World Continence Week is from 20 to 26 June 2022 and continence experts, Meredith Gresham and Christine Sender Ivanov*, advise on preventing, understanding and managing incontinence for people living with dementia.
Continence refers to your ability to control the movements of your bladder and bowels. It can be a difficult topic to discuss, especially early in dementia, yet incontinence is a very common experience for people with and without dementia. The Continence Foundation of Australia estimates that 1 in 4 adult Australians living in the community experience incontinence, but sadly only a small proportion seek help from a health care professional.
The good news is that much can be done to prevent or manage incontinence including incontinence in dementia.
Help prevent incontinence
To help prevent incontinence the Continence Foundation of Australia recommends practicing 5 Healthy Habits:
- Stay physically active
- Eat a diet rich in fibre
- Drink enough water, restricting fluid can make incontinence worse!
- Exercise your pelvic floor muscles, and
- Practice good toilet habits
You can read more about the 5 healthy habits via the Continence Foundation of Australia.
Understand the reasons for incontinence
Understanding the reasons for the incontinence is key. There are many reasons a person with dementia may have incontinence including infection, weak pelvic floor muscles, the side effects of certain medications, other medical conditions such as uncontrolled diabetes or prostate problems in men, or constipation can trigger incontinence. It is important to talk with your doctor or a continence nurse advisor to identify if any of these conditions may be contributing to incontinence so they can recommend treatment that can help.
Understand how dementia may affect incontinence
Later in the course of dementia, changes in the brain can mean finding and using the toilet appropriately can be more difficult. Night lights showing the way from bed to toilet and signage on the toilet door or leaving the toilet/bathroom door open can be helpful. A contrasting-coloured toilet seat (eg. a dark grey toilet seat on a white pedestal) gives more visual information for people whose visual perceptual abilities may be affected by dementia. Building a routine around drinking enough fluids, reducing alcohol and caffeine, and adding a regular toileting schedule can also be useful.
Keeping toileting dignified
A University of Sydney study about assisting people with dementia use the toilet found people are sometimes anxious about the indignity of having someone assist them with using the toilet. Continence nurse advisors can recommend appropriate continence aids (eg. pads, special underwear and bed protection) and using new electronic bidets that replace existing toilet seats can be a game changer for a dignified assistance with clean up. Electronic bidets give a warm water wash after opening bowels or urinating. For more information, watch this Hammond Care video on You Tube about using bidets in dementia care.
Keep involved in life
There is a National Public Toilet Map that can help you when planning trips and outings. Some people even early in dementia have difficulty in recognising the ‘stick figure’ men’s and women’s toilet signs. Practice recognising and using the wheelchair toilet sign and use these toilets for the disabled which are unisex and have room for another person to assist if required. The use of continence aids together with routinely toileting can improve your confidence in getting out and about.
Help is at hand. Try these strategies:
You can get free information and advice from Nurse Continence specialists on the National Continence Helpline, phone 1800 33 00 66 between 8am-8pm Monday- Friday
There are government subsidies to help with the cost of incontinence products through the Continence Aids Payment Scheme. People with dementia are eligible for this scheme.
*Special thanks to Christine Sender Ivanov, Clinical Nurse Consultant, Dementia Care Coordinator and Continence Service Coordinator, War Memorial Hospital, Waverly) for her contribution to this article.