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Dementia and Urinary Incontinence
Why do people with dementia experience bladder control problems?
People with dementia suffer memory loss and may be confused and disoriented. This can cause a breakdown in the mechanisms necessary for bladder control.
Dementia causes changes in the brain which may interfere with the person's ability to:
- recognise the need to pass urine;
- 'hold on' until they get to the toilet;
- find the toilet;
- recognise when the bladder is completely emptied; and
- adjust clothing appropriately.
Incontinence may develop or worsen in unfamiliar surroundings, or during episodes of depression, anxiety or stress.
People with dementia, just like other adults, are susceptible to other causes of incontinence such as urinary tract infection, constipation, senile vaginitis (vaginal irritation after menopause), an enlarged prostate gland or side effects of certain medications.
Can anything be done for dementia suffered with incontinence?
YES. While their dementia may prevent them from participating in some treatments, much may be possible to ensure maximum comfort and dignity.
Seek help from their local doctor who may be able to treat them directly or will refer them onto a continence advisor for a continence assessment. (See back of this leaflet for details of continence resources and services available.)
What will the assessment include?
Assessment includes a physical examination and a record of relevant information, for example, the person may:
- forget to take down clothes when going to the toilet;
- have difficulty in finding the toilet;
- urinate in inappropriate places;
- pass urine more often than usual;
- saturate clothing/bedding without warning;
- wet on standing up from a chair or bed; or
- suffer from constipation, diarrhoea or faecal incontinence.
It is often necessary to rely on the carer to provide this important information and to record bladder and bowel function, that is:
- What time the person goes to the toilet and/or wets.
- How wet the person is, for example:
minor = dampens underpants;
moderate = wets through to skirts/pants
severe = floods chair/floor/bed.
- How often they open their bowels.
What can be done to minimise the episodes of incontinence and maintain the person's dignity?
Underlying conditions such as urinary tract infection, constipation or senile vaginitis often respond to treatment and the incontinence may possibly subside.
In some situations, medications may help, but they can also worsen incontinence and increase confusion. Therefore medications must be closely monitored and stopped if any side effects occur.
Where possible, encourage the person to drink six to eight glasses of fluids a day, unless otherwise advised by their doctor. This helps to prevent urinary tract infection and constipation and to maintain good bladder health. Avoid excessive amounts of coffee, tea and cola as the caffeine in these drinks can irritate the bladder and can cause frequency and urgency to urinate.
Maintain regular bowel habits and prevent/treat constipation.
Ask or remind the person to use the toilet at regular intervals - at the times when they usually need to go or before they are likely to be wet.
If the person is no longer able to recognise the need to use the toilet then take the person to the toilet at regular intervals. This may be every 2 to 3 hours, depending on how much they drink and their wetting pattern. It may be necessary to stay with them to help them and remind them why they are there. Frequent toileting (for example, hourly) is not encouraged.
Adjust clothing, if appropriate, to make it easier for the person to manage, for example, velcro fastening instead of zips and buttons. Easy to manage clothing such as tracksuits may make undressing easier.
Keep the way to the toilet clear and free of clutter and use a night-light if required. Make the toilet door easily identifiable.
Whilst the above may not overcome the incontinence, they may reduce the incidence of severity of the problem. Quality of life of the person and the carer may also be improved by the use of incontinence aids such as pads and pants. It may be possible to receive some financial assistance with the cost of incontinence aids. Advice on eligibility and types of aids available can be sought from the National Continence
Consider utilising community resources to assist with the demands of caring for a person with dementia, such as laundry, shopping, etc. Services such as Home Help or District Nursing may be available in the local area.
Consult their doctor, continence advisor, community health nurse or Aged Care Assessment Services if this could help.
Can medication be helpful in treating the person with dementia and incontinence?
In the first instance, the person's doctor should review all medications being taken as some of these may actually be causing or aggravating the incontinence.
In some cases, medications can be prescribed by their doctor to help them overcome their incontinence, for example:
- Antibiotics may be prescribed to treat a recognised urinary tract infection.
- Hormonal replacement therapy (tablets, patches or vaginal creams) may help post-menopausal women by reducing frequency and urgency to urinate.
- Bladder relaxant tablets may be given to settle at irritable bladder down, improve its capacity and therefore reduce the urgency and frequency of going to the toilet.
- Tablets may occasionally be given to help the person pass urine when there is a blockage at the base of the bladder or in their uretha.
BEWARE that these medications may produce side-effects such as a dry mouth, constipation, impaired balance and lethargy. In the person with dementia there is also a risk of increased confusion. Medication use requires careful professional monitoring.
Where can help be found?
There are many health professionals qualified to assist you with bladder control problems. You may seek assistance from your doctor who may offer treatment directly or refer you to a specialist, or to a qualified continence advisor. You may also seek help and obtain information directly from the following sources:
- National Helpline 1800 330 066
- Continence services and clinics.
- Continence Nurse Advisors.
- Local Community Health Centres.
- Local Doctors.
- Domiciliary Nursing Services.
- Independent Living Centres.
- Continence Foundation of Australia.
- Australian Physiotherapy Association in your state (see telephone book)
East Valley Division General Practice, Victoria,
Level 1, Pathology Building, Repatriation Campus, A&RMC,
Heidelberg West VIC 3081. .. map
Phone: 03 9496 4333, Fax: 03 9496 4349, Email: firstname.lastname@example.org,
Please note: NEVDGP does not provide
an on-line consultation