What to know about dementia and bladder control

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Dementia describes a group of conditions that involve the loss of cognitive function. It affects memory, thinking, orientation, comprehension, calculation, learning, language, and judgment. It may also cause mood and behavior changes.

About 53% of people with dementia have incontinence. This is significantly more than is typical.

Urinary incontinence or loss of bladder control is the unintentional passing of urine, which can be distressing for individuals with dementia and their caregivers.

People living with dementia may experience urinary incontinence or bathroom issues for many reasons, including:

• memory issues and a reduced ability to concentrate on daily tasks, making them forget they need to use the bathroom
• an inability to recognize the physical sensation of needing to go to the bathroom
• changes in behavior, such as resisting going to the toilet
• language or communication problems that prevent the person from getting help when necessary

These causes are complex and involve a variety of psychological and functional factors. Therefore, it can be hard to identify a specific cause.

The main physical reason is that for people with dementia, signals that allow communication between the bladder and the brain control the ability to pass urine. As the bladder fills, the central nervous system (CNS) sends signals to a brain region called the pontine micturition center (PMC).

This signal reaches the bladder to promote urination.

The CNS also plays a role in bladder contraction and the voluntary release of urine. This requires coordinating the relaxation of the muscles receiving input from the autonomic nervous system, which handles involuntary body functions, and those that the PMC controls.

Lesions in the brain regions that control urination can also affect bladder control and lead to urinary incontinence. These lesions can result from protein deposits such as amyloid plaques and neurofibrillary tangles, which are common in people with Alzheimer’s disease, the most common type of dementia.

A lack of bladder control has various adverse effects on an individual. It can cause:

• feelings of embarrassment or loss of dignity
• low self-esteem
• depression
• skin problems due to prolonged exposure to urine or feces
• increased risk of urinary tract infections (UTIs)

The first step in managing incontinence in people with dementia is thoroughly assessing the problem. After that, an individual, their caregiver, and medical professionals can implement coping strategies.

Assessment

In this assessment, the healthcare professional will perform a physical evaluation and ask a few questions to understand:

• a person’s medical history
• specific times of the day where incontinence occurs
• the presence of urinary or fecal incontinence
• the volume of urine or feces a person passes
• the effect of incontinence on quality of life

The doctor may also ask the individual or their caregiver to record information regarding their fluid intake and the occurrence of incontinence.

A physical examination includes a urine dip test, bladder scan, or in-and-out urine catheterization. The urine dip test can show signals of UTIs, kidney inflammation, dehydration, and diabetes.

These conditions can contribute to urinary incontinence.

The bladder scan, or in-and-out urine catheterization, can show if there is any incomplete bladder emptying and urinary retention.

How to reduce and manage accidents

Doctors should involve spouses, relatives, and carers in planning management strategies. As much as possible, healthcare professionals should also involve the individual.

Management strategies for people with dementia and incontinence include:

• Promoting a toileting pattern: For example, taking an individual to the toilet after breakfast or when they are most likely to have incontinence.
• Reminders: These involve frequently asking the person if they need to use the toilet.
• Medications: This can help ease some symptoms such as urge and stress incontinence.
• Incontinence pads: These can help keep the person dry and reduce any complications relating to incontinence. However, they will not prevent it from happening — they are there for severe cases when other strategies do not work. Incontinence pads come in various formats, including disposable inserts, wrap-around pants, pullup pads, and reusable models.
• Managing fluid intake: A person should avoid excessive fluid consumption, especially before bed. Caregivers can encourage them to drink enough water throughout the day to avoid dehydration.
• Caffeine: People should avoid excess caffeine since it can stimulate urination and irritate the bladder.

Treatment may involve medication, pelvic and bladder muscle strengthening exercises, and lifestyle modifications. In severe cases, a person may need surgery.

• Bladder training: These are exercises that requirefollowing a fixed bathroom schedule whether or not the person feels the urge to urinate. If they feel the urge to urinate before a specific interval, they can use relaxation techniques to suppress it. After achieving success, the person should extend the interval by several minutes.
• Pelvic floor exercises: There are exercises to strengthen the muscles around the bladder, bottom, vagina, or penis.
• Medication: The doctor may prescribe anticholinergic agents to decrease urine leakage. The currently available medications include oxybutynin, tolterodine, solifenacin, and trospium. However, they can cause side effects, most commonly dry mouth and constipation. In males with an enlarged prostate, a doctor may prescribe medications that relax the prostate and improve incontinence, such as alpha-blockers.
• Catheterization: Doctors only recommend this in severe cases or when wounds take time to heal. The procedure involves using a thin, flexible tube to carry urine out of the bladder.

Trouble using the bathroom or loss and loss of bladder control are common symptoms in people with dementia. Individuals with urinary incontinence symptoms, such as leakage of urine when sneezing, laughing while lifting light weights, or a sudden urge to urinate, should seek medical help.

Dementia has a range of effects, and losing bladder control can affect a person’s quality of life. However, there are strategies to manage incontinence and avoid accidents.

These include nonpharmacological measures, such as exercises to strengthen bladder muscles and behavioral adjustments. Medications can also help reduce urine leakage and prevent the negative consequences of incontinence.