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Dementia & Incontinence Management

There are several different types of Dementia and each person experiencing this condition may have varying types and levels of incontinence.

It is vital to establish an accurate continence assessment. This will identify what type of incontinence the individual is experiencing and thus should ensure an appropriate management plan. People who have dementia may also have a continence issue that is not related to their Dementia, but simply to another disease or due to the ageing process.

As part of the continence assessment, an accurate fluid input/output record should be obtained. This will enable a Healthcare Professional to advise whether the person’s fluid intake is adequate for their body weight. They will also be able to interpret the urinary output by noting what time a patient empties their bladder, which may help to determine any pattern to their output. Also from this, a Healthcare Professional should be able to define a toileting programme designed specifically around the individual.

It is normal to empty your bladder every 3-4 hours and to go to the toilet 4-7 times within a 24 hour period. However, people with dementia can pass urine more often than normal. Also check what type of fluid they are drinking as consuming drinks with caffeine can cause urgency and irritate the bladder.

People with dementia can find it difficult to remember where the toilet is, so a picture of a toilet on the toilet doors, as opposed to a written word (eg toilet or ladies), can be useful to help the individual remember where the toilet is. Having a brightly coloured toilet seat in a contrast colour to the bathroom suite or floor is preferable so the person can easily identify the actual toilet.

As well as having an individual toileting programme, it is advisable to look for signs that the patient needs or is looking for a toilet. They may appear anxious or be fidgeting with clothing or have a change in facial expressions. If there is a specific sign this should be documented in the person's notes so all care staff are aware that this could mean they are looking for a toilet.

To aid a patient’s independence and dignity, it is important they are wearing appropriate clothing, for example, no buttons or complicated zips or clips. If necessary, clothing can be adapted. When helping patients who have a continence dysfunction, ensure that their dignity and privacy is maintained at all times.
 
After an accurate continence assessment has been carried out and it has been established that an incontinence product is required, it is important to remember the product should be as small as possible, but as large as necessary. A small product is far more comfortable for the wearer so they are less likely to be irritated by it’s presence and thus less likely to remove it. Disposable products can be highly absorbent even in small sizes; a product does not have to be large to be absorbent.