Toilet problems, continence and dementia

It’s common for people to have more difficulties using the toilet as they get older, particularly if they have dementia.

Accidents and incontinence can cause problems, especially as a person’s condition progresses. This can be upsetting for the person with dementia and difficult when you’re supporting them.

Many people find it difficult to talk about these issues. However, support is available. With the right help and advice, incontinence and toilet problems can be managed or sometimes prevented.

What is incontinence?

Incontinence is the unintentional leakage of pee (urine) or poo (faeces) or both – known as ‘double incontinence’.

Urinary incontinence

Urinary incontinence may be a small occasional leak of pee, a continued leak after peeing, or total loss of bladder control.

There are several types of urinary incontinence. One of these – especially common in people with dementia – is an overactive bladder. This causes the feeling of a sudden and intense need to pee, and frequent peeing.

Women are also at particular risk of a type of urinary incontinence called stress incontinence, often caused by pregnancy and childbirth. This is when a cough, sneeze or laugh causes a small leak of pee.

Faecal incontinence

Faecal incontinence can range from accidentally leaking a small amount of poo when breaking wind, to having no bowel control at all. Faecal incontinence is less common than urinary incontinence. It affects men and women about equally.

Why does a person become incontinent?

There are lots of possible reasons why someone loses continence. A person is more at risk of incontinence if they are older, or if they have dementia.

Incontinence in older people

In some cases, older people have a higher risk of incontinence because of a medical condition, which may be treatable. Medical causes of incontinence in older people include:

• urinary tract infection (UTI) – this is where bacteria get into the tube (the urethra) that empties pee from the bladder out of the body. This can lead to infection of the bladder or kidneys. Symptoms can include a sudden urge to pee, pain or a ‘burning’ feeling when peeing, a fever and urinary incontinence. A urinary tract infection can usually be treated with antibiotics
• constipation – this is uncomfortable and makes both emptying and controlling the bladder more difficult. Constipation is also a very common cause of faecal incontinence. When the bowel gets full of very hard poo which cannot be passed, liquid poo can leak out from around the edges of the blockage. It is easy to confuse this with diarrhoea
• prostate gland problems – these affect men, and may be treatable
• side effects of medication – the GP may be able to address these by changing the person’s prescription or altering the dose
• other gut conditions – such as irritable bowel syndrome (IBS).

Many people find it embarrassing to talk about these problems, and this can stop them from seeking help from health professionals. GPs and specialists deal with issues like these frequently and it’s important to get advice and support from them. Medical causes can often be treated or managed.

Incontinence and toilet problems in people with dementia

A person with dementia is more likely to have accidents, incontinence or difficulties using the toilet than a person of the same age who doesn’t have dementia.

For some people, incontinence develops because messages between the brain and the bladder or bowel don’t work properly. They may not recognise that they have a full bladder or bowel, or be able to control them. Other reasons include:

• not reacting quickly enough to the sensation of needing to use the toilet
• not getting to the toilet in time – for example, because of limited mobility
• not being able to tell someone that they need to go to the toilet because of difficulty communicating
• not understanding a prompt from someone to use the toilet
• not being able to find, recognise or use the toilet. If someone becomes confused about their surroundings, they may pee in an inappropriate place (such as a wastepaper basket) because they have mistaken it for a toilet
• not being able to, or forgetting how to, do things needed to use the toilet, such as undoing clothing 
• not letting others help with going to the toilet or refusing to use it – this could be due to embarrassment or not understanding an offer of help
• not making any attempt to find the toilet – this could be due to depression or a lack of motivation, or because the person is distracted
• embarrassment after an accident, which the person unsuccessfully tries to manage. For example, they may try to hide wet or soiled clothes at the back of a drawer to deal with later, and then forget they’ve put them there.