Continence management - What can be done?

This information is for carers of people with dementia. If the person with dementia has difficulties with continence there is a lot that can be done to help or even prevent the problem. 

If you require further information about continence or other issues regarding dementia call the freephone Dementia Helpline 0808 808 3000. 

What can be done?

If the person becomes incontinent, don't just accept it as part of the illness.  He or she may not be truly incontinent at all but may just have forgotten the way to the toilet or how to recognise it.  Or he or she may not recognise the feeling of a full bladder.

The best solution is to seek advice and work out ways in which to manage the incontinence. In many cases the incontinence can be improved or even cured. Even when the problem does not clear up completely, there are many practical ways of coping with incontinence by using:

• aids such as pants and pads, or protective sheets on the bed
• equipment such as commodes, or hand held urinals
• services such as laundry services.

First step - consult your family doctor

There are many reasons why someone may experience loss of continence. These may or may not be associated with dementia, and the first step is to consult your GP or family doctor.  

Information which will help the GP diagnose what is wrong:

• How often is the person incontinent, is there a problem with urine and/or faecal incontinence and how often did they go to the toilet in a set period?
• When did the problem start?
• How severe is the problem; is there just a trickle or is the person saturated?
• Has there been any increase in confusion or any other changes in the person's behaviour?
• Has there been any fever or does the person appear to find it painful to go?
• Is the person on any medication?
• Does the person pass urine in any strange places, eg in a rubbish bin?

Treatable conditions

The first thing the GP will do is check to see if there's a physical/medical problem causing the incontinence. These could include:

• Urinary tract infections. This type of infection usually responds to treatment with antibiotics. Make sure the person is drinking enough fluids (6-8 glasses daily). Contrary to what you might expect, to drink less makes the problem worse. Urinary tract infections can increase confusion considerably, but this will get better after treatment.
• Constipation. This can be helped by changing the person's diet to include more food rich in fibre eg cereals, bread, fruit. Drinking plenty of fluids and keeping physically active will also help.
• Senile vaginitis (vaginal irritation after menopause), which can be treated.
• Prostate gland trouble. After assessment, the relevant medication will be recommended. If the medication does not work an operation may be advised.
• Reaction to drugs/medication. The GP may alter the dose or change the drugs.

Once the doctor has examined the person he or she will suggest treatments.

Finding help and support

The GP can refer the person to other professionals who can help:

• The community/district nurse can visit you at home and advise on how to manage the incontinence. He or she may be able to help with bladder training or pelvic floor exercises if appropriate. The community nurse will arrange the supply of pads and may organise a home bathing service.
• The continence advisor is a specialist nurse who can assess the person's condition and decide how best to treat it. He or she will be able to give you advice on how to manage the incontinence and what products will help.
• A hospital specialist such as an urologist, gynaecologist or geriatrician may carry out bladder tests and specialist treatments.
• A physiotherapist can teach pelvic floor exercises, if appropriate, and help to improve the person's mobility.
• An occupational therapist can advise on aids and equipment, which will help the person use the toilet. You can be referred to an occupational therapist through the social work department or the hospital specialist.
• In some areas there is a laundry service which will help you cope with the additional washing you may have to do. Ask the social work department, district nurse or continence advisor if there is a laundry service in your area.