Dementia is a general term used to describe various symptoms of cognitive decline and memory loss. One of the many questions that caregivers and family members of dementia patients often ask is whether the disease affects a person’s ability to control bowel movements or “forget how to poop”.
What causes bowel control issues in dementia patients?
There are a few reasons why dementia patients may experience fecal incontinence or difficulty controlling their bowels:
- Damage to the brain regions that control bowel movements – Areas like the frontal lobe and basal ganglia help regulate bowel control. Dementia damages these areas.
- General memory loss – Forgetting to go to the bathroom or not recognizing the urge to go.
- Muscle weakness – Not being able to fully relax the anal sphincter or pelvic floor muscles.
- Medication side effects – Some medications like diuretics can cause urgency.
- Reduced mobility – Having trouble getting to the bathroom in time.
- Loss of inhibition – Forgetting social norms and going wherever when needed.
So while dementia patients don’t completely “forget” how to poop, the disease affects the systems involved in controlling and holding bowel movements.
How common is fecal incontinence in dementia patients?
It’s estimated that anywhere from 30-60% of people with dementia experience fecal incontinence or bowel control issues. Some key statistics:
- One study found 41% of dementia patients in nursing homes had regular fecal incontinence.
- Other studies show rates as high as 60% in late-stage Alzheimer’s patients.
- Incontinence is more common in vascular and Lewy body dementia than Alzheimer’s.
- Men with dementia may experience fecal incontinence more than women.
So loss of bowel control is a common and expected symptom as dementia progresses. However, it still causes distress and poses health risks for patients.
Can dementia patients lose the ability to feel when they need to poop?
Yes, many dementia patients lose that sense of rectal fullness and the urge to have a bowel movement. There are a couple reasons behind this:
- The rectum and intestine send signals to the brain when stool is ready to be evacuated. Dementia disrupts these pathways.
- The prefrontal cortex also helps regulate defecation urges. Damage to this area makes patients less aware.
- Dementia patients may not recognize the meaning of rectal signals to poop.
This reduced bowel awareness combined with memory loss is why some dementia patients will pass stool without consciously knowing they had to go. The intrinsic ability to poop is still there, but the urge and control become impaired.
Do dementia patients forget where the bathroom is located?
Yes, dementia patients’ memory loss and confusion can make it difficult for them to remember where the bathroom is located. A few things that can happen:
- They may not recall the bathroom location in an unfamiliar place.
- They can get lost or disoriented while trying to walk to the bathroom.
- They might mistake a closet or other room for the bathroom.
- Loss of inhibition makes them urinate or defecate wherever is convenient.
Even in a familiar home, a dementia patient’s spatial memory and recognition of rooms can deteriorate. This contributes to bathroom accidents. Providing visual cues like signs can help trigger their memory.
Do dementia patients remember how to use the toilet?
In the early stages of dementia, most patients retain the ability to use the toilet, wipe, flush, wash hands, etc. But as cognition declines they can begin to forget steps involved in toileting or using the bathroom properly. Difficulties include:
- Forgetting to lift the toilet seat up (men)
- Not wiping properly after urinating or having a bowel movement
- Forgetting to flush the toilet
- Not washing hands after using the bathroom
- Attempting to use furniture items or random objects as a toilet
Re-teaching toileting skills by providing verbal cues and positive reinforcement can help dementia patients re-learn how to use the bathroom correctly.
What hygiene issues are caused by loss of bathroom skills?
Dementia patients who have trouble controlling bowels or using the toilet properly often experience hygiene issues like:
- Sitting in stool or urine leading to skin irritation
- Spreading feces to clothes, furniture, floors due to incomplete wiping
- Strong odors from retaining stool in underwear
- Embarrassment or isolation due to poor hygiene
- Greater risk of urinary tract infections and skin infections
Good perineal hygiene is important for managing bowel incontinence in dementia. Gentle cleaning after each episode, moisture barriers, and frequent clothing changes can help.
What health risks are caused by bathroom issues in dementia?
Dementia patients who cannot properly toilet or clean themselves are at risk of:
- Skin breakdown – Moisture from urine or stool macerates skin over time.
- Pressure ulcers – Sitting in one position in wet undergarments increases ulcer risk.
- Urinary tract infections – Bladder control loss increases UTI risk.
- Sepsis – Bacteria from pressure ulcers or UTIs can enter bloodstream.
- Dehydration – Inability to toilet leads to limiting fluid intake.
- Falls – Rushing to the bathroom or attempting to use it unsafely.
Ongoing incontinence care, good hygiene, and early treatment of infections helps reduce these health risks for dementia patients.
What communication strategies help dementia patients use the bathroom?
Here are some tips for communicating bathroom needs to someone with dementia:
- Use simple, clear phrases like “Time to go to the bathroom now”
- Remind them frequently to go and avoid waiting for them to tell you
- Have set toileting schedules to prevent accidents
- Use visual cues like pictures of a toilet on the bathroom door
- Guide them gently to bathroom instead of relying on directions
- Stay positive – don’t scold bathroom accidents
Being consistent and providing cues, reminders and reassurance helps compensate for memory loss around toileting.
What adaptations help dementia patients use the toilet independently?
There are many adaptive devices and home modifications that make toileting easier for dementia patients such as:
- Raised toilet seat with grab bars
- Bedside commode or urinal
- Motion sensor night lights guiding the bathroom path
- Large visual signage and arrows pointing to bathroom
- Removing locks or obstacles that hamper access
- Toilet safety rails and frames providing stability
- Automatic flushing toilets
Consulting an occupational therapist can help identify assistive toileting options tailored for each patient’s needs and home layout.
What are the best incontinence products for dementia patients?
Recommended incontinence products for dementia patients include:
- Absorbent adult underwear: Disposable underwear looks normal but has absorbent pads sewn in.
- Maximum absorbency pads: Large, overnight size pads absorb more liquid and can be worn longer.
- Waterproof mattress pads: Protect mattresses from urine and spilled liquids.
- Moisture barrier ointments: Cream forms a protective layer to avoid skin irritation.
- Peri-wash cleansing gels: No-rinse formula gently cleans without irritating skin.
The most suitable products depend on the severity of incontinence and the patient’s skin condition. A continence nurse can recommend appropriate options.
What routine helps manage bathroom needs for dementia patients?
A structured routine around bathroom use can help dementia patients maintain continence longer. Useful tips include:
- Take to the toilet every 2 hours during the day.
- Limit fluid intake 2 hours before bedtime.
- Encourage using the toilet before and after meals.
- Use audio and visual reminders when it’s time to go.
- Assist with cleansing and changing soiled clothing right away.
- Track accidents to identify patterns causing leakage.
Recording bowel movements also helps identify constipation issues early. Having a consistent, patient toileting routine makes the process easier for dementia patients.
When should families consider using adult diapers for dementia patients?
It’s reasonable to introduce adult diapers or absorbent briefs when the dementia patient:
- Is incontinent multiple times per day
- Is resisting sitting on the toilet when guided
- Can no longer communicate need to use bathroom
- Has skin integrity issues from moisture
- Is up frequently at night to change wet garments
Ideally, try other solutions first like prompted voiding, limiting fluids, and timed toileting before moving to diapers full time. Work with a doctor or nurse for guidance.
How can families help keep dementia patients clean after bathroom accidents?
Tips to help keep dementia patients clean after incontinence episodes or bowel accidents:
- Use pH balanced wipes to gently clean the perineal area front to back.
- Apply protective moisture barrier cream after each cleaning.
- Rinse soiled clothing in cold water, change bedding promptly.
- Schedule showers/baths for patient daily or every other day.
- Use incontinence pads, pants, chucks to contain leakage.
- Keep extra clothes, pads, and cleaning supplies accessible.
Staying on top of accidents and using good hygiene practices reduces odor, skin breakdown, and supports the patient’s dignity.
When should a dementia patient’s bathroom difficulties warrant medical attention?
See a doctor or nurse if the dementia patient has:
- Blood or pus in urine or stool
- No bowel movement in 3+ days, straining to pass stool
- Frequent diarrhea lasting over 72 hours
- Vomiting that prevents keeping down food/fluids
- Skin rashes, open sores, or tears in skin from moisture
- Burning sensation or pain when urinating
- Fever over 100 F, chills, foul-smelling urine
Routine urinalysis, stool tests, and physical exams help diagnose underlying infection or constipation issues.
When is surgery an option for improving bathroom functions in dementia?
Surgical options may be considered for dementia patients who have:
- Severely prolapsed bladder: Surgery can reposition bladder to prevent urine leakage.
- Blocked urinary flow: Surgeries like TURP remove prostate tissue obstructing urine flow in men.
- Difficulty emptying bladder: Botox injections in bladder muscle can help urine flow.
- Anal sphincter dysfunction: Sacral nerve stimulation helps tighten muscles.
- Rectal prolapse: Surgery can repair/remove section of protruding rectum.
The risks and benefits must be weighed carefully before surgery due to anesthesia risks and dementia patients’ limited ability to cooperate post-operatively.
How can families cope with bathroom care for a dementia patient?
Caring for a dementia patient’s toileting needs can be challenging. Tips to cope include:
- Take breaks from care duties and get respite help.
- Join support groups to exchange self-care tips.
- Focus on each small accomplishment.
- Invest in care aids like disposable pads, raisilifts, etc.
- Adjust expectations as patient declines and celebrate small victories.
- Meet the patient where they’re at each day/moment.
- Remember it’s the disease, not the person, causing this loss of function.
Being honest about care challenges and prioritizing your own needs equips you to handle this difficult role in a sustainable way.
Conclusion
Dementia patients often experience urinary and fecal incontinence as their cognitive abilities decline. While they may not completely “forget” how to use the toilet, damage to brain regions controlling bowel movements along with confusion and memory loss makes it increasingly difficult. Implementing toileting routines, using adult briefs as needed, adapting bathrooms, and watching for infections helps manage bathroom challenges. Medical oversight, open communication with families, and engaging home care support improves quality of life despite this loss of independence in toileting.