The Primary Types of Incontinence Caused by Dementia
Functional Incontinence
Functional incontinence is the most common type caused by the cognitive and physical impairments of dementia. The bladder and urinary tract may be working normally, but the person cannot respond appropriately to the urge to urinate. This can be a result of several factors related to dementia:
- Memory loss and confusion: A person may forget where the toilet is, what the toilet is for, or become disoriented in their own home.
- Mobility issues: Physical limitations, such as difficulty walking or issues with balance, prevent a person from getting to the bathroom in time.
- Difficulty with tasks: The complex sequence of using a toilet, which includes undressing and redressing, can become overwhelming.
- Communication problems: The person may be unable to express the need to use the bathroom to a caregiver.
Urge Incontinence (Overactive Bladder)
Urge incontinence, also known as overactive bladder, is caused by neurological changes associated with certain types of dementia, especially in later stages. This condition occurs when the bladder muscles contract involuntarily, creating a sudden, urgent need to urinate that is difficult to suppress. The communication between the brain and bladder is disrupted, leading to a loss of the normal inhibitory signals that help control urination.
- Alzheimer's disease: Studies suggest that lesions in the cholinergic pathways of the brain can disrupt normal bladder function, contributing to detrusor overactivity and urge incontinence.
- Vascular dementia: Incontinence can be an early symptom of vascular dementia due to white matter lesions in the brain affecting the neural pathways that control bladder function.
- Dementia with Lewy bodies (DLB): Patients with DLB frequently experience autonomic dysfunction that can present as detrusor overactivity.
Mixed Incontinence and Other Causes
It is common for dementia patients to experience more than one type of incontinence simultaneously, which is known as mixed incontinence. Often, functional incontinence is combined with urge incontinence. It is also crucial to remember that not all incontinence in a patient with dementia is directly caused by the condition itself. Treatable, underlying medical issues must be ruled out by a doctor.
- Urinary Tract Infections (UTIs): UTIs can cause or worsen incontinence, especially in the elderly, and may present with confusion rather than typical symptoms.
- Constipation: A full bowel can put pressure on the bladder, leading to incontinence.
- Medication side effects: Some medications, including those used to treat dementia like cholinesterase inhibitors, can affect bladder control.
- Co-morbidities: Other conditions common in the elderly, such as diabetes, prostate enlargement, or pelvic floor weakness, can also cause incontinence.
Managing Incontinence in Patients with Dementia
Management for incontinence in a dementia patient is a multi-faceted approach focusing on comfort, dignity, and addressing the root cause, if possible. The management strategy depends heavily on the specific type of incontinence and the stage of dementia.
- Environmental adjustments: Making the bathroom easier to find and use can significantly help with functional incontinence. This includes clear signs, nightlights, and ensuring easy access.
- Scheduled toileting: Caregivers can help establish a toileting schedule, known as prompted voiding, to ensure regular bathroom use before accidents occur.
- Appropriate clothing: Using clothing that is easy to remove, with features like elastic waistbands, can help reduce the time needed for toileting.
- Continence products: Absorbent products, like pads or adult briefs, can help manage episodes, particularly when away from home or in advanced stages of the disease.
- Medication management: A doctor should review all medications to ensure none are contributing to incontinence. In some cases, medication may be used to treat urge incontinence, but side effects on cognition must be considered.
Comparison of Incontinence Types Caused by Dementia
| Feature | Functional Incontinence | Urge Incontinence | Mixed Incontinence |
|---|---|---|---|
| Primary Cause | Cognitive impairment (forgetting, disorientation) and physical limitations (mobility) | Neurological damage affecting bladder control signals | Combination of functional and urge incontinence |
| Symptom Profile | The person has a normal bladder sensation but cannot get to or use the toilet in time. | Sudden, uncontrollable urge to urinate, often leading to leakage before reaching the toilet. | Symptoms include both inability to make it to the toilet and a sudden, strong urge. |
| Dementia Stage | Can occur in mid-to-later stages as cognitive and physical decline progresses. | Can appear earlier in specific dementias like DLB or vascular dementia, but also common in advanced AD. | Often seen as dementia progresses, with overlapping cognitive and neurological issues. |
| Underlying Bladder | Bladder function is typically normal. | Bladder may be overactive due to nerve damage. | The underlying bladder condition can vary. |
| Key Management | Environmental adjustments, prompted voiding, appropriate clothing. | Medications (considering cognitive side effects), bladder training, prompted voiding. | Combines strategies for both functional and urge types. |
Conclusion
Incontinence in dementia patients is a complex issue with multiple potential causes, most commonly including functional and urge incontinence. Functional incontinence results from the cognitive and mobility challenges of the disease, while urge incontinence is caused by neurological damage affecting bladder control. For many, the reality is a mix of both. Effective management requires a thorough medical evaluation to address any treatable underlying conditions, followed by a compassionate approach focused on environmental changes, structured toileting routines, and the use of appropriate products to maintain dignity. By understanding these specific types, caregivers can provide more targeted and effective support, ultimately improving the quality of life for both the patient and their family. For more information and support on managing continence in dementia, a resource such as the Alzheimer's Association offers practical tips and guidance.
