Home > Caregivers, Hygeine/grooming, Strategies, Types of dementia > Strategies for Incontinence in Frontotemporal Dementia

Strategies for Incontinence in Frontotemporal Dementia

Incontinence (both bladder and bowel) is a problem that usually occurs in the middle to later stages of most kinds of dementia.  There are a number of reasons for it.  These may include a lack of recognition that the bladder or bowels need to be emptied, forgetting where the bathroom is located or getting distracted while on the way there, and others.  And there are a number of strategies that can be used to prevent or manage incontinence in persons with dementia.

Earlier today, I found an article that spoke particularly to those problems unique to those with frontotemporal dementia.  However, it seems to me that several of these could be used for incontinence caused by just about any kind of dementia.  The original list can be found here, but I’ve added a few of my own personal reflections here and there.

1.  Be sure to consult with the doctor to determine if there is a physical reason for the incontinence (infection, tumors, etc.).  Many post-menopausal women experience stress incontinence, for example, which is not directly due to the dementia.  However, a woman with stress incontinence may be unaware when she has had an episode of incontinence, or be able to reason how to deal with it.

2.  It is not unusual for persons with frontotemporal dementia to have an accident when over-stimulated, for example when in a setting where there is a crowd making a lot of noise, especially early in the disease.  This could be a yardstick for determining how much stimulation a person can handle.  A caregiver should encourage the person with dementia to wear a protective garment of some sort — there are many on the market now that are thin and cannot be detected by others.  If asking the person to wear a garment doesn’t work, it may be necessary to tell him that he is not going to go with you unless he puts one on.

3.  Be sure that the person goes to the bathroom 20 minutes after the first meal of the day.  We all seem to have a reflex that kicks in about this time, so be sure to make use of that to encourage the person to empty his bowels.

4.  Limit the person’s intake of caffeine, as it stimulates the bladder.

5.  Don’t ask the person to wait for you in the car while you do your shopping.  This will most likely cause him to become anxious, which will stimulate an evacuation of bladder or bowels.

6.  Encourage plenty of fluid intake during the day to increase the urge to urinate.  Plan trips to the bathroom about two hours apart, whether at home or out and about.

7.  Many people with FTD may feel the urge to void or move their bowels, but will not remember what to do about it.  When you learn the person’s internal schedule regarding such matters, try to prompt him to visit the bathroom at the appropriate times.

8.  In the latter stages of dementia, a person may no longer be able to respond to prompts to use the bathroom.  This is the time when use of incontinence products becomes most important, perhaps even doubling them if needed.  Put a plastic sheet or lawn and leaf bags under the sheets on the bed.  There are also disposable pads available that can be placed on top of the bottom sheet as needed, to keep from having to change the entire bed if an accident occurs.

9. Be sure that the person gets enough fiber in his diet.  Two large oatmeal cookies as an afternoon snack works well.  There are also fiber pills and powders that can be mixed with liquid.

10.  Ensure that incontinence briefs are changed at least two to three times a day, even if they are not soiled, to avoid urinary tract infections.

11.  If the person has trouble adapting to the incontinence briefs, take his “regular” underpants out of the drawer and replace them with the briefs.  Before long, he will get used to wearing them.

12.  If the person does have an accident on the rug, use cleaning products designed for pets.  A standard product for cleaning rugs will not deal with the bacteria present in human feces.

13.  (This point I have added to the list provided.)  Be sure to deal with both prompts for going to the bathroom, as well as accidents that do occur, in a matter-of-fact way that does not belittle the person with dementia or make him feel guilty for having difficulty controlling his bodily urges.

  1. November 25, 2012 at 5:42 PM

    Great Blog, and thanks for bringing his difficult topic up.

    You should post it as a comment on The Alzheimer’s Reading room too.

    Bob De Marco asked me to write a blog about incontinence and dementia, after I posted this blog; http://kateswaffer.com/2012/04/25/dementia-and-incontinence/ but so far I’ve not had time to do so!

    Take care.

  2. November 26, 2012 at 12:02 PM

    Thanks for the good words, as always. I’ll have to check that out.

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