Over 55 million people are affected by dementia worldwide and while it’s not a normal part of aging, it’s most common in people 65 and over. Dementia is an umbrella term for various progressive and irreversible neurological conditions that are characterised by a gradual decline in cognitive function. This includes memory, thinking, reasoning and behavioural changes, impacting a person’s ability to live independently.
Early on when someone is experiencing dementia, complex tasks become more difficult. These are things like managing finances, paying bills, driving, cooking and keeping up to date with appointments.
As dementia progresses personal care becomes compromised with things like showering, using the toilet, dressing and grooming requiring assistance. Communication is challenged with people not being able to remember friends or family and finding the right words to follow conversations. People with dementia may also become disoriented in familiar places leading to wandering.
As dementia, in its later stages, can impact toileting and personal care, incontinence is likely to occur. In fact, incontinence rates in people with dementia are reported to be significantly higher (up to 50% or more) than those without dementia.
As a carer, it’s essential that the care you provide to your care recipients that have dementia prioritises dignity, comfort and emotional care. Reducing anxiety and agitation and focusing on empathy, without treating the care you provide like a task, is necessary for people with dementia.
Causes of Incontinence in Dementia
Incontinence in dementia patients can be caused by a number of factors, including certain medications, physical or medical conditions, stress, or not being able to recognise or find the bathroom. If a person with dementia suddenly starts experiencing incontinence, consulting with a health care professional to determine the possible cause is important.
For people with dementia, the loss of bladder control is likely inevitable with time, but several things can be done to help the dementia patient remain independent and maintain a high quality of life for as long as possible.
A thorough check of medications by a health care professional can determine if medications or diet are causing incontinence, or perhaps making it worse. Sleeping pills and anxiety-reducing drugs may relax the bladder muscles, while certain beverages can irritate the bladder. Medical conditions such as urinary tract infections, prostate problems or diabetes may be making incontinence symptoms worse.
Types of Incontinence in Dementia
Incontinence in dementia generally develops in the later stages of dementia with about 50% of people experiencing urinary or faecal incontinence. There are many types of incontinence that can occur in people with dementia.
Functional incontinence
Functional Incontinence is the result of being unable to retain urine due to an alternate health condition. The health conditions that can cause Functional Incontinence are psychological or physical conditions that make it difficult to reach the toilet.
Urge incontinence
Urge incontinence involves a sudden, intense need to urinate. This can sometimes be caused by nervous disorders, certain medications, alcohol, or menopause, which weakens pelvic floor muscles.
Overflow incontinence
Overflow or Drip Incontinence describes a person's inability to completely empty their bladder due to an obstruction and, as a result, can cause urine leakage.
Faecal incontinence
Bowel incontinence, or fecal incontinence, involves unintentional stool loss and can result from conditions like weakened anal muscles, constipation, or prolapse.
Effective Management Strategies for Incontinence in Dementia Patients
Managing incontinence in people living with dementia requires patience, consistency, and a supportive environment. As dementia progresses, individuals may struggle to recognise the urge to use the toilet, remember where the bathroom is, or communicate their needs. Effective management focuses on maintaining dignity, reducing distress, and supporting both the person and their caregivers.
Establish a Routine
Creating a consistent toileting routine can significantly reduce incontinence episodes. Caregivers can encourage bathroom visits at regular intervals throughout the day — such as after waking, after meals, and before bedtime. Scheduled toileting helps compensate for the reduced ability to recognise bodily signals that often occurs with dementia. Keeping routines predictable also helps the person feel more secure and reduces anxiety around toileting.
Environmental Modifications
Adapting the home environment can make it easier for people with dementia to find and use the bathroom independently. Clear signage on bathroom doors, leaving the door open or well-lit at night, and ensuring a clear pathway to the toilet can help reduce confusion. Clothing that is easy to remove, such as elastic waistbands, can also prevent accidents when urgency occurs.
Use of Continence Products and Aids
Continence products and assistive devices can provide practical support while maintaining comfort and dignity. Absorbent pads, protective underwear, mattress protectors, and bed pads can help manage leaks and protect bedding and furniture. For individuals with mobility challenges, aids such as commodes, raised toilet seats, or grab rails can make toileting safer and more accessible.
Promote Hygiene and Skin Health
Good hygiene practices are essential to prevent skin irritation, infections, and discomfort. After any episode of incontinence, the skin should be gently cleansed and thoroughly dried. Barrier creams and skin protection products can help reduce moisture-related skin damage. Regular skin checks are also important to identify early signs of redness, irritation, or pressure injuries.
Encourage Hydration and Nutrition
While it may seem logical to limit fluids to prevent accidents, restricting hydration can worsen bladder irritation and increase the risk of urinary tract infections and constipation. Encouraging regular fluid intake throughout the day supports bladder care and overall wellbeing. A balanced diet rich in fibre can also help prevent constipation, which can contribute to bladder control issues.
Pelvic Floor Training
Pelvic floor exercises can help strengthen the muscles that support bladder control. In the early stages of dementia, individuals may still be able to follow guided exercises with support from healthcare professionals or caregivers. Strengthening these muscles can improve continence and reduce the frequency of leaks.
Behavioural and Emotional Support
Incontinence can be distressing or embarrassing for individuals with dementia. Providing reassurance, maintaining privacy, and avoiding blame are important aspects of care. Caregivers should approach accidents calmly and respectfully to help preserve the person’s dignity and self-esteem. Emotional support and clear communication can help reduce anxiety and create a more positive caregiving environment.
Guidance and Support for Carers and Caregivers
Navigating the special care needs of your care recipient with dementia and incontinence is difficult and time consuming. Continence care takes up a great deal of effort and care when it comes to overall care for a dementia patient.
Poorly managed continence care affects overall health and creates extra work load in the form of laundry, washing, bathing and changing clothes. All of these activities can be stressful for someone with dementia, who, depending on the progression of their illness, may either be embarrassed or stressed about the situation, or may not understand why they have to be bathed by a stranger.
If a patient uses incontinence products, minimising the amount of product changes while still avoiding leaks can be a major challenge. It's important to choose the right incontinence product and take the condition into account when choosing.
Developing an individual routine, based on the continence pattern, progression of dementia and overall health of your care recipient, is essential for good continence care. For some, a toileting program may be recommended, with automatic reminders and timetables to prompt a visit to the toilet or changing of an incontinence product.
When to Seek Professional Help
Incontinence is common in people with dementia, but certain symptoms may indicate complications that require medical attention. Caregivers should seek professional advice if there are signs of urinary tract infections (UTIs), such as sudden confusion, fever, pain during urination, strong-smelling urine or frequent urges to urinate. It is also important to watch for skin problems like persistent redness, rashes, sores or broken skin caused by prolonged moisture.
If incontinence becomes difficult to manage, a healthcare professional may refer the person to specialists such as continence nurses, geriatricians, or occupational therapists. These professionals can assess possible underlying causes, recommend treatment options and suggest home modifications or assistive aids to make toileting safer and more manageable.
Conclusion
Managing incontinence in dementia requires understanding, patience, and a compassionate approach. By recognising the possible causes, identifying the type of incontinence, and implementing practical management strategies, carers can help reduce discomfort and maintain dignity for the person living with dementia. Consistent routines, supportive environments, and the appropriate use of incontinence products can make daily care more manageable and improve overall quality of life.
While incontinence can be challenging, approaching care with empathy and respect can make a meaningful difference for both the person with dementia and their caregiver. Seeking guidance from healthcare professionals and connecting with support networks can also provide reassurance, practical advice, and encouragement along the way. With patience and the right support, it is possible to create a caring environment that promotes comfort, dignity, and wellbeing.
Sources
Better Health Channel. (n.d.). Dementia and continence issues. Victorian Government. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dementia-continence-issues
National Institute on Aging. (n.d.). Urinary incontinence in older adults. U.S. Department of Health and Human Services. https://www.nia.nih.gov/health/bladder-health-and-incontinence/urinary-incontinence-older-adults
National Institute on Aging. (n.d.). What is dementia? Symptoms, types, and diagnosis. U.S. Department of Health and Human Services. https://www.nia.nih.gov/health/alzheimers-and-dementia/what-dementia-symptoms-types-and-diagnosis
New Hampshire Dementia Training Initiative. (2023, January 11). Dementia effects on activities of daily living (ADLs). https://nhdementiatraining.org/2023/01/11/dementia-effects-on-activities-of-daily-living-adls/
Dementia Australia. (n.d.). Continence and dementia. https://www.dementia.org.au/living-dementia/home-life/continence
Continence Health Australia. (n.d.). Dementia and bladder and bowel control. https://www.continence.org.au/information-incontinence-english/dementia-and-bladder-and-bowel-control