Accidents are Common! Incontinence and Dementia.


A common problem people with dementia face is incontinence, which means controlling bowel and bladder function. Incontinence increases the challenges and burden of caregiving. It is a leading cause for placing a loved one in a nursing home. This blog post will discuss some common reasons a person with dementia may experience incontinence and strategies to prevent and manage the problem.


Over 50% of people with more advanced stages of dementia experience incontinence. (Consider reading the blog post, stages of dementia on GeriAcademy). It is important to discuss with a primary care doctor when a loved one experiences symptoms such as urine leakage, soiled undergarments/bedding, or difficulty using the bathroom.


Your loved one's doctor can often offer simple solutions to treat or improve incontinence symptoms. As a geriatrician who routinely manages patients with dementia, I see this problem often.


When evaluating a person in my office, I ask questions that help me identify the cause of the problem. Some common questions include:

  • What medical problems has a person been diagnosed with?

  • How long has the individual experienced this problem?

  • Are there any behavioral changes associated with the problem? Is the person more agitated or appears to be in pain? Sometimes people with dementia cannot tell us that they are in pain. They may express pain symptoms with agitation, increased confusion from their baseline, or holding/rubbing a hurting body part.

  • How often is the person experiencing incontinence?

  • Is there a particular time of day or night that they experience more incontinence?

  • Are they experiencing incontinence of bladder, bowel, or both?

  • What medications is the person taking?

  • What time of day are they taking each medicine?

  • Have there been any recent medication changes?

  • Is the person recognizing that they need to urinate?

  • Does the person try to make it to the bathroom to urinate, and can they get to the bathroom?

  • Is the person confusing other places for the toilet?

  • Does the person have issues with constipation? What are their regular bowel habits? have bowel habits changed?

  • Does the person experience leaking of urine with laughing, coughing, or sneezing?

  • What are the person's drinking habits? Do they consume caffeine? What is their daily fluid intake?

Once I have gathered the appropriate history and examined the person, I can treat or manage the problem.


For example, a person may need:

  • Adjustment of medications that may be causing increased urination or making it difficult to hold urine.

  • Mediation adjustments to address other medical problems such as uncontrolled diabetes or heart failure, enlarged prostate, anxiety, depression, or other medical issues.

  • Treatment of a urinary tract infection.

  • Physical or occupational therapy consultation due to physical incapacity. Medical equipment such as a walker or bedside commode.

  • Adjustments to their daily fluid intake include reducing caffeine intake and decreased fluid intake in the evenings.

  • Stool softener, sometimes constipation can also contribute to both bowel and bladder incontinence.

  • Reminders to go to the bathroom every 2-3 hours.

  • Pictures/signs on the bathroom door help recognize where the bathroom is.

  • Assistance when using the restroom.

A note on medications and incontinence


Many classes of medications can cause incontinence. It is important to pay close attention to symptoms when any medicine is added or adjusted. Some types of medications that can cause incontinence include:

  • Alph-Adrenergic Agonists like clonidine are sometimes used to treat medical problems like high blood pressure.

  • Antipsychotics are sometimes used in dementia patients to treat behaviors and disturbing hallucinations.

  • Antidepressants are sometimes used in dementia patients to treat anxiety and depressed mood.

  • Diuretics are also known as water pills used to treat heart failure.

  • Calcium Channel blockers are Common heart and blood pressure medications.

  • Benzodiazepines, common mediations include lorazepam (Ativan) or alprazolam (Xanax) used to help with anxiety and sleep.

  • Estrogens


Another word of caution- Some medications used for overactive bladder can worsen the symptoms of dementia. Some of these medications can be purchased over the counter, speak to your loved one's doctor before using any medication.


Conclusion


In conclusion, incontinence is common in people with dementia. It is vital to speak to your loved one's doctor about this problem because treatment options are available.


I hope you found this post on urinary incontinence to be helpful. Consider reading other posts on GeriAcademy. GeriAcademy is an informational resource and should not be used as a substitute for care provided by a medical doctor.


References

1. Panesar, Kiran. (2014). Drug-Induced Urinary Incontinence. U.S.Pharm.2014;39(8):24-29.

2. Yap, P., & Tan, D. (2006). Urinary incontinence in dementia: A practical approach. Australian family physician, 35(4).