Toilet problems and continence

4. Tips for carers: the importance of maintaining a healthy bladder and bowels

Keeping the urinary tract and bowels healthy is a good first step to preventing toilet problems and incontinence. You can help to make sure the person with dementia is following these tips:

  • Drink six to eight glasses of fluids each day – more if the person has hard stools. Not drinking enough fluids, or not drinking them for long periods of time (for example, to avoid the need to go to the toilet during the night), can cause constipation.
  • Eat a balanced diet with at least five daily portions of fruit and vegetables, and enough fibre to ensure regular bowel movement.
  • Fibre can be found in cereals, brown rice and potatoes, for example.
  • Keep active. Walking every day (if the person is able to) helps with regular bowel movements.
  • Try to build going to the toilet into the person’s daily routine, and allow enough time for the person to empty their bowels. Trying to go a few minutes after a meal often works – many people favour going after breakfast.

If a health professional has suggested the person with dementia might have an overactive bladder, they will also advise avoiding drinks which may irritate the bladder. This could include replacing tea, coffee, cola or alcohol with water, herbal teas, squash and diluted fruit juices.

Women with mild dementia and urinary stress incontinence sometimes learn pelvic floor exercises, with the support of a specialist continence nurse or physiotherapist. These exercises can cure stress incontinence caused by weakness of the pelvic floor muscles due to childbirth or ageing.

Constipation

If the person with dementia has constipation, laxatives might be able to help. Laxatives are a type of medication designed to relieve constipation and are widely available over the counter. However, they should not be used for more than a week without seeking advice from a GP or pharmacist, as the symptoms may be masking another condition.

If constipation is the cause of faecal incontinence, it is possible to massage the person’s abdomen to relieve the blockage. Specialist continence nurses can train you to use this technique, although being successful will depend on how the person with dementia reacts. It requires the person with dementia to co-operate, and they may not like this sensation.