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At What Stage of Dementia Does Incontinence Occur?

at what stage of dementia does incontinence occur

It is essential to understand at what stage of dementia can incontinence occur to prepare accordingly (in advance).

Up to 70% of people with dementia develop incontinence (urinating or defecating involuntarily). It’s especially common in later stages of dementia due to an assortment of reasons.

Some are directly related to dementia, while others aren’t. Physical changes that occur with other conditions or with the aging process also can contribute.

Why do People with Dementia Become Incontinent?

why-do-people with dementia become incontinent
People with dementia may become incontinent for a variety of reasons – and often, for several at once.

Stress Incontinence

Many older women experience “stress incontinence”. When the weakened bladder muscles are “stressed” by a sneeze or a laugh, they may leak small amounts of urine.

Urge Incontinence

Urge incontinence is a common condition among elders, characterized by a sudden and intense need to urinate, followed by the loss of a large amount of urine.

Functional Incontinence

Mobility challenges can make it hard to get to the toilet on time.

Difficulty Managing Clothing

Unzipping or unbuttoning pants can become a challenge due to various reasons, including arthritis or cognitive changes.

Communication Deficits

People with dementia may be unable to communicate the need to use the restroom.

Cognitive Changes

A person may forget how to complete the sequence of events needed to successfully remove clothing and use the toilet.

The brain may become less able to recognize the signal from the body that it needs the bathroom.

Difficulty finding the bathroom, recognizing the toilet, or comprehending how to use it can present a major barrier.

How to Minimize Urinary Incontinence

how to minimize urinary incontinence
There are many ways to minimize urinary incontinence. The solution for each individual will depend on the cause, or causes, in their unique case. A multi-pronged approach, tailor fit to their situation, will likely be most effective.

Locate the Toilet

Placing signs, or a trail of masking tape on the floor, to help the person find the toilet may help. Sometimes pictures are easier for the person to understand than written words.

Keep the light on in the bathroom, or place a portable commode, or urinal, at the bedside to help someone who has trouble finding the bathroom during the night.

Replace Troublesome Clothing

Elastic waist bands can make toileting easier for those who have difficulty managing buttons or zippers.

Watch for Non-Verbal Clues

Pay attention to the person’s non-verbal communication. Even if they can’t always articulate that they need the bathroom, people often show outward behavioral signs. Common signs of needing the restroom include:

  • Fidgeting with or removing clothing
  • Pacing, wandering or going in and out of different rooms
  • Peering around frantically

Toileting Plan

toileting plan for dementia
One of the best ways to minimize incontinence is to develop a personalized toileting plan based on the person’s needs.

Initially, the “plan” may be as simple and informal as reminding the person to use the bathroom before leaving the house. Over time, the frequency and amount of oversight or assistance may increase.

Pay attention to when the person usually needs the restroom and try to anticipate it. Remind or assist them regularly just before they are likely to need it.

Example:

Larry is a senior with middle-stage Alzheimer’s Disease. He has difficulty recognizing when he needs to urinate, and usually doesn’t get to the toilet on time. He wears incontinent briefs, which used to be wet almost every time he went to the bathroom.

His wife, Roberta, used to ask him if he needed the bathroom, but he would always tell her “no”. Now, however, she doesn’t ask him. Instead, she walks with him to the restroom regularly – when he wakes up, before each meal, after dinner and before bed.

She also wakes him up around midnight and again around 5:00 a.m. If she doesn’t wake him up he will usually wake up on his own around 1:00 and 6:00 in a rush to find the bathroom. Not only is this upsetting to him, it is unsafe because he won’t slow down enough to use his walker.

With this plan, Larry’s brief has rarely been wet at all over the past several months. However, last week he started taking a new diuretic medication to reduce the swelling in his legs, and he immediately started to have accidents again. When Larry went to the toilet before lunch his incontinent brief was soaked.

After a few days, Roberta was able to adjust the plan to the new needs. She started walking Larry to use the toilet after breakfast, and again around 10:30. Larry is back to enjoying accident-free days at this time.

The Importance of Sleep

It’s worth thinking twice about waking up someone with dementia to prevent overnight incontinence. Sleep deprivation can seriously impact both physical and mental health. It can also worsen the symptoms of dementia.

Depending on the situation, it may be worth considering a quality night brief instead. These special briefs are designed for extended wear and can absorb large amounts of urine, keeping it away from the person’s skin. Regular briefs should not be worn if they are wet. Extremely damaging to skin, it also increases the risk of urinary tract infections and pressure ulcers.

Keep Drinking

Some elders avoid drinking fluids because they are afraid of having to urinate more or having an accident. However, dehydration is a serious concern for elders. It can worsen confusion, contribute to falls, or lead to a medical emergency. Elders with dementia tend to be at especially high risk for dehydration.

Caffeine and certain medications can cause an increase in urination, which can contribute to both incontinence and dehydration. In general, it’s a good idea to avoid caffeine and to take diuretic medication in the early waking hours. Always discuss medications, including what time they are taken, with the person’s doctor.

Talk to the Doctor

There are medications for “overactive bladder”, but beware: this is not the cause of most incontinence in dementia. Furthermore, some of these medications can worsen dementia symptoms significantly.

There are also other potential treatments for incontinence depending on its cause. Discuss all medications and any concerns about incontinence with the person’s doctor.

Watch for Urinary Tract Infections

Sudden onset or increase in incontinence can be a sign of a medical condition, such as a urinary tract infection. UTI’s can greatly impact the health and behavior of a person with dementia. Other signs that may indicate an infection could include:

  • Fever
  • Increased confusion
  • Changes in behavior
  • Dark or odorous urine
  • Discomfort with urination
  • Low back pain

If incontinence is new or sudden, talk with the person’s doctor.

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