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Bladder and Bowel Problems in People Living with Dementia

Bladder and, to a lesser extent, bowel problems are more common as we get older.

They are not a normal feature of aging. However, having a dementia can make these problems more difficult to cope with and, as dementia progresses, new problems can occur. A person with Alzheimer’s disease may either leak pee by accident (urinary incontinence) or have bowel accidents (fecal incontinence), or sometimes both may occur.

Our brain is very important in sending messages letting us know when our bladder or bowel needs to be emptied, but, with dementia, these messages might not be received. We may also lose the ability to recognize messages or understand what to do when these messages are received. Losing control over a bodily function can be degrading. It is also potentially embarrassing and difficult for both the person and care partner.

When incontinence happens
Think about the possible reasons for the accident. These thoughts will guide how you might deal with or prevent incontinence from recurring. Keeping a diary of bladder or bowel habits can help to establish a pattern and can be very useful to health care providers in deciding if there is a treatable medical cause. Try also to remember that as the dementia progresses, accidents will happen regardless of your best efforts to prevent them.

Things to consider
Many bladder or bowel problems can be treated, such as bladder infections, constipation, stress (exertional incontinence) or urgency incontinence, and (for men) prostate problems which make bladder emptying difficult.

Drinking large amounts of coffee, tea or sodas can make bladder problems worse. Try replacements to see if there is an improvement.

Do not restrict a person’s fluid intake for fear of leakage concentrated urine can actually make urinary frequency worse. Dehydration also worsens constipation and the effects of dehydration are far worse than occasional bladder accidents.

Many medications can contribute to incontinence, including anti-dementia drugs so ask your physician to review all medications and make adjustments if possible.

Can he/she communicate his or her need to visit the toilet? Are there behaviours which might signal the need? Sometimes agitation of anxiety is the only outward sign of a need to empty the bladder or bowel. Can the person understand the message their body is sending that it is time to go to the toilet?

Is the way to the washroom clear, easy to understand, well-lit at night and clearly labelled? (Make sure there is nothing that might resemble a toilet or urinal in the living area.) Would providing a bedside commode or a urinal make toileting at night easier?

Personal reactions
Everyone is different. Upon being incontinent, some people may be upset and embarrassed, but others may not be. Some people may try to hide the evidence, by removing wet or soiled clothing and hiding it. Others may wrap up poo and try to throw it away. Some people, on messing themselves, may smear the poo on walls or surfaces. If these problems aren’t helped by the advice below, see your healthcare practitioner for advice.

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