If you’re living with or caring for someone with dementia, a loss of bladder or bowel control can be challenging. Fortunately, there are effective ways of managing faecal and urinary incontinence.
What, exactly, is incontinence?
Incontinence is the accidental or involuntary loss of urine from the bladder, or faeces and wind from the bowel, and is especially rife among older people and those in advanced stages of dementia.
The condition is just one of a number of hurdles encountered during the advanced stages of dementia, and its presence has an impact on both the patient and the caregiver.
However, incontinence isn’t just limited to people with dementia. According to the Continence Foundation of Australia, close to 5 million Australians are affected by the condition for a variety of reasons.
Although there are different types of incontinence, each with a number of possible causes, the following four types are most common:
• Urinary incontinence –when the person has little control over when they urinate.
• Faecal incontinence – loss of bowel control, leading to the involuntary passage of stools.
• Urge incontinence –when the urge to urinate develops suddenly, resulting in urine leakage.
• Functional incontinence – when the person knows they have to go, but for mental or physical reasons cannot to get to the bathroom.
Functional incontinence often occurs when a person has trouble recognising the need to go to the bathroom. It may also be the result of medication, constipation or a urinary tract infection. In a person with dementia, it might simply be a matter of not remembering where the toilet is or struggling to articulate the need to use the bathroom.
Tips for caregivers
While a loss of certain bodily functions is inevitable with age and/or some disease conditions, one shouldn’t forget that it can have a significant demoralising impact on the affected person. For this reason, it’s important to treat the situation with a level of sensitivity.
Try the following:
• Be supportive and reassure the person instead of adding to their embarrassment.
• Don’t let the person go without fluids as this may cause urinary tract infections.
• Limit fluids before bedtime.
• Gently encourage regular toilet times.
• Don’t infantilise the person by speaking with a baby voice.
• Learn to identify the person’s trigger words or signs for using the toilet.
• Always keep the path to the bathroom uncluttered.
• Lay down glow-in-the-dark tape to mark the path to the toilet.
• Highlight the toilet seat with a bright fabric cover.
• Place a portable urinal or commode in the bedroom if the person struggles with mobility.
• Make sure the person can undo his/her own zip and buttons. If not, a pair of pyjama pants or sweatpants might be more suitable.
• Leave the toilet door open but respect the person’s need for privacy.
How caregivers can help themselves
Taking care of someone with dementia can be stressful and, at times, it can become difficult to remain positive – especially if the person suffers from incontinence.
An Australian Institute of Health and Welfare report shows that, in 2009, some 73,000 people identified themselves as a primary caregiver who spent an average of 40 hours per week managing another person’s incontinence. This created massive dents in the moral and emotional wellbeing of the carers, with 49.6% experiencing a change in their physical or emotional wellbeing, 45% displaying weariness and lacking energy, while 39.5% were overcome by worry or depression.
As important as it is for caregivers to make the life of their patients more manageable, it’s also important for them to look after themselves.
Try the following:
• Remember that you’re not alone.
• Talk to someone about your worries and stress.
• Join a local support group.
• Take a break from your responsibilities by getting other family members to assist.
REMEMBER: Incontinence can be treated and managed. In many cases it can also be cured. Speak to a medical professional about the various options available.