Urinary incontinence in dementia - a practical approach

Urinary incontinence is a common problem in dementia. Almost invariably, the person with dementia will develop incontinence as the disease progresses. However, the primary reasons for incontinence are often not because of any significant pathology in the urinary system. Rather, it is due to factors outside the urinary system. The term 'functional incontinence' has hence been applied. Maintenance of continence requires mobility, manual dexterity, mental capacit and motivation. Clearly, the person with dementia is vulnerable to developing problems in these domains.

This article provides a comprehensive overview of how the stage and type of dementia may account for cognitive and functional deficits, the psycho-emotional world and behaviour of the patient, their care environment, and possible medical factors and pathology in the urinary system.

Management is directed at turning around reversible factors, preserving independence and dignity of the patient, and providing sensitive and empathetic care even if the problem is not completely remediable. In those with more advanced dementia, timed and prompted voiding have shown the most promise.