Caregiving Issues

Caring for Dementia Patients with Urinary Incontinence

Caring for a loved one with dementia can be challenging, especially when it comes to managing incontinence and prolapse. In this article, we provide tips and resources for caregivers to find the best solution for their loved one's needs.

Diane Carbo

07 Nov 2023 — 7 min read

Dementia Patients' Needs: Dealing with Incontinence and Prolapse

Caring for Dementia Patients Incontinence or prolapse…

Dementia often leads to a decline in cognitive function, which can result in various challenges for caregivers. One of the most distressing issues is urinary incontinence, which can significantly impact the quality of life for both patients and their caregivers.

Lesions in the spinal cord can impact neural networks that control bladder function, contributing to urinary incontinence in dementia patients.

Understanding Dementia and Incontinence

Dementia is a progressive neurological disorder that affects memory, thinking, and behavior. As the disease advances, people with dementia may experience a range of physical and cognitive symptoms, including incontinence. Incontinence is a common issue in people with dementia, affecting up to 90% of those living in care homes. It can be caused by a combination of factors, including cognitive impairment, physical limitations, and medical conditions.

Urinary incontinence is the loss of bladder control, resulting in the involuntary leakage of urine. Faecal incontinence is the loss of bowel control, resulting in the involuntary leakage of faeces. Functional incontinence is incontinence caused by a physical or cognitive impairment that prevents a person from reaching the toilet in time. Understanding these different types of incontinence can help caregivers provide better support and care for their loved ones.

Caring for Dementia Patients Incontinence or prolapse…

There are many challenges people with dementia face. It is a learning experience for the person living with it and the people who care for them.

The Centers for Disease Control estimates that more than a quarter of all caregivers of someone 50 or older provide help for a person suffering some sort of dementia, cognitive impairment, or disorder like Alzheimer’s disease. Along the way, the caregiver may have to discover how to help a person with several medical conditions, including urinary incontinence, which can be associated with Alzheimer's disease due to lesions in the cholinergic pathways disrupting the micturition reflex.

Dementia patients with incontinence may be one of those conditions.

There are a number of reasons why someone could become incontinent. Many women suffer from relatively common conditions like Pelvic Organ Prolapse. Or Stress Urinary Incontinence. That may make this a bigger issue if their dementia worsens.

More on Caring for Dementia Patients Incontinence or Prolapse …

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Have more questions? Check out the Frequently Asked Question section of the website. You will find a lot of different questions answered directly.

Pelvic Organ Prolapse occurs when the pelvic floor muscles become weak and allow the bladder or uterus to drop and sink into the vagina.

A variety of factors contribute to prolapse:

Childbirth
Menopause
Extra body weight
Chronic coughing

Stress Urinary Incontinence is a condition when people release urine during physical activities like coughing, sneezing, laughing, and exercise. This is the most common type of incontinence in women and can occur due to similar reasons to prolapse (like age and childbirth).

Treatment for prolapse and incontinence is based on the severity of the condition.

There are non-surgical solutions, including exercises and a small device called a pessary. This device is inserted into the vagina to support prolapsed organs.

There are also surgical options, including one very controversial treatment.

Transvaginal mesh implants. These implants are surgically inserted through the vagina. They are to support the pelvic organs. Unfortunately, these implants have been linked to serious complications. They are the subject of more than 20,000 lawsuits. Women report intense pain and internal damage. The mesh can cut through tissues and even organs.

Women who may be experiencing issues with incontinence or prolapse may want to see a urogynecologist. That is a doctor who is trained to treat pelvic floor disorders.

More on Caring for dementia patients Incontinence or prolapse

Caregivers Need a Plan to Manage Incontinence Issues

Incontinence is a common problem with people with dementia. It’s important to stress that it is not a symptom of dementia.

The effects of incontinence are actually pretty manageable until the very late stages. Fecal incontinence typically appears in the mid to late stages of dementia.

It is important for a caregiver to come up with a plan for the person they are caring for and determine how they will react if certain situations occur. Finding the balance between being a caregiver and allowing the patient to maintain a certain level of dignity may be tough. Some of the basic ways experts recommend finding that balance include:

Help the patient feel less embarrassed about incidents. Don’t scold them or make them feel guilty when it occurs.
Respect their privacy and comfort. It may involve providing waterproof bedding or incontinence padding and pants.
Do not withhold fluids. This could make matters worse by causing dehydration or a urinary tract infection. Learn how to manage the issue instead — like limiting fluids before bedtime.
If an incident occurs, it’s important to act quickly to help the person clean up and get comfortable again.

In the later stages of dementia, a person's ability to react and remember diminishes significantly, impacting their recognition of bodily urges such as the need to urinate or have a bowel movement.

Some caregivers may have a hard time dealing with incontinence. If the caregiver’s concerns begin to affect their relationship with their family member, they may need to seek advice from someone specifically trained to deal with incontinence issues. This could be an NP in the urologist office or a pelvic floor Physical therapist.

There are plenty of resources that can help you deal with the incontinence issues. These can help you with the proper information on techniques and supplies to provide meaningful care for a person with dementia.

Additional Care Considerations

Managing incontinence in people with dementia requires a comprehensive approach that addresses the physical, emotional, and social needs of the individual. Here are some additional care considerations:

Encourage the person with dementia to drink fluids regularly to help maintain bladder and bowel health.
Promote a nutritious diet that includes fiber-rich foods to help regulate bowel movements.
Encourage physical activity to help maintain muscle strength and mobility.
Use a raised toilet seat to make it easier for the person to get on and off the toilet.
Utilize incontinence products such as pads and pull-up pants to help manage incontinence.
Establish a routine by encouraging the person to use the toilet regularly.
Consider using a commode or bedpan if the person is unable to get to the toilet.
Provide emotional support and reassurance to help the person cope with the embarrassment and frustration of incontinence.
Seek the help of a continence advisor or healthcare professional for additional guidance and support.

It’s also important to note that incontinence can be a symptom of an underlying medical condition, such as a urinary tract infection or overactive bladder. If the person with dementia is experiencing incontinence, it’s essential to seek medical attention to rule out any underlying conditions.

In addition, people with dementia may experience other urinary symptoms, such as frequency, urgency, or nocturia. These symptoms can be caused by a range of factors, including cognitive impairment, physical limitations, and medical conditions.

Advanced dementia can also lead to a range of physical and cognitive symptoms, including incontinence. Vascular dementia, for example, can cause damage to the brain’s blood vessels, leading to cognitive impairment and physical symptoms such as incontinence.

Faecal incontinence can also be a symptom of dementia, particularly in the later stages of the disease. It’s essential to seek medical attention if the person with dementia is experiencing faecal incontinence, as it can be a sign of an underlying medical condition.

Normal pressure hydrocephalus (NPH) is a condition that can cause cognitive impairment, gait disturbance, and urinary incontinence. It’s essential to seek medical attention if the person with dementia is experiencing these symptoms, as NPH can be treated with surgery.

In conclusion, managing incontinence in people with dementia requires a comprehensive approach that addresses the physical, emotional, and social needs of the individual. By providing emotional support, encouraging regular toilet use, and using incontinence products, caregivers can help manage incontinence and improve the quality of life for people with dementia.