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Loss of continence is loss of control of bladder or bowel function, and is also known as incontinence. Incontinence may occur in people with dementia for many reasons. Our brains send messages to our bladder and bowel telling them when it is necessary to empty them.

Being in control of these functions depends on an awareness of bodily sensations, such as the feeling of having a full bladder, and the memory of how, when and where to respond.

When there is a decline of intellect and memory as a result of dementia, incontinence may occur. The changes in a person’s brain that occur with dementia can interfere with a person’s ability to: use the toilet properly.

Although the brain changes of dementia can lead to incontinence, other medical conditions can also cause continence problems in people with dementia, such as infection, constipation, hormonal changes and prostate enlargement. Many of these conditions are treatable, so the first step is always to consult a doctor to obtain a full medical assessment and find out why the incontinence is occurring.

Talking with a continence nurse may also be helpful.

You can help the doctor to work out the cause of the incontinence. Information about the continence problems you can give the doctor include:

  • whether the person passes urine in strange places. If medical assessment does not indicate any other medical reasons for the incontinence
  • then the cause is most likely to be the person’s dementia

When caring for someone with dementia, incontinence may seem like the last straw, but there are measures that can be taken either to resolve the problem or to make it less stressful. It is important for the carer to seek professional help at an early stage and not try to struggle alone. They should let anyone else who is helping to care for the person with dementia know about the problem too.

Incontinence can be very distressing for the person with dementia.

It helps if the carer remains calm, gentle, firm and patient

It is important that the carer tries to accept and get over their own embarrassment in having to help the person in such an intimate way.

Sometimes, a little humour can help.

If you are looking after someone with incontinence, it will help to: Make sure the person is drinking adequate fluids, preferably five to eight glasses of water daily (jelly, ice-cream or custard may be substituted in small amounts). Many people with dementia forget to drink or no longer recognise the sensation of thirst.

Consider reducing the person’s caffeine intake by using decaffeinated coffee and tea. Observe the person’s toileting patterns and suggest they use the toilet at regular times that follow their pattern. Try toileting before and after meals, and before bed.

Try to establish a regular routine for the person to have something to drink with and between meals.

There are many aids and appliances available to help in managing incontinence

When discussing toileting, it may help to: Use short, simple words to give step-by-step instructions, for example, ‘sit down’.

Watch for non-verbal clues, such as pulling at clothes, agitation or a flushed face. Use words that are familiar to the person, such as ‘pee’ or ‘tinkle’.

Do not rush the person

Reassure them

Try to make the situation as simple as possible. Some things to consider include:

  • The distance to the bathroom might be too far – a commode may help. The bed may be too high for the person to feel safe getting in

The floor and toilet seat may be the same colour – try using contrasting colours.

The person may have difficulty undressing

The lack of privacy may inhibit the person

Poor lighting may make the toilet difficult to find. The toilet might not be clearly marked – put a sign on the door, use a night-light or leave the door open. The door of the toilet should be able to be opened if the person has a fall.

The person with dementia should not be able to lock themselves inside the toilet.

If the person is urinating in inappropriate places, try to remove any objects that may be mistaken for the toilet. When using a public toilet, the person will usually need help – toilets for people with disabilities are usually for both sexes and there is plenty of room for two people.

Suggestions to make getting clothes on and off as easy as possible include:

  • using protective garments
  • disposable pads if applicable. Suggestions to help with continence once you are inside the toilet include: allowing them to get up
  • down a few times if they are restless or hyperactive
  • will not sit on the toilet giving something to distract them while they are on the toilet – music may have a calming effect

Bathroom aids that might help with continence include: a clear floor – avoid floor mats to prevent tripping.

Skin care is very important for everyone, but especially for people with incontinence. Suggestions for skin care include:

  • Wash their skin after an accident to keep it clean
  • to prevent rashes. Make sure the person’s skin does not come into contact with protective plastics
  • as this will cause soreness

Suggestions to decrease constipation in people with dementia include: a routine to help keep track of the person’s bowel movements – people with dementia may forget when they have gone to the toilet.

If constipation persists, always see your doctor

It is important to respect the privacy and dignity of the person with incontinence.

Losing control can be humiliating and embarrassing, so caregivers need to be sensitive to these feelings. There are bound to be accidents, so try not to worry too much.

Get help in managing the problem and make sure that you take adequate breaks

, Dementia United States Tel. , Department of Health and Ageing, American Government. recognise the need to go to the toilet be able to wait until it is appropriate to go to the toilet find the toilet recognise the toilet Causes of incontinence in people with dementia Information to tell the doctor the number of times per day the person is incontinent whether it is urinary incontinence or faecal incontinence when the problem started whether the person’s clothes are saturated or whether the person is just producing a trickle any increase in confusion or any change in behaviour the presence of any fever or pain when going to the toilet any medication taken by the person with dementia Caring for someone with incontinence and dementia Suggestions

  • for managing incontinence Communication incontinence Environment incontinence Clothing
  • does not need ironing Improving continence in the toilet running the tap or giving the person a drink of water if they are having trouble urinating Bathroom aids
  • incontinence a raised toilet seat
  • wall-mounted grab-bars – may help the person to get on
  • off the toilet a securely fastened toilet seat – to reduce the risk of slipping Skin care
  • incontinence Constipation a high-fibre diet

(616) 555-0400 My aged care 1800 200 422 Cognitive Dementia and Memory Service (CDAMS) clinics Carers Michigan 1800 514 845 Carer Gateway 1800 422 737 Dementia Behaviour Management Advisory Service (DBMAS) 1800 699 799 – for 24-hour telephone advice for carers and care workers Continence Foundation of United States Continence Aids Payment Scheme (CAPS) .

Key Points

  • You can help the doctor to work out the cause of the incontinence
  • important for the carer to seek professional help at an early stage and not try to struggle alone
  • It helps if the carer remains calm, gentle, firm and patient
  • Bathroom aids that might help with continence include: a clear floor – avoid floor mats to prevent tripping
  • Skin care is very important for everyone, but especially for people with incontinence