1. Why are people living with dementia at higher risk of continence problems?
Key points
People living with dementia are around three times more likely to experience urinary incontinence and five times more likely to experience faecal incontinence compared to others of the same age without dementia.
People living with dementia can have all the physical problems that cause bladder or bowel incontinence.
Dementia adds additional risk factors to the process of reaching and successfully using the toilet, including:
- Recognising the need to pass urine or open bowels
- Identifying the correct place in which to pass urine or open bowels
- Reaching the correct place in which to pass urine or open bowels
- Holding on until they reach that place or open bowels
- Passing urine or opening bowels once they get there
Any of these steps can be affected in someone with dementia and can start earlier in the disease progression than you might think, often when people are still very mobile and out and about. For example, signals from the bladder and bowel might not be recognised, which can cause agitation. The person might recognise the need to urinate, but not be able to find the correct place or be able to reach it in time. The processes of removing clothing or meeting hygiene needs (e.g. wiping) might be forgotten.
Adding to the problem, common continence management strategies (e.g. toilet planning or using pads) might be challenging.
“I never had anybody advise me on his incontinence at all, in any form. They never even referred to it. ”
Family carer