Toilet problems and continence

Read our guide to toilet problems and incontinence, including causes, solutions and how this might affect a person with dementia.

People with dementia can experience difficulties with using the toilet. Accidents and incontinence can also cause problems, particularly as their condition progresses. This can be upsetting for the person and for those around them. However, incontinence is not an inevitable consequence of dementia and support is available. This can be a sensitive topic for many people, but talking about it can help to deal with the problem.

These pages give practical tips to help prevent or manage incontinence, and looks at the professional support available.

What is incontinence? 

Incontinence is the involuntary (not on purpose) leakage of urine or faeces, or both, known as ‘double incontinence’.

Urinary incontinence

Urinary incontinence may be a small occasional leak, a trickling after passing urine, or total loss of bladder control.

There are several different types of urinary incontinence. Probably the most common form in people with dementia is an overactive bladder. This gives the feeling of a sudden and intense need to go, and frequent urination.

Women are also at particular risk of a different type of urinary incontinence called stress incontinence. This is when a cough, sneeze or laugh causes a small leak of urine.

Faecal incontinence

Faecal incontinence may range from passing a small amount of faeces 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.

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Why might a person become incontinent?

Incontinence in older people

Older people in general have a higher risk of incontinence. In some cases this is because of a medical condition, which may be treatable. Medical causes of incontinence, in older people with or without dementia, include:

  • urinary tract infection (UTI) – this is where bacteria get into the urethra (the tube that allows the passage of urine from the bladder to outside the body) and infect the bladder or kidneys. Symptoms can include a sudden urge to urinate, pain or a ‘burning’ feeling when passing urine, a fever and urinary incontinence. A urinary tract infection can usually be treated with a course of antibiotics
  • constipation – this is uncomfortable and makes both emptying the bladder and ‘holding on’ more difficult. Constipation is also a very common cause of faecal incontinence, for example when liquid faeces flow around a hard, impacted stool
  • prostate gland trouble – this condition affects men, and may be treatable
  • side effects of medication – the GP may be able to address this by changing the person’s prescription or altering the dose
  • other gut conditions such as irritable bowel syndrome.

Many people feel embarrassed about these problems and this stops them seeking help from health professionals. However, it is important to talk about them with the GP or specialists, as 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, problems with the toilet or incontinence than a person of the same age who doesn’t have dementia.

The reasons for this can include:

  • not being able to react quickly enough to the sensation of needing to use the toilet
  • failing to get to the toilet in time – for example, because of mobility problems
  • not being able to tell someone that they need to go to the toilet because of problems communicating
  • not being able to find, recognise, or use the toilet. If someone becomes confused about their surroundings, they may urinate in an inappropriate place (such as a wastepaper basket) because they have mistaken it for a toilet
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  • not understanding a prompt from someone to use the toilet
  • not being able to, or forgetting how to, perform the activities of using the toilet, such as undoing clothing and personal hygiene
  • not letting others help with going to the toilet, perhaps 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 lack of motivation, or because the person is distracted
  • embarrassment after an accident, which the person unsuccessfully tries to deal with. This may lead to wet or soiled clothes or faeces being put out of sight. For example, they may be wrapped up and put at the back of a drawer to be dealt with later, only to be forgotten about.

For some people, incontinence develops because messages between the brain and the bladder or bowel don’t work properly. This may mean people don’t recognise that they have a full bladder or bowel, or have the control needed to empty them. However, this is not a common cause of toilet problems and incontinence in people with dementia. It usually only occurs when the person’s dementia is more advanced.

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