Dementia and Bladder and Bowel Control

WHY DO PEOPLE WITH DEMENTIA HAVE TROUBLE WITH BLADDER AND BOWEL CONTROL?

People with dementia have memory loss. They may be confused and not know where they are. This confusion can cause bladder and bowel control problems or make the problems worse.

People with dementia may have trouble with:

• knowing they need to pass urine or empty their bowels
• holding on until they get to the toilet finding the toilet
• knowing they need to unzip trousers when going to the toilet 
• knowing they need to pull down their pants when going to the toilet 
• being away from home and not knowing where the toilet is 
• urinating or opening their bowels in places they should not
• depression, anxiety, stress or illness.These can make bladder and bowel control problems worse.

CAN ANYTHING BE DONE FOR PEOPLE WITH DEMENTIA WHO HAVE TROUBLE WITH BLADDER AND BOWEL CONTROL?

Yes.

Dementia may rule out some treatments but there are still ways to provide comfort and dignity.

Here are some tips to work in a helpful way with people with dementia

• Watch the person’s bladder and bowel habits for a while. This may show a pattern of toileting habits.
• Watch for signs that they want to go to the toilet. For example, they may become restless, walk a certain way or pull at their clothing. The person can then be taken to the toilet in time.
• People with dementia or confusion may not notice the urge to empty their bladder or bowels. This can lead to wetting of pants or leaking of normal bowel actions. A common time for bowel motions to happen is soon after a meal, often after breakfast.
• Listen with care and respond to the person
• Get rid of clutter in the living areas. This may make it easier for them to find their way to the toilet.
• Keep the space around them simple and well known to them. 
• Show respect and sincere care.

Check bladder and bowel control 

Seek help from their doctor, continence nurse advisor or continence physiotherapist.

A bladder and bowel control check-up will include a physical check. The health professional will ask about when, where and why problems happen.

The carer is often the best person to give the details needed. The carer might be asked to give details about:

• the time the person goes to the toilet and/or leaks 
• how much leakage there is
• when and how often they open their bowels.

How to help poor bladder and bowel control

• Make sure the person with dementia drinks fluid every day. Fluid is anything they drink and includes milk, juice and soup. The best fluid to drink is water.
• Fluids can: 
  • make the bowels work better 
  • keep the bladder healthy
  • help treat bladder infections.

Cut down on drinks that contain caffeine. Caffeine can upset the bladder. There is caffeine in coffee and cola drinks. There is less caffeine in tea.

Avoid constipation. Make sure the person:

• • eats two pieces of fruit and five serves of vegetables daily
  • drinks fluid every day. Fluid is anything they drink and includes milk, juice and soup. The best fluid to drink is water
  • keeps as mobile as possible 
• Treat constipation when it occurs.
• Watch for signs the person wants to go to the toilet.
• Make a note of the times they most often go to the toilet. Also note the times they are most often wet.
• Ask or help them to use the toilet at these noted times. Taking them to the toilet at these times may cut down on accidents.
• If they have trouble with zips or buttons change to track suits. Trousers with elastic waists are easier to use. You can also use Velcro to fasten trousers.
• Keep the path to the toilet clear. Don’t leave things in the way that might make it harder to get to the toilet.
• A night light may help. This can make the toilet door easier to see.
• Use outside help to ease the load of caring for a person with dementia. You may be able to get help with laundry, shopping and respite care from health and community organisations.

Seek advice 

The doctor, continence nurse advisor or continence physiotherapist can help find the causes of the problem. They can then suggest ways to treat problems including:

• reviewing their medicines
• suggesting the use of products to contain bladder and bowel loss. These might be pads or special pants. You can get advice about the right types of products to use. These products aim to improve quality of life. 

You may be able to get funds to help pay for continence products. You can get advice about eligibility by calling the National Continence Helpline 1800 33 00 66.

CAN MEDICINE HELP WITH BLADDER AND BOWEL CONTROL?

Yes.

• Antibiotics may be given to treat a bladder infection.
• If dementia is mild, tablets may be given to help settle an overactive bladder and help the bladder store more urine. They can cut down the number of times the person goes to the toilet. It is normal to go to the toilet about four to six times during the day and get up once each night over an eight hour sleep.
• In some men with big prostates, the urethra (urine tube) is too narrow to let the urine out. Sometimes medicine can make it easier to pass urine in this situation.
• Some medicines may cause bladder and bowel control problems, or make them worse. Medicines should be checked by a doctor and may need to be changed.

Side effects of medicines

Side effects might include:

• increased confusion
• dry mouth 
• constipation 
• poor balance 
• lack of energy 

There are some broad rules for working in a helpful way with people with dementia:

• Listen with care and respond to the person.
• Get rid of clutter. Keep the space around them simple and well known to them.
• Show respect and sincere care.

Check bladder and bowel control

Seek help from their doctor, physiotherapist, or continence nurse.

A bladder and bowel control check up will include a physical check and questions about when, where and why problems happen.

The carer is often the best person to give the details needed to check bladder and bowel control, such as:

• the time the person goes to the toilet and/or leaks;
• how wet the person is; minor = underwear is damp; moderate = skirt or trousers are wet; or severe = chair, floor or bed is flooded; and
• when and how often they open their bowels.

Manage poor bladder and bowel control

• Treat the cause of the problem. Their doctor, physiotherapist or continence nurse can help find the causes and suggest how to treat them.
• Review medicines. Medicines may help, but they can also make people more confused, and make bladder and bowel control problems worse.
• Make sure the person with dementia drinks 1.5 - 2 litres of fluid per day (unless a doctor says this is not okay). Drinking water can help treat bladder infections, make the bowels work better and keep the bladder healthy. Coffee, tea and cola have a lot of caffeine, which can upset the bladder and make the bladder harder to control. Try to cut down on how many of these drinks they have.
• Treat constipation. Make sure they eat lots of fruits and vegetables, drink lots of water through the day, and stay active.
• Watch for signs they want to go to the toilet. Ask them to use the toilet at the times you think they most often go or are most often wet. If you note the time this happens you will be able to see if it gets better.
• If they have trouble with zips and buttons, change to track suits, trousers with elastic waists, or use Velcro.
• Keep the way to the toilet clear. Don’t leave things in the way that might make it hard to get to the toilet. A night light may help. Make the toilet door easy to see.
• Think about using community resources to help with the load of caring for a person with dementia – such as laundry, shopping and respite care.

Bladder management products such as pads and pants may improve quality of life. You may be able to get some help to cover the cost of these products. Advice on whether you are able to receive this help and the types of products you can get can be found on the National Continence Helpline (Free call* 1800 33 00 66). These things may reduce how often bladder and bowel mishaps occur and how bad they are.

Can medicine help with Bladder and Bowel control?

Yes!

• Antibiotics may be given to treat a bladder infection.
• Hormone replacement therapy (tablets, patches or creams) may make it easier for post menopausal women to control their bladder.
• Tablets to relax the bladder may be given to settle an upset bladder, so it can store more urine. This can cut down the number of times the person needs to go to the toilet.
• Tablets may sometimes be given to make it easier to pass urine when the base of the bladder is blocked, if the urine tube is closing too tight to let the urine out.
• Some medicines may cause bladder and bowel control problems, or make them worse. Medicines should be checked by a doctor, to see if any need to be changed.
• Some medicines for bladder and bowel control problems may cause problems like dry mouth, constipation, poor balance and lack of energy. For people with dementia, there is also a risk they may get more confused. Use of medicines should be watched with care by their doctor. Tell the doctor about any problems the medicines cause.

Seek Help

Qualified nurses are available if you call the National Continence Helpline on 1800 33 00 66* Monday to Friday, between 8.00am to 8.00pm (Australian Eastern Standard Time) for free:

• Information
• Advice 
• Leaflets

If you have difficulty speaking or understanding English you can access the Helpline through the free Telephone Interpreter Service on 13 14 50. The phone will be answered in English, so please name the language you speak and wait on the phone. You will be connected to an interpreter who speaks your language. Tell the interpreter you wish to call the National Continence Helpline on 1800 33 00 66. Wait on the phone to be connected and the interpreter will assist you to speak with a continence nurse advisor. All calls are confidential.

Visit health.gov.au/bladder-bowel or continence.org.au/other-languages