Bowel Incontinence and Alzheimer’s Disease

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Logo for UNC Chapel Hill, Cecil G. Sheps Center

Bowel incontinence is when someone leaks stool or has an entire bowel movement by accident. This might be because they couldn’t get to the bathroom in time or didn't realize what’s happening. It’s common in people who have Alzheimer’s disease.

Bowel incontinence isn’t usually an urgent problem, but get medical help right away if your loved one has:

If your loved one has a bloody bowel movement, stay calm. These aren’t usually serious. Help them clean up, and as you do, try to estimate the amount of blood. If it’s just a little, it may be caused by something simple, such as the frequent use of toilet paper, hemorrhoids, or irritation to the anus or rectum.

In some cases, if there’s only a small amount of blood, it may be OK to watch and see if it comes back. But if your loved one is on blood thinners, get medical help right away.

Call their doctor if they have:

  • Bowel incontinence and a low-grade fever that are new or getting worse
  • Bowel incontinence that starts or gets worse after starting a new medicine
  • Bowel incontinence with diarrhea and belly pain or nausea
  • More than six unformed or watery stools in a 24-hour period
  • Constipation for several days, followed by bowel incontinence
  • Greasy, pale, or foul-smelling stools
  • Red, raw, tender, or open skin on the buttocks or around the genitals

You should also call their doctor if you notice signs of dehydration (when you don’t drink enough liquid to meet your body’s needs). These can include:

  • Dry mouth, nose, or eyes
  • Urinating very little, or not urinating for 8 or more hours
  • A dry tongue, especially if it’s so dry it has grooves or furrows in it
  • Sunken eyes
  • A heart rate faster than 100 beats per minute
  • Being less alert or more confused than usual
  • Extreme weakness
  • Dark yellow urine
  • Trouble speaking

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Causes of Bowel Incontinence

There can be many causes for incontinence in someone with Alzheimer’s disease. It can be related to the dementia itself. The person may not recognize the urge to go or may have trouble finding the bathroom or taking off clothing.

Other reasons for bowel incontinence include:

  • Poor diet
  • Side effects of medicines
  • Severe constipation
  • Medical reasons including chronic bowel disease, diabetes, Parkinson’s disease, and urinary tract infections
  • Weakness from surgery
  • Diarrhea from a virus or bacterial infection

Home Care

If your loved one has a large bowel accident, try to stay calm and reassuring. If they seem upset, try a distraction like calming music while you help them clean up.

Take off the soiled clothes as soon as possible. Wear gloves and keep the clothes away from their hands and face. Wash their genital area with a soft washcloth and mild cleanser. You can also use adult wipes without chemicals, perfumes, or alcohol. When you clean the vagina, be sure to wipe from front to back to keep bacteria from being carried inside. If there’s a large mess, help them wash in the tub or shower. Pat the skin dry before helping them get dressed.

If accidents happen often, use absorbent briefs to make cleanup easier. Protect their skin with an over-the-counter product like petroleum jelly.

Be sure to use gloves when cleaning up bowel accidents. Wash your hands well after helping in the bathroom or cleaning up accidents. Wash all soiled clothes and linens in hot water. Use a germ-killing cleaner in the bathroom and other areas in contact with stool.

If your loved one won’t eat or drink because they’re afraid of having a bowel accident, be supportive and matter-of-fact. Tell them you’re there to help and it’s not their fault. Remind them that bowel movements are normal and that food and drink won’t cause the accidents.

Safety Tips

You can do a few things to make the accidents happen less often and prevent complications.

Make sure they have easy access to the bathroom, and help them with toileting as needed.

  • Keep the path to the bathroom clear and well lit.
  • If they have trouble finding the bathroom, keep the bathroom door open so they can see inside. Use brightly colored reflective tape to mark the doorway.
  • Some people need privacy in the bathroom, while others don’t mind company. If they seem uncomfortable, look away or leave the room, but stay nearby.
  • Give them plenty of time to be sure they’ve finished the bowel movement.
  • If they seem restless, give them something to hold or listen to while they sit.
  • If they’re confused about how to use the toilet, gently give them step-by-step instructions. For example, you might pat the toilet and say “Put your bottom here.”
  • Have them wear clothing that's easy to take off. Instead of buttons and zippers, try Velcro straps and elastic waistbands.
  • If none of these work, have them use a bedside commode or bed pan.

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People with Alzheimer’s disease may not know they need to use the bathroom. They may also be unable or embarrassed to ask for help. By watching their behavior, you may be able to help them to the bathroom in time.

For example, they may suddenly get restless or upset. They may pace, make sounds, or tug at their clothes. Other times, they may suddenly get quiet or stop what they’re doing.

You also might start a toileting routine:

  • Keep track of when they have urine or bowel accidents to note any patterns. It may help to keep a log for several days.
  • If you find that bowel movements tend to happen at a certain time of day, such as right after morning coffee, try gently helping them sit on the toilet at that time. Bowel movements are common after meals.

Constipation Issues

If your loved one is afraid of an accident, they may eat poorly or hold stool in and become constipated. Signs of constipation include:

  • Straining or pushing very hard with bowel movements
  • Hard stools
  • Having two or fewer bowel movements per week
  • Feeling like they still “have to go” after a bowel movement, like there’s something blocking stool from coming out, or that they need to use their fingers to get stool out

Severe constipation happens when someone can’t have a bowel movement for several days or more.

To help keep this from happening, offer them between 4 and 6 cups of their favorite fluid every day. Stay away from alcohol and caffeine. Help them eat a healthy, high-fiber diet. Fruits, vegetables, and whole grains are high in fiber. Aim for between 20 grams to 35 grams of fiber every day. If it’s hard for them to get enough fiber in the foods they eat, try an over-the-counter fiber supplement like calcium polycarbophil (Fibercon), methylcellulose (Citrucel), psyllium seed (Metamucil), or wheat dextran (Benefiber). Encourage physical activity like walking or stretching every day.

Severe constipation can lead to a fecal impaction, which is when a hard ball of stool creates a blockage in the gut. Often liquid stool leaks around the blockage, making it seem like a case of diarrhea. This is sometimes a cause of bowel incontinence.

Your loved one may have a fecal impaction if they go several days without bowel movements, followed by sudden watery diarrhea. They may also have belly pain, swelling, or vomiting, especially after eating. If you think there’s a fecal impaction, call their doctor right away, and don’t give diarrhea medicine.

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Reviewed by Melinda Ratini, DO, MS on August 24, 2018

Sources

SOURCES:

International Foundation for Functional Gastrointestinal Disorders: “Prevalence of Bowel Incontinence.”

Journal of Advanced Nursing: “Nurses’ Knowledge and Beliefs About Continence Interventions in Long-Term Care.”

Nursing Standard: “Educating Home Caretakers on Fecal Continence in People with Dementia.”

Vital Health Statistics: “Prevalence of Incontinence among Older Americans.”

Alzheimer’s Association: “Incontinence.”

Today’s Caregiver: “Dementia and Incontinence Treatment.”

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