How to Cope with Bowel & Bladder Complications

Incontinence, or a loss of bowel and/or bladder control, is common as we all age. In general, incontinence can be caused by a variety of things. However, with a medical condition like Alzheimer’s disease, causes can include: forgetting where the bathroom is, not recognizing the need to go to the bathroom, other medical conditions, medication side effects, stress, constipation, or trouble removing clothing.¹ Approximately 60 to 70 percent of individuals with Alzheimer’s will experience some incontinence issues at some point as the disease progresses.² Symptoms can include trouble fully emptying the bladder, leaking urine or stool, and stained underwear or bed sheets. While incontinence can happen in any stage of Alzheimer’s disease, it’s most common in later stages.³

If you suddenly experience a loss of bladder or bowel control, tell your doctor. It is important that the underlying cause is determined. If it’s something like a urinary tract infection or a prostate issue, these things can be addressed; if a medication is causing incontinence, the drug may be changed or the dosage decreased. If the cause is a medical condition or worsening of your Alzheimer’s disease, you and your doctor can discuss plans of action and ways you and your caregiver can address this.

Bowel issues in Alzheimer’s disease

Both constipation and bowel incontinence can occur in Alzheimer’s disease, for a variety of reasons. A person may not be eating a balanced diet or enough food or liquid, leading to constipation; or they may not be able to recognize the signs of having to have a bowel movement, and so they have bowel incontinence and soil their clothes. Medication may cause constipation, and it’s important to keep track of medications the person is taking and any possible side effects like constipation or diarrhea.

If constipation is an issue not resolved by dietary changes, sometimes over-the-counter laxatives are helpful. Talk with the store pharmacist or the person’s physician about which kind of laxatives would be better, either bulking laxatives (which work the same way fiber does, making it easier for stool to pass), or stimulant laxatives, which encourage the gut to excrete the stool.²

Bladder issues in Alzheimer’s disease

In addition to not being able to recognize the urge to urinate, bladder incontinence may occur in those with Alzheimer’s because of mobility issues, prostate problems, medications, or not being able to remove clothes in time. Urinary tract infections can also occur due to medications, soiled clothing (bacteria getting into the urinary tract), and dehydration.^1,2 Helpful products can include incontinence pads and pants, which can help draw urine away from the skin; a male continence sheath, which fits over the penis with an attached leg bag and can be helpful at night; and bed pads or mattress protectors.²

If a urinary tract infection (UTI) develops, symptoms can include burning with urination, pain in lower back or abdomen, a frequent and intense need to urinate, fever or chills, cloudy urine, or significant fatigue. The person needs to see their general practitioner, who will be able to test for a UTI and can then prescribe antibiotics. If UTIs are recurrent, the doctor may choose to prescribe a low dose antibiotic that is taken regularly, to hopefully prevent further infections.²

Tips and tricks to address bowel & bladder issues

There are things that can be done to address bowel and bladder incontinence and reduce the risk of any accidents. Find what works best for the person with Alzheimer’s disease, and try to find ways to incorporate these things into an everyday routine:^1,2

• Have the person wear clothing that is easy to pull up and down: clothing that can be easily removed can help cut down on time in the bathroom and may help reduce trouble figuring out how to take it off to use the bathroom
• Set up a routine: use the bathroom after each meal or at a specified interval throughout the day
• Take the time: don’t rush in the bathroom, give the person enough time to empty their bladder and/or bowels
• Consider using continence products like incontinence briefs, bed pads, or mattress protectors
• Limit fluids as the evening goes on, especially if incontinence is happening at night; avoid alcohol and caffeine which may make the person need to urinate more
• Clearly label the bathroom as such
• If there are safety concerns, consider installing grab bars near the toilet or a raised toilet seat to help make toileting easier
• Consider a bedside commode during the night

For caregivers

In addition to the above-mentioned tips, here are some caregiver-specific recommendations:¹

• Notice nonverbal cues like hiding, tugging on clothing, pacing, sudden silence, and facial expressions; these can all signal the need to use the bathroom
• Keep a record of when accidents occur; this can help provide the doctor with more information and any pattern that might exist
• Ask the person if they need to use the bathroom at regular intervals (every 2-3 hours)
• Be patient if accidents happen; stay calm and be reassuring
• Assist the person in a public restroom
• Keep the path to the bathroom free of obstacles such as throw rugs
• Make sure to keep everything dry; if the skin is irritated, call the doctor. Petroleum jelly may help protect the skin

If an individual is experiencing bowel or bladder issues or incontinence, talk with the doctor about it. This is a common part of the disease, and the doctor can discuss a daily routine and food and drink intake, and if necessary, review all of the medications, and do an exam to find out what may be causing the incontinence. This is treatable and manageable, and a person with Alzheimer’s disease doesn’t have to be isolated with this.