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Continence

Many people with dementia experience bladder and/or bowel incontinence. Here, we share expert advice for managing these difficulties.

Incontinence is the unintentional passing of urine (urinary incontinence) or faeces (faecal incontinence). Some people have both types (double incontinence).

Problems with incontinence and using the toilet may be due to dementia itself, or other reasons such as physical health conditions.

Incontinence can be distressing for the person with dementia and those who care for them. However, there are ways to manage incontinence and maintain their dignity.

Reasons for incontinence in a person with dementia include:

  • reduced mobility, causing difficulties reaching the toilet in time
  • memory problems – they might forget to use the toilet, or where it is
  • difficulty recognising the physical signals of needing the toilet
  • difficulty communicating that they need the toilet
  • problems with coordination, eg undoing buttons and zips
  • old age
  • damage to the area of the brain that controls the bladder

Many physical conditions can also cause incontinence, including:

  • constipation
  • prostate problems
  • urinary tract infections (UTIs)
  • diabetes
  • strokes
  • muscular problems, eg Parkinson’s
  • bladder/kidney infections
  • taking medication that can affect bladder/bowel control

If a person with dementia is experiencing incontinence, book a check-up with their GP, as some causes can be treatable.

You can also arrange an assessment with an NHS continence service – you can request this yourself, or ask the GP to refer you.

These clinics are staffed by specialists who can investigate the causes of incontinence, suggest treatments that may help, and advise you on managing the problem.

  • Find out about the person’s usual toileting routines, eg how often they usually have bowel movements, and at what times of day
  • Look for non-verbal signs of needing the toilet, such as fidgeting, pacing, holding their crotch or stomach, or going to the corner of the room
  • Pay attention to the language the person uses – phrases like “I need to go out” may indicate that they need the toilet
  • Try prompting them to go to the toilet every two hours
  • The person may hide wet or soiled clothing or bedding due to embarrassment. Instead of pointing this out, quietly remove the soiled items and replace them
  • Don’t stop the person from drinking – this can cause dehydration and constipation and make incontinence worse
  • Encourage them to drink six to eight glasses of fluid per day
  • Limit how much they drink in the hour before bedtime
  • A balanced diet with plenty of high-fibre foods, fruit and vegetables will encourage regular bowel movements
  • Keep routes to the toilet clear – remove clutter and trip hazards
  • Put a written sign or picture of a toilet on the door
  • Keep the toilet door ajar and leave a light on at night
  • For men, ensure the toilet seat is left up
  • Install a toilet seat and grab rails in a strong, bright colour that is easy to see. Blue tends to be more visible than red
  • Consider a commode or portable urinal for night-time use
  • Keep wipes, hand sanitiser, incontinence pads, clean clothing and disposable gloves in the bathroom

A person with dementia may need you to guide them to the toilet.

You might need to help them with their clothes, but if possible, encourage them to do it themselves in small steps: for instance, “Can you undo your zip? Now can you pull down your trousers?”

Loose clothes such as tracksuit bottoms, or clothes with Velcro fastenings, might be easier for some people.

The person may need you to help them sit down on the toilet – but if it’s appropriate, give them some privacy while staying close by. If they stand to urinate, encourage them to sit down at least once a day to open their bowels.

Allow the person plenty of time to use the toilet, then check the bowl to see if they have passed urine or stools. If you notice any irregularities, such as blood, inform their GP or nurse.

Afterwards, encourage or help them to wipe themselves and wash their hands.

There are many protective products for incontinence, including pads, disposable pants, bed and chair protection such as absorbent mats and waterproof sheets and adapted clothing.

Some of these may be available free of charge on the NHS. They are also readily available from pharmacies, some supermarkets and online.

The person’s district nurse or a continence clinic adviser can help you decide which products to use.

Wet and soiled skin is more prone to sores and infections, so it’s important to help the person with dementia stay clean and dry using soap-free products. Pat the skin dry gently.

If you use barrier creams or ointments, be aware that they can reduce the absorbency of incontinence products.

If the skin becomes red or broken, arrange an urgent appointment with the person’s GP to prevent infections and further skin damage.

To speak to a specialist Admiral Nurse about continence or any other aspect of dementia, please call our free Dementia Helpline on 0800 888 6678 (Monday-Friday 9am-9pm, Saturday and Sunday 9am-5pm, every day except 25th December), email helpline@dementiauk.org or you can book a phone or virtual appointment with an Admiral Nurse.

You may also find the following helpful:

Dementia UK resources

Other resources

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