Alzheimer’s disease is a progressive neurodegenerative disorder that affects memory, thinking, and behavior. As Alzheimer’s progresses, it can impact nearly all aspects of daily living, including bowel and bladder function.
Summary
In the early and moderate stages of Alzheimer’s disease, bowel changes are relatively mild. Constipation is more common than diarrhea or incontinence. As the disease advances to later stages, bowel issues tend to become more severe. Incontinence, diarrhea, and constipation are all common. Specific bowel changes that can occur with Alzheimer’s include:
- Constipation
- Diarrhea
- Fecal incontinence
- Difficulty sensing the urge to have a bowel movement
- Forgetting to go to the bathroom
Bowel control problems in Alzheimer’s are often related to damage in the brain regions that regulate defecation reflexes. Loss of independence and mobility as Alzheimer’s progresses can also contribute. Caregivers can help manage bowel issues in Alzheimer’s patients by establishing a bathroom routine, ensuring adequate hydration and fiber, and using incontinence pads.
Bowel changes in early Alzheimer’s
In the early stages of Alzheimer’s disease, bowel changes tend to be relatively mild. Many people with early Alzheimer’s do not experience significant effects on their bowel movements or continence.
However, some common bowel-related symptoms in early stage Alzheimer’s include:
- Constipation – Straining to pass hardened stool is more common than loose stool or diarrhea in early Alzheimer’s. Constipation may result from reduced fluid intake, less physical activity, medication side effects, or dietary changes.
- Forgetting to go to the bathroom – Short-term memory loss can make patients forget to go to the bathroom at regular intervals. They may urinate or defecate less frequently.
- Incomplete evacuation – Some patients have difficulty fully emptying their bowels due to weakened abdominal muscles or incomplete relaxation of the pelvic floor.
Patients in the early stages of Alzheimer’s disease are often still continent of bowel movements. However, constipation needs to be prevented and treated to avoid complications like impaction or bowel obstruction.
Bowel problems in moderate Alzheimer’s
As Alzheimer’s disease progresses to the moderate stage, bowel symptoms typically become more pronounced. bladder control is also affected.
Common bowel problems in moderate stage Alzheimer’s include:
- Increasing constipation – Due to immobility, poor hydration, and medication side effects
- Fecal incontinence – The inability to control bowel movements
- Diarrhea – From infection, medication effects, or digestive changes
- Hesitancy or straining – Difficulty initiating bowel movements
- Bowel obstruction – From severe constipation or improperly chewed food
By the moderate Alzheimer’s stage, significant brain cell death has occurred in regions that control defecation reflexes. This affects the ability to sense rectal fullness and contract the anal sphincter.
Bowel impairment in late-stage Alzheimer’s
In late or severe Alzheimer’s disease, bowel problems are quite prevalent:
- Urinary and fecal incontinence – Loss of bowel and bladder control occurs in at least 50-60% of late-stage Alzheimer’s patients
- Diarrhea – Both infection-related diarrhea and medication-induced diarrhea are common
- Constipation – Due to immobility and inadequate hydration
- Bowel obstruction – From severe constipation or fecal impaction
- Hernias – From constant straining
- Hemorrhoids – Related to constipation and prolonged siting/lying down
Severe Alzheimer’s patients often need assistance toileting or may require adult diapers. Meticulous perineal hygiene is required to prevent skin breakdown.
Factors that contribute to bowel problems in Alzheimer’s
Several factors can contribute to the bowel issues that occur with Alzheimer’s progression:
- Brain changes – Alzheimer’s causes degeneration in brain regions like the frontal cortex that control bowel and bladder function. This affects the defecation reflex.
- Immobility – Lack of activity leads to slowed gastrointestinal motility and constipation.
- Medications – Drugs for Alzheimer’s symptoms like anticholinergics can cause constipation. Laxatives and antipsychotics may cause diarrhea.
- Dehydration – Inadequate fluid intake exacerbates constipation.
- Diet – Lack of fiber, fruits, and vegetables can worsen constipation issues.
- Infections – Urinary tract infections and gastroenteritis infections often cause diarrhea in Alzheimer’s patients.
- Impaired chewing/swallowing – May increase choking risk and cause diarrhea or constipation.
- Reduced physical strength – Weakened abdominal muscles make it difficult to bear down to evacuate stool.
Both Alzheimer’s-related neurodegeneration and secondary factors impact bowel function as the disease advances.
Typical bowel patterns in Alzheimer’s
While bowel patterns can vary greatly, there are some typical changes seen at different stages of Alzheimer’s:
| Alzheimer’s Stage | Typical Bowel Pattern |
|---|---|
| Early-stage | Mild constipation |
| Moderate-stage | Constipation and diarrhea |
| Late-stage | Fecal incontinence, constipation, diarrhea |
The bowel issues grow more severe and complex as Alzheimer’s progresses. Careful management is needed to prevent complications.
Can constipation cause Alzheimer’s?
There is no evidence that constipation directly causes Alzheimer’s disease or dementia. The characteristic brain changes of Alzheimer’s are due to amyloid beta plaques and neurofibrillary tangles, not constipation.
However, severe chronic constipation may potentially contribute to cognitive impairment indirectly. For example:
- Chronic laxative use can alter electrolyte balances, potentially affecting brain function
- Straining to defecate can reduce blood flow, depriving the brain of oxygen
- Impaction risk may necessitate bowel obstruction surgery, which carries risks of anesthesia effects on cognition
Overall, routine constipation is unlikely to impact Alzheimer’s risk or prognosis. But badly managed constipation can potentially have indirect effects on the brain.
Can Alzheimer’s be mistaken for bowel disorders?
The cognitive and behavioral symptoms of Alzheimer’s disease can sometimes overlap with symptoms of bowel disorders like irritable bowel syndrome (IBS). For example:
- Anxiety and restlessness may occur in both IBS and Alzheimer’s dementia
- Sleep disturbances are common to Alzheimer’s and IBS
- IBS diarrhea and constipation can also happen in Alzheimer’s
- Forgetting to eat or take medications may mimic IBS flares
Due to the overlapping symptoms, mild Alzheimer’s dementia can occasionally be mistaken for IBS or vice versa. Thorough evaluation by a gastroenterologist and neurologist is needed to distinguish between the two conditions.
Tips for managing bowel problems in Alzheimer’s
Caregivers can help prevent and manage bowel problems in Alzheimer’s patients using strategies like:
- Maintaining a regular and predictable bathroom schedule
- Reminding the patient to use the toilet every 2-3 hours
- Ensuring adequate daily fluid intake to prevent constipation
- Serving high fiber foods like fruits, veggies, and whole grains
- Giving laxatives or stool softeners for constipation, if needed
- Using incontinence briefs or pads for accidental leakage
- Monitoring for signs of infection or obstruction
- Consulting with a doctor if significant diarrhea or constipation occur
With attentive care and bowel management, Alzheimer’s patients can often avoid extensive GI complications.
When to see a doctor
Consult a physician promptly if an Alzheimer’s patient experiences:
- Blood in stool
- Black, tarry stools
- Persistent vomiting
- Severe diarrhea lasting over 48 hours
- No bowel movement for 3+ days
- Abdominal pain or distension
- Constant fecal incontinence
These can indicate an obstruction, impaction, infection, or other complication requiring medical treatment.
Conclusion
Bowel symptoms like constipation, diarrhea and incontinence frequently occur in Alzheimer’s disease. Issues are typically mild in early stages but worsen with progression. Contributing factors include brain changes, reduced mobility, medications, dehydration, and infections. Careful bowel management can often prevent complications. Consult a doctor promptly for blood in stool, persistent diarrhea/vomiting, or lack of defecation for multiple days, as these may indicate a serious complication requiring treatment.