Bladder control problems
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‍Why do people with dementia experience bladder control problems?
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People with dementia always have memory problems and may be confused and disorientated but they can also have problems with bladder control.

Dementia causes changes in the brain, which may interfere with the ability to:
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- Recognise the need to pass urine
- 'Hold on' until they get to the toilet
- Find the toilet
- Recognise when the bladder is filling or completely empty
- Get clothes on and off to use the toiletIncontinence may develop or worsen in unfamiliar surroundings, or during episodes of depression, anxiety, stress, or other illness

‍Remember
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‍People with dementia, just like other adults, can have other causes of incontinence that people without dementia get. This includes urinary tract infection, constipation, atrophic vaginitis (vaginal irritation and inflammation after menopause), an enlarged prostate gland, and side effects from medications.

‍Can anything be done for dementia sufferers with incontinence? YES!
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‍Dementia does make it difficult to use some treatments for bladder control, but there is still a lot that can be done to ensure maximum comfort and dignity. Seeking help from a doctor is important. The doctor may be able to treat them directly or refer them to a continence advisor, or other specialists, for a detailed continence assessment.

‍Management strategies
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‍The full assessment for bladder control problems needs a detailed story, called a history, about the problem and a physical examination.'

Difficulties encountered by the patient may include:
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- Forgetting to take down clothes when going to the toilet
- Having difficulty finding the toilet
- Urinating in inappropriate places
- Passing urine more often than usual
- Saturating clothing/bedding without warning
- Wetting on standing up from a chair or bed
- Suffering from constipation, diarrhoea, or faecal incontinence

Carers and family members can often provide this important information and as part of the assessment record bladder and bowel function.

These records usually include:

- What time the person goes to the toilet and/or wets.
- How wet the person is, for example, minor = damp underpants, moderate=wets through to skirts/pants, severe = floods chair/floor/bed.
- How often they open their bowels.

What can be done to minimise the episodes of incontinence and maintain the person's dignity?

1. Treat any underlying conditions such as urinary tract infection, constipation, or atrophic vaginitis (inflammation of the vagina and surrounding tissue after menopause).
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2. In some situations, medications may help, but dementia makes these medications harder to use because they can also worsen incontinence and increase confusion. If medications are used they must be closely monitored and altered if any side effects occur.
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3. Where possible, encourage the person to drink six to eight glasses of fluids a day, unless otherwise advised by their doctor. This helps to prevent urinary tract infections and constipation and to maintain good bladder health. Avoidance of excessive amounts of coffee, tea and cola drinks, may help because the caffeine in these drinks may make the bladder overactive and cause frequent and urgent need to pass urine.
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4. Maintain regular bowel habits and prevent/treat constipation.
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5. The person may need to be reminded to use the toilet at regular intervals - at the times when they usually need to go, or before they are likely to be wet.
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6. If they are no longer able to recognise the need to use the toilet they should be taken to the toilet at regular intervals. This may be every 2 to 3 hours, depending on how much they drink and their wetting pattern. It may be necessary to stay with them to help them and remind them why they are there. Frequent toileting, for example, every hour, is tiring and usually not very helpful.
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7. Adjust clothing, if appropriate, to make it easier for them to manage. For example, velcro fastening instead of zips and buttons. Easy to manage clothing such as tracksuits may make undressing easier.
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8. Keep the way to the toilet clear and free of clutter and use a night-light if required. Make the toilet door easily identifiable.

9. These suggestions may not completely overcome the incontinence but they usually reduce the incidence or severity of the problem. Quality of life for the person with dementia and the carer may also be improved by the use of incontinence aids such as pads. It may be possible to receive some financial assistance with the cost of incontinence aids.

‍Advice on eligibility and the types of aids available can come from:
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- Your local continence advisor
- Alzheimers New Zealand
- Needs Assessment Service Coordinators
- The local hospital through a General Practitioner

Community healthcare and support services can help with caring for a person with dementia. Home Help or other support services and District Nursing may be available in the local area. Usually, a General Practitioner or a Continence Advisor knows how to get help.

‍Can medication be helpful in treating the person with dementia and incontinence?

‍Medications being taken already need a doctor review because some of these may cause or aggravate incontinence. In some cases, medications can be prescribed by a doctor or specialist nurse to help treat incontinence. For example:

- Antibiotics may be used to treat a urinary tract infection.
- Hormone replacement therapy (tablets, patches or vaginal creams) may help post-menopausal women by reducing frequency and urgency caused by atrophic vaginitis.
- Bladder relaxant medication may be given to help calm an overactive bladder and may reduce the urgent and frequent need to go to the toilet.
- Some medications are useful when there is obstruction or blockage to urine flow caused by the prostate gland.

BE AWARE that some of these medications have side effects such as a dry mouth, constipation, impaired balance, and lethargy. In a person with dementia, there is also a risk of increased confusion. Medication use requires careful professional monitoring.

‍Where can help be found?
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‍There are many health professionals qualified to assist you with bladder control problems. You may seek assistance from your doctor who may offer treatment directly, or refer you to a specialist, or to a qualified continence advisor. You may also seek help and obtain information directly from the following sources:

- National Helpline 0800 650 659
- General Practitioners
- Continence Nurse Advisors
- Disability Resource Centre
- District Nursing Services
- Independent Living Centres
- Alzheimers National Office

Ph: 0800 004 001
‍www.alzheimers.org.nz

‍This document has been developed by, and remains the property of, the Continence Foundation of Australia © Continence Foundation of Australia 2015Reproduced with permission from the Continence Foundation of Australia