Planning for your future care if you have dementia

It is common for people with Dementia to experience problems with going to the toilet.

Sometimes bowel or urinary incontinence can be a problem. A person with dementia can be more prone to incontinence, often if you are not drinking enough or simply are not able to get to the toilet in time. This can be upsetting for you and for the person who cares for you. It is important to remember that it is not your fault, and that help is at hand.

Both men and women can experience incontinence and it can happen for different reasons:

• women may experience incontinence following the menopause as reduced oestrogen can cause urge incontinence, stress incontinence and vulval irritation.
• men can have trouble in passing and dribbling of urine usually due to enlargement of the Prostate gland. Men can also have pelvic floor weakness.
• bladder oversensitivity.
• Urinary Tract Infection.
• constipation can cause both urinary and bowel incontinence.
• some medicines can affect your bladder and bowels and cause constipation or diarrhoea. Some analgesics (painkillers)can cause constipation. Consult your pharmacy or GP if you think this is happening.

Even though it may be difficult, it is important to try and talk to close family or a friend about the problem and to speak with your doctor. Tell your doctor about any changes to your bladder or bowel habit, such as constipation for more than 6 weeks, and particularly if any bleeding is noticed in your poo or urine.

Sometimes your GP may need to refer you to the Urology or Gastroenterology Department to see a Specialist if there is an underlying condition causing your incontinence.

The aim of treatment is to help you to regain some bladder or bowel control and to help you to manage the problem with understanding and dignity. If the incontinence is not improving, please speak to your GP who can refer you to a Community Nursing Team (District Nurse) or your local Continence Team for a continence assessment and helpful advice such as pelvic floor exercises and bladder retraining.

If the problem persists, either of the teams can order or recommend continence supplies to help you manage the incontinence such as pads and pants. These are generally free of charge and can be delivered directly to your home via an ordering system. Sheath systems and bags, if recommended for men can be ordered on prescription via your GP, Community Nursing Team, or Continence Team.

Here are some tips to help:

• recognise the signs that you or the person you care for needs to go to the toilet, this is often fidgeting and restlessness.
• make sure the route to the toilet is not obstructed. The toilet door should be well lit and a sign on the door with a picture can help to locate it easily. Leave the toilet door open if not in use.
• use of a contrasting colour toilet seat such as black, this helps it to be seen easily.
• If missing the bowl is a problem, a man may feel more comfortable to urinate, sitting down.
• allow privacy, but disable locks or use a lock that can be unlocked from outside the room if the person is at risk of locking themselves in.
• allow time to relax, have access to books, newspapers, etc.
• mirrors should be obscured if reflections cause confusion.
• easy to remove clothing using elastic or Velcro fasteners.
• use of night time lighting sensors.
• hire of aids to help with using the toilet such as a raised toilet seat and handrails or a commode can be arranged via an Occupational Therapy home assessment, through your GP or local council.
• a Radar key for publicly accessible toilets can help to avoid queues. This can be obtained from [email protected]
• a sunflower lanyard. This allows you to voluntarily share that you have a disability or condition enabling you gain more support, understanding or more time at work, in shops or on public transport or to reduce the need for queuing which can be distressing if you have toilet needs. https://hdsunflower.com
• The blue badge scheme helps you to park closer to public toilets. You can check your eligibility via https://www.gov.uk

You should:

• eat regular meals with plenty of fibre and fresh fruit and vegetables, remember your five a day! This can help prevent constipation.
• have plenty of drinks, aim for at least 6-8 glasses a day. Try to avoid caffeine, alcohol, and fizzy drinks, these can make you dehydrated. Reduce fluids two hours before bedtime if night time incontinence is a problem but make up for this in the daytime.
• try to keep a regular routine with having bowels open, after breakfast is a good time.
• skin care is important. Washing should be gentle and using non- perfumed products. Large soft wash wipes can be obtained from pharmacies. Emollient creams are soothing for sore skin and can be recommended by your pharmacy. Be aware that there is a fire risk with creams of this type, so avoid smoking or being near to people who smoke. Do not sit too close to open fires.
• maintain an active lifestyle; activities such as walking, dancing gardening and exercise classes can help your bowel and bladder function as well as being enjoyable and keeping you fit

These are some useful contacts:

The Continence Team
Buckinghamshire Healthcare NHS Trust.
Brookside Clinic
Station Way East
Aylesbury
Buckinghamshire.
HP20 2SR

Tel: 01296 831060
www.buckshealthcare.nhs.uk

Alzheimer’s society
Contact them for useful advice regarding incontinence and using the toilet.

Tel: 0333 150 3456
Alzheimers.org.uk