Dementia significantly impacts bowel function, and changes to bowel habits are a common, though often overlooked, symptom associated with the progressive decline in cognitive function. The disease interferes with the complex neurological signals that govern the digestive system. This neurological breakdown, combined with other physical and behavioral changes, makes bowel problems a frequent occurrence as the disease advances.
How Dementia Affects Control Over Bowel Function
Bowel control relies on a sophisticated communication loop between the gut and the brain, a system that dementia progressively disrupts. Neurological damage interferes with the autonomic nervous system, which controls involuntary functions like gut motility or peristalsis. This disruption results in the muscular contractions that move waste through the intestines becoming slower and less coordinated.
Cognitive decline also erodes the ability to recognize internal cues, meaning the person may no longer sense the urge to defecate. The complex sequence of toileting becomes challenging to initiate and complete. This includes difficulty finding the bathroom, removing clothing, or sitting down in time.
Reduced physical mobility, a common consequence of advanced dementia, further slows the digestive process. When a person is less active, movement no longer assists the natural transit of stool through the colon, exacerbating the sluggishness caused by neurological changes.
Common Bowel Issues: Constipation and Incontinence
Constipation is the most frequent bowel issue experienced by people with dementia, often preceding the onset of incontinence. This problem stems directly from slowed gut motility, decreased fluid intake, and the inability to recognize or communicate the need for a bowel movement. When stool remains in the colon for too long, more water is absorbed, making the waste hard and difficult to pass.
Severe constipation can lead to complications, including fecal impaction, where a mass of hard stool becomes lodged in the rectum. Liquid stool may leak around the blockage, which is known as overflow incontinence and can be mistakenly identified as diarrhea.
Fecal incontinence, the inability to control the passage of stool, often occurs later in the disease process. This loss of control is usually functional, resulting from the person being unable to physically reach the toilet or cognitively failing to register the need. Incontinence causes distress and can increase the risk of skin breakdown and infection.
Non-Disease Factors Influencing Bowel Changes
Bowel function can be worsened by factors separate from the primary neurological pathology of dementia. Many medications prescribed for dementia-related symptoms, such as pain relievers, antipsychotics, and anticholinergics, have constipation as a known side effect. These drugs can further slow down gut movement, making regular bowel movements challenging.
Insufficient intake of fluids and fiber is another major contributor to constipation. Individuals with dementia may forget to drink water, have difficulty swallowing, or experience a reduced appetite, leading to chronic dehydration. A lack of dietary fiber, which provides bulk to the stool, causes it to become dry and hard.
Environmental and behavioral changes also influence regularity. Changes in routine, unfamiliar environments, or emotional stress can disrupt the body’s natural rhythm. Confusion associated with dementia can also lead to the person ignoring the urge to defecate or resisting attempts by a caregiver to assist with toileting.
Practical Management and Caregiver Strategies
Toileting Schedule and Environment
Establishing a predictable and consistent toileting schedule is an effective behavioral strategy for promoting bowel regularity. This involves encouraging the person to use the toilet at fixed times, such as 15 to 30 minutes after meals, to take advantage of the body’s natural gastrocolic reflex. Ensuring the path to the bathroom is clear, well-lit, and easily identifiable can help reduce accidents.
Diet and Hydration
Lifestyle interventions focus on optimizing stool consistency through diet and hydration. Caregivers should aim for a fiber intake of 20 to 35 grams daily, incorporating specific foods like prunes, kiwis, apples, and whole grains. Adequate fluid intake, generally six to eight glasses per day, is necessary for fiber to work effectively and prevent dehydration.
Activity and Medication
Encouraging safe physical activity, such as walking or seated exercises, helps stimulate peristalsis, the muscular contractions that move waste. Gentle movement is a non-pharmacological method for maintaining gut motility. If lifestyle measures are insufficient, over-the-counter aids can be used, but only with medical guidance. Stool softeners or bulk-forming laxatives are generally preferred as a starting point. Caregivers should avoid harsh stimulant laxatives for regular use, as these can lead to dependency and potentially worsen cognitive issues through dehydration and electrolyte imbalance.
Managing Incontinence
For managing incontinence, using high-quality protective garments, often referred to as protective underwear, is recommended. Prompt cleaning after an accident is necessary to prevent skin breakdown, and barrier creams should be applied to protect the skin from prolonged moisture exposure. Any sudden change in bowel habits, or signs of severe constipation like abdominal pain or watery leakage, warrants an immediate consultation with a physician.