Incontinence (wetting and soiling)
Medical and physical issues
My mother sometimes came back from the day centre having wet herself. But at home she’s fine. She couldn’t find the toilet at the centre and I think she didn’t want to ask because she felt she ought to know. I spoke to the staff and now every so often one of them takes her there. My mother would try every door looking for the toilet, so I put a notice on the door, which read, “Ladies” and she had no problem finding it. But a friend who tried this said a picture of a lavatory worked best for his mother.
The person with dementia may suffer from urinary incontinence (wetting) at some point. Faecal incontinence (soiling) does occasionally happen, but tends to be more common in the later stages of the disease. For the person with dementia, any kind of incontinence can be extremely distressing. They may feel ashamed and humiliated. You might also find it difficult to deal with. You may feel disgusted or embarrassed and wonder how you will ever cope. But it is important to realise that incontinence is not always solely due to physical causes. It can be caused by other problems such as memory loss, disorientation, communication problems or an associated medical problem. Usually, by paying careful attention to the person with dementia and altering certain features of your home, you can reduce the number of “accidents” and/or limit the unpleasant consequences.
How to prevent incontinence or limit the consequences of it
Consult a doctor
As incontinence is treatable in some cases, it is a good idea to consult your doctor. You should be prepared to answer questions relating to the frequency and nature of the problem. The doctor may find that it is caused by a medical problem that can be treated such as a urinary tract infection. Alternatively, he or she might find that it is caused by medication which makes the person with dementia confused.
Make the toilet recognisable, accessible and easy to use
Sometimes an accident occurs because the person with dementia cannot find the toilet in time, even in their own home. It is therefore important to make sure that the toilet is clearly marked (see section three of the chapter on communication). Painting the toilet door a different colour helps some people. If the toilet is comfortable, easy to use and the room warm, the person might be more inclined to sit there for the necessary length of time. Grip rails and a slightly raised seat can help to make access and use of the toilet easier. For men who have difficulty remembering where to urinate, it may help to colour the water in the toilet to make it more of a contrast and therefore easier to distinguish. It can also help a man to direct the stream if the urine bowl is fixed at the right height. Keep the entrance to the toilet clear, make sure that the door is not too stiff or the handle too difficult to manipulate, and leave a light on. The nearer the toilet is, the greater the chance there is of the person getting there in time.
Develop a routine
Keep a note of when the person goes to the toilet and whenever they are incontinent. You might, for example, notice that they have suffered from incontinence on a few occasions half an hour after breakfast. You could then try to make sure that they go to the toilet just after breakfast. You might also be able to notice the kind of signs the person gives when they need to go, so that you can interpret them in other situations. Developing a routine can help make sure that they go to the toilet regularly, even if it is not always necessary. For some people a subtle reminder or hint might be sufficient, whereas for others you may have to take them to the toilet and even provide assistance.
Avoid aggravating the problem
It is important to ensure that the person with dementia drinks plenty of water (about 8 cups/one a half litres a day). However, it is best not to give them anything to drink in the hour or so before they go to bed. You should also be careful when using tranquillisers as they can cause drowsiness and the person may can carry on sleeping even when their body is sending signals that it is necessary to go to the toilet. If night wetting is a problem, you might find it necessary to wake the person in the middle of the night to ensure that they go to the toilet. Certain items of clothing may hamper the person, when they have an urgent need. Please see the chapter on dressing for details of clothing, which can prove difficult to remove.
Protect bedding and upholstery
Despite all the efforts you make, accidents will almost certainly occur from time to time. It is therefore advisable to protect the furniture. Place plastic covers under cushions and loose covers. It is possible to obtain waterproof covers for mattresses, but care should be taken that the plastic does not come into contact with the skin, as this can cause bedsores (please see chapter on pressure sores). Special absorbent under sheets are available, as well as reusable and disposable bed pads. Continental quilts are easier when it comes to making beds and protective covers exist for these as well as for pillows. If incontinence is a regular problem, it would be a good idea to replace carpets with vinyl or linoleum as it is easier to wash and reduces the problem of odour.
The use of continence aids
If the problem of incontinence becomes more severe, you should consider the use of continence aids. You may find it difficult to approach the subject with the person and you will certainly need to be very careful not to offend them. Continence aids are not only a solution for you but also for the person with dementia as they make the problem of incontinence less visible to other people. The different kinds of continence pad vary greatly in their degree of absorbency, fittings and suitability for day or night-time use. The choice and size of the pad is important as too large a pad may be too obvious and also restrict walking, whereas too small a pad may be uncomfortable. Hand held urinal bottles can be useful, particularly at night. Chamber pots and bedpans are another alternative but some people find them difficult to use. Other possibilities include urinal devices for men or catheters for men or women. However, catheters should be fitted by a doctor or nurse and are generally considered to be a last resort. In any case, you might find it useful to discuss the different possibilities with your doctor.
How to cope with incontinence
Embarrassment and disgust
Don’t worry if you find it difficult to deal with incontinence. Many people do. Going to the toilet is a taboo subject in many households. Although you feel uneasy about it, you can probably imagine how humiliating an experience it must be for the person with dementia. Instead of making a big issue of incontinence, try to adopt a matter of fact attitude and reassure the person that there is no need to feel ashamed. Your attitude is extremely important because if the person feels guilty and senses that you blame them, they may try to conceal evidence of accidents and this will only make your task more difficult in the long run. It might be easier to be sympathetic and uncritical if you remember that incontinence is caused by the disease and is not deliberate. Talking with other carers who have experience dealing with incontinence might help you to come to terms with the feelings you have and the unease you may feel about carrying out such intimate care.
Incontinence can lead to skin irritations and soreness. For this reason, it is important to make sure that the person with dementia washes properly after an accident. Warm soapy water is usually sufficient, but make sure that the person is thoroughly dry and has clean clothes to put on. If sores do develop, it is best to contact a doctor, as they can sometimes be difficult to treat (please see chapter on pressure sores). You will then be faced with the task of cleaning up. If you cannot wash the soiled clothes straight away, put them in a container with a sealed lid so as to prevent them from making the room smell. Deodorisers are more effective at getting rid of the smell than air fresheners, which simply add to what you are trying to hide. To neutralise the smell of urine on carpets, you will find that white vinegar is fairly effective. In addition, try to keep the place well ventilated and, above all, don’t feel embarrassed or blame yourself if there is a faint persisting odour – you can only do your best!
Last Updated: Tuesday 11 August 2009