Understanding How Lewy Body Dementia Causes Incontinence

Affecting over one million Americans, Lewy body dementia (LBD) is known for causing fluctuating cognition and movement issues. Yet, for many caregivers, the question, "Does Lewy body dementia cause incontinence?", becomes a major concern as the disease progresses and impacts basic bodily functions.

Quick Summary

Lewy body dementia frequently causes incontinence by disrupting the autonomic nervous system, which controls involuntary functions like bladder and bowel activity. This can manifest as urgency, poor bladder emptying, and constipation, often earlier in the disease than with other dementias.

Key Points

• Autonomic Dysfunction is the Cause: Incontinence in LBD stems from the disease's impact on the autonomic nervous system, not just cognitive decline.

• Incontinence Can Appear Early: Unlike Alzheimer's, LBD can cause incontinence in the early stages, often presenting as urgency and constipation.

• Management is Multi-Faceted: A combination of routines, environmental modifications, and fluid management is key to minimizing accidents.

• Medication Requires Caution: Caregivers should consult a neurologist before using incontinence medication, as some can worsen cognitive symptoms.

• Caregiver Support is Vital: Learning to manage incontinence with patience and dignity is essential for improving the quality of life for both the person with LBD and the caregiver.

• Prompt UTIs Treatment: Sudden changes in incontinence should be checked by a doctor for potential urinary tract infections.

The Connection Between Lewy Body Dementia and Bodily Functions

Lewy body dementia is a progressive neurodegenerative disease characterized by the buildup of alpha-synuclein protein deposits, known as Lewy bodies, in the brain. These abnormal clumps disrupt the normal functioning of brain cells, affecting regions responsible for thought, memory, and movement. Crucially, they also accumulate in the autonomic nervous system, which governs involuntary body processes like blood pressure, heart rate, sweating, and digestion.

Autonomic Dysfunction and Incontinence

Damage to the autonomic nervous system, a condition known as dysautonomia, is the primary reason Lewy body dementia causes incontinence. This nerve damage interferes with the brain's ability to communicate effectively with the bladder and bowels. As a result, the body's automatic signals for regulating these functions are compromised. The most common manifestations include:

• Urinary Incontinence: This can include urgency, frequency, and urge incontinence, where an overwhelming need to urinate results in accidental leakage. A 2008 study found that detrusor overactivity (an overactive bladder muscle) was more prevalent in patients with Dementia with Lewy Bodies than in those with Parkinson's disease or Alzheimer's.
• Constipation: Bowel issues, including severe and persistent constipation, are also a direct result of autonomic dysfunction and can begin early in the disease course. Impaired muscle movement in the bowel wall slows the passage of food waste, leading to discomfort and other complications.

Early Onset Compared to Other Dementias

An important distinction of incontinence in Lewy body dementia is its timing. Unlike Alzheimer's disease, where incontinence typically emerges in the more advanced stages, it can be an earlier symptom in LBD. This earlier onset is directly related to the widespread impact of Lewy bodies on the autonomic nervous system from a relatively early point in the disease's progression.

Management Strategies for Incontinence in LBD

Managing incontinence in LBD requires a multi-faceted approach, combining practical strategies with medical interventions. Caregivers play a crucial role in implementing these methods effectively while preserving the individual's dignity.

Non-Medical Management

1. Establish a Routine: Regular, scheduled trips to the bathroom can help retrain the bladder and reduce accidents. This works best when integrated into the person's daily habits, such as after meals and before bedtime.
2. Modify the Environment: Make the path to the bathroom clear and well-lit. Use contrasting colors for the toilet seat or a picture on the door to aid in visibility and recognition.
3. Adjust Fluid Intake: Encourage regular fluid intake throughout the day to prevent dehydration, which can irritate the bladder. However, limit intake before bed to reduce nighttime urination (nocturia).
4. Promote a High-Fiber Diet: A diet rich in fiber, along with adequate hydration, can help manage constipation, a frequent contributor to bowel incontinence.
5. Use Absorbent Products: When accidents are frequent, high-quality, absorbent pads or adult briefs can provide peace of mind for both the person and the caregiver. Introduce these products with sensitivity to protect comfort and dignity.

Medical and Other Interventions

• Medication: For urinary incontinence, doctors may prescribe medications to address bladder overactivity. However, some common anticholinergic drugs can worsen cognitive symptoms in LBD, so a neurologist should carefully manage all medications.
• Physical Therapy: Working with a physical therapist can help improve mobility and balance, making it easier for a person to get to the bathroom in time.
• Treatment for UTIs: Sudden worsening of incontinence or behavioral changes may signal a urinary tract infection (UTI). Caregivers should watch for symptoms like pain or frequent, unsuccessful urges and seek prompt medical treatment with antibiotics.

LBD vs. Alzheimer's: Incontinence Comparison

To highlight the unique aspects of incontinence in Lewy body dementia, the following table compares it with Alzheimer's disease.

Feature	Lewy Body Dementia (LBD)	Alzheimer's Disease (AD)
Onset of Incontinence	Often appears in earlier stages of the disease, sometimes with the onset of other autonomic symptoms.	Typically occurs in more advanced stages as cognitive decline becomes severe.
Underlying Cause	Primarily due to dysautonomia (autonomic nervous system dysfunction), affecting involuntary bladder and bowel control.	Mostly functional incontinence, resulting from a patient's inability to recognize the need to use the toilet or navigate to it.
Primary Symptom Type	Commonly presents as urge incontinence (overactive bladder) and constipation.	Incontinence is more of a cognitive and motivational issue than a direct neurological control problem.

Conclusion

While the challenges of incontinence in Lewy body dementia are significant, they are a well-documented part of the disease progression. Understanding the root cause—dysautonomia—is the first step toward effective management. By implementing practical strategies, utilizing available products, and working closely with a medical care team, caregivers and individuals with LBD can significantly improve quality of life. The Lewy Body Dementia Association provides excellent resources for families navigating this complex condition.

Frequently Asked Questions

Why does Lewy body dementia cause incontinence?

Lewy body dementia causes incontinence by damaging the autonomic nervous system, which regulates involuntary body functions. This damage disrupts the brain's signals to the bladder and bowels, leading to a loss of control.

Is incontinence an early symptom of Lewy body dementia?

Yes, urinary incontinence can be an early symptom of Lewy body dementia, often appearing sooner than it would in other forms of dementia like Alzheimer's.

How can caregivers manage urinary incontinence in LBD?

Caregivers can manage urinary incontinence by establishing a regular bathroom schedule, modifying the environment to make the toilet easily accessible, managing fluid intake, and using absorbent products respectfully.

Can Lewy body dementia cause bowel incontinence?

Yes, bowel incontinence can occur, often resulting from severe constipation caused by autonomic nervous system damage. A high-fiber diet and hydration are important for management.

What is the difference between LBD and Alzheimer's incontinence?

Incontinence in LBD is typically a direct neurological issue (autonomic dysfunction) and appears earlier, often as urge incontinence. In Alzheimer's, it is a later-stage symptom linked to functional and cognitive decline.

Are there medications for LBD incontinence?

While there are medications for bladder overactivity, they must be used with caution in LBD patients, as some can worsen cognitive symptoms. A neurologist should always be consulted.

How can caregivers maintain dignity when managing incontinence?

Caregivers can maintain dignity by communicating calmly and clearly, involving the individual in their care as much as possible, offering privacy, and focusing on solutions rather than blame.