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Incontinence can be upsetting and humiliating for the person with dementia and stressful for the carer. But approaching the problem with understanding, matter-of-factness and humor can improve the situation for everyone concerned.

Although incontinence can be a distressing problem, it's a surprisingly common one, so the good news is that there is plenty of help out there. The first steps to dealing with incontinence are to get properly informed about the problem and to find out what help and support is available.

What is incontinence?

There are two types of incontinence:

• Urinary incontinence – when someone loses control of their bladder
• Fecal incontinence – when someone loses control of their bowels.

This may happen all or most of the time, or the person may just experience the occasional leakage. Urinary incontinence is far more common than fecal incontinence. Either way, both types of incontinence may be treatable, so the first step is to consult the GP.

Why is incontinence so distressing?

Hygiene is a very personal issue. From a very young age, we are trained to control our urges to go to the toilet, so incontinence can make a person feel that they are losing control. This can affect their sense of dignity and self esteem. Many people find it very hard to accept that they need help from someone else in such an intimate area of their life – even (or sometimes, especially) if the person is very close to them.

How can it affect people with dementia?

People with dementia react differently to the experience of incontinence. Some people find it very distressing and humiliating, while others appear to accept it. Common occurrences include:

Hiding the evidence

If someone feels very ashamed of their incontinence, they may try to hide the evidence. They may take off their wet or soiled clothes and hide them, or wrap feces in a parcel and try to throw it away.

Although incontinence can be a distressing problem, it’s a surprisingly common one, so the good news is that there is plenty of help out there. The first steps to dealing with incontinence are to get properly informed about the problem and to find out what help and support is available.

Going to the loo in the wrong place

If someone becomes confused about their surroundings, they may urinate in an inappropriate place, such as a wastepaper basket, because they have mistaken it for a toilet.

How can you help as a caregiver?

If the person you are caring for has an accident, the three most important things you can do are:

• Try to overcome any embarrassment or distaste you may feel.
• Don’t be angry or appear upset.
• Remember it’s not their fault.

This may not be easy, however. If you’re finding your feelings difficult to handle, talk them through with your community nurse or continence adviser. It’s important to try not to let dealing with incontinence get in the way of your relationship with the person you are caring for.

Why might someone with dementia become incontinent?

Incontinence is not an inevitable symptom of dementia, but there are a number of reasons why someone with dementia could become incontinent. These include various medical conditions. People with dementia may also develop problems because they:

• Forget to go to the toilet
• Mistake other things, such as a wastepaper basket, for the toilet
• Don’t know where the toilet is.

Treatable conditions

Conditions that may cause urinary incontinence include:

• Urinary tract infections These usually respond to treatment with medication.
• Prostate gland trouble This affects men, and may be resolved with an operation.
• Side-effects of medication The GP can address this by changing the person’s prescription or altering the dose.
• Severe constipation Constipation can put pressure on the bladder, and can also lead to fecal incontinence. Eating foods that are high in fiber, drinking plenty of fluids and keeping physically active can help prevent this.

continue: Practical Considerations

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Reviewed: 02/2006