Urinary 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

Urinary incontinence is when someone accidentally leaks pee. It’s very common in older people, especially those who have Alzheimer’s disease.

Urinary incontinence isn’t usually a health problem by itself, but you should let their doctor know if it’s happening.

Leakage that happens or gets worse suddenly is usually a sign of a treatable problem such as constipation, an infection, or a side effect of medicine. The kind that happens slowly as Alzheimer’s disease goes on can’t be cured, but you can do some things to manage it.

Get medical help for your loved one right away if they can’t pee in many tries over several hours and have lower belly pain. This could be a sign of a blockage in the urethra (the tube that carries urine away from the bladder).

Urinary incontinence sometimes happens along with an infection. Call their doctor if you see any of these signs along with urine leakage:

Types

There are four main types of urinary incontinence. It’s possible for someone to have more than one kind at a time.

Urge incontinence. This is often called “overactive bladder.” It happens when the muscles around the bladder squeeze at the wrong time. This gives someone a sudden urge to pee, and they may not always make it to bathroom in time. This is the most common cause of incontinence in people with Alzheimer’s disease because changes in the brain gradually take away the ability to hold pee in.

Functional incontinence. This is when someone can’t get to the toilet because they can’t move quickly enough, or they may not realize they have to pee. It often happens in people who are depressed, have Alzheimer’s disease, have serious muscle weakness, or can’t walk.

Stress incontinence. This is when small amounts of pee leak out when someone coughs, laughs, sneezes, or does something active. It happens more often in women, especially if they’ve had children. Childbirth can stretch and weaken the muscles around the bladder.

Overflow incontinence. This happens when a person can’t empty their bladder all the way, and pee leaks out of a full bladder. It’s often caused by diabetes, multiple sclerosis, prostate disease, constipation, and certain medications.

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Home Care

One of the easiest things you can do is to keep a record of when the leakage happens. This is called an incontinence log. It helps the doctor figure out why it’s happening and what the best treatment plan might be. It can also help you know when your loved one needs to use the bathroom so you can make a planned “pee break” schedule.

It’s also important to keep your loved one comfortable and dry -- wetness can irritate their skin. Check them regularly (at least every 2 hours). Call their doctor if their skin is irritated or damaged. Over-the-counter products, like petroleum jelly, can help protect their skin.

After each accident, wash the area with soap and water and dry it. Adult wet wipes can help make cleanup easier. Wear disposable gloves, and wash your hands before and afterward.

Try different absorbent pads and briefs to see what works best. Ones made just for men or for women are likely to be more comfortable and fit better. Disposable pads can be used to protect the sheets and cut down on bed changes. You can also use rubberized flannel baby sheets.

Your loved one may have sudden urges to go, so make sure they can get to the bathroom easily. Keep the bathroom door open when no one’s in there, clear the path of obstacles and throw rugs, and leave lights on nearby at all times. If they have trouble getting themselves to the bathroom, have them use a bedside commode, urinal, or bed pan.

It helps to have them wear clothes that are easy to take off when they use the bathroom. Instead of buttons and zippers, use Velcro straps and elastic waist bands. Install a raised toilet seat and grab bars.

People in the middle or late stages of Alzheimer’s disease will sometimes tell you they need to go with “trigger words” that don’t have anything to do with using the bathroom. They might also show signs of restlessness or anxiety. Pay attention to how they act right before they have an accident to learn the signs that they need to go.

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Once you know these signs, watch your loved one for them. Remind them to let you know if they need to pee. Then help them use the bathroom on a set schedule. This can be based on their incontinence log, or every 2 hours. Give them positive feedback when they stay dry or go to the toilet.

Keep in mind that your loved one may not always want your help in the bathroom. Be patient, and help them to be as independent as they can. Give them plenty of time. Step out or look the other way if they seem uncomfortable with you there. Give step-by-step directions and encourage them if they need it, but try not to sound annoyed or treat them like a child.

Prevent Urinary Tract Infections

You might think someone is leaking urine because they drink too much, but this usually isn’t the case. If you hold back fluids, your loved one can get dehydrated and be more likely to get urine infections.

If they have accidents at night, it’s OK for them not to drink for 3 hours before bedtime, as long as they get plenty of fluids during the day. Alcohol and caffeine can make people need to pee more, so don’t offer them in large amounts, and stay away from them before bedtime.

  • Help your loved one to drink lots of fluids by offering drinks they like often. Their urine should be a light yellow to clear color.
  • When you clean the vagina, always wipe from front to back, to keep bowel bacteria out of the vagina.
  • Keep them from getting constipated by helping them eat a high-fiber diet.
  • Try cranberry juice or tablets. Some studies have shown that these may help prevent infections. While other research doesn’t agree, it’s generally regarded as safe and may help. Just be sure your loved one isn’t on any medications that shouldn’t be taken with cranberry juice.
  • For women, talk to a doctor about a vaginal estrogen cream to help prevent UTIs.

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Catheters

If urinary leakage is an issue, you may wonder if it would be easier for your loved one to use a catheter (a thin tube that brings urine from the bladder, through the urethra, out into a bag). Most doctors agree this isn’t a good idea because bacteria can move up the catheter into the bladder. This makes the risk of infection very high. Also, the catheter can be uncomfortable and irritating to your loved one, and it may cause bleeding.

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:

Alzheimer’s Association: “Incontinence.”

American Academy of Orthopaedic Surgeons: “Lifting Techniques for Home Caregivers.”

Washington State Department of Social and Health Services: “Caregivers’ Handbook: A Guide for Family and Other Unpaid Caregivers Who Care for an Adult or Senior with Disabilities.”

American Family Physician: “Diagnostic Evaluation of Urinary Incontinence in Geriatric Patients.”

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