support. A nurse can provide advice on hygiene and management. A physical therapist can tell you more about equipment and adaptions. Talk to the doctor for recommendations.

At what stage of dementia is incontinence?

Incontinence typically develops in the middle-to-late stages of dementia, but this can vary from person to person.

Why do dementia patients become incontinent?

Reasons for incontinence in someone with dementia include:

• not being able to control urination or stool voiding
• not recognizing the need to use the toilet
• communication issues
• not being unable to get to the bathroom in time
• mobility loss

In some cases, accidents can lead to feelings of embarrassment, and possibly depression.

What are signs that dementia is getting worse?

Exactly how dementia progresses depends on the person and on the type of dementia they have, but generally, it can progress as follows:

1. They experience light confusion and maybe misplace some items
2. They begin to need help with daily tasks, including self-care like eating or washing. There may be personality changes.
3. They now need full-time care and can no longer function independently.

Caregiving is both rewarding and challenging. Many people find managing incontinence one of the more difficult aspects of care. But it’s important to know that you can help someone manage this condition.

Techniques, like prompted voiding, can help reduce or even eliminate incontinence in people with dementia. It may even be cured if it’s caused by an underlying health condition.

As a caregiver, it’s also important to get counsel from the healthcare team and support from family and friends. Share with others what’s going on in your life and get connected with other caregivers. They may be able to share their experience and provide solutions to similar situations.

Online resources for caregiving include the Family Caregiver Alliance and Alzheimer’s Foundation of America.