Always make sure the doctor does an evaluation to
rule out infections, tumors, etc. for both urinary or
If the patient is still early in the disease, there are
two frontotemporal dementia-specific issues:
Many people with this condition have bowel and bladder
accidents when over stimulated, such as at a shopping
center. I would use this as an indicator of how
much stimulus the individual can manage and try to avoid
crowds, loud places, etc.
Try to get him/her to wear a protective garment.
Many refuse the bulkier garments. A one-size
pull-up brief might be more comfortable. You are
not going to ask permission, but say, “If you are coming
with me, put these on.”
Make sure he/she is taken to the toilet (or insist they
go) 20 minutes after the first meal. There is a
normal reflex that makes us want to have a BM then, so
you can try for an evacuation.
Avoid all caffeine as it irritates the bladder.
Do not leave him or her outside to wait for you as
anxiety will build.
Increase general fluid intake during the day to enhance
the urge to urinate.
Plan “pit stops” every two hours while out.
People with this condition have abulia (failure to
initiate) and do not recognize they need to find a
toilet when the urge presents. I had one client
who would wake each morning and then have a BM in bed.
It upset his wife as she thought he was doing it to be
rude to her. He was continent the rest of the day.
All she had to do was wake him at 6 am and tell him to
go to the bathroom and he evacuated normally. So,
prompting and directing should become a way of life
after noting what the patient’s usual schedule is.
In later dementia, the person may have
incontinence that may not respond to prompting. This is
usually managed by continuing to try to prompt, but
using the incontinence products even doubled when
necessary. Pad the bed with lawn and leaf bags under the
sheets and make a draw sheet to minimize the amount of
late night changing.
Provide adequate fiber using two large oatmeal raisin
cookies each afternoon with a glass of liquid.
Incontinence briefs need to be changed two or three
times per day even if not soiled because of the risk of
To help the individual adapt to the briefs, take the
underpants out of the dresser drawer and replace with
pull-up briefs. After a while, they will “get it.”
Finally, if there are “accidents” on a rug, use a pet
disinfectant. Standard cleaners do not kill the fecal
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