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ALZHEIMER’S DISEASE: VOLUNTARY INCONTINENCE OF URINE AND FAECES
Voluntary incontinence of urine
As the bladder fills with urine a stage is reached when we realize that we could pass urine if we wanted to and if it was appropriate, but at this stage it is not urgent – we can suppress this sensation, for example, when sitting in the cinema or on a bus. Some time later, however, another sensation tells us that we have to go soon. Gradually the feeling gets more urgent and painful. If stuck in a lift or tied to a chair, all of us would inevitably have to pass urine, i.e. be voluntarily incontinent. We would know what was happening, but force of circumstance would cause the incontinence.
A person with Alzheimer’s disease in a strange environment will suffer this latter fate; they know that they need to go but often cannot communicate this or else can’t find the toilet. The person is then either incontinent or they pass urine in an unacceptable place (sink, waste bin, etc.). Carers and others often know when the toilet is needed because the sufferer gets a little more agitated, begins to get up and wander and may clutch their private parts. Guiding them to a toilet quickly often saves the day. The environment is thus extremely important, not only for the mentally confused but also the other main group that are prone to voluntary incontinence, the immobile. A person with a physical handicap (such as a stroke) will find the stairs up to or down to a public toilet as daunting as you or I would find climbing Everest. A poorly designed environment can mean misery to the disabled and a lot of bladder discomfort.
Drugs (especially diuretics/water tablets) can cause sudden incontinence. The strong acting ones begin to work within minutes and fill the bladder so quickly that the incontinence starts before the person is really aware of it, especially if they are a little confused and perhaps slightly immobile. Some people sit on the toilet for a good few hours after taking their tablets, until the danger of incontinence has worn off. It is simpler and better to see one’s doctor and change the medication.
We should perhaps remember that for millions of people passing urine when and where they like is a fact of life and as culturally accepted as our use of toilets with all mod cons.
Voluntary incontinence of faeces
This is much less common, but the same basic principles as above apply. It is easy enough to ignore the desire to have one’s bowels open, and eventually the urge can go away (the motions move back up the large bowel). However if this is done frequently then the motions dam up and get passed involuntarily.
Confusion is again one of the main causes of voluntary incontinence of faeces, and being able to find a toilet the best way of treating it. Thus the environment and immobility also play an important role. Again, cultural differences spring to mind, for in some countries faeces form the basis of manure in the fields and are passed accordingly.
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