Q+A - Dr. Adrian Wagg

Dr. Adrian Wagg reflects on the issue of incontinence

Photo by Cooper & O’Hara.

Photo by Cooper & O’Hara.

Incontinence or the inability to control one’s bladder is a big fear for many as they age, but it’s especially concerning for people living with dementia. Toileting issues are often what determines a person’s ability to stay in their home. Accidents related to incontinence are almost always out of the person’s control, but dealing with incontinence is often more than care partners can handle. Dr. Adrian Wagg, professor in the University of Alberta’s faculty of medicine’s division of geriatric medicine, specializes in the topic of incontinence. He wants people to better understand this condition.

[Incontinence] is a big concern for patients, but also their care partners. It’s such a huge change in roles when partners are having to deliver quite intimate care.
— Dr. Adrian Wagg

Q  |  Why is incontinence such a pressing issue for people with dementia?  

A |  It’s a big concern for patients, but also their care partners. It’s such a huge change in roles when partners are having to deliver quite intimate care. It can sometimes be the straw that breaks the camel’s back and facilitates the decision to institutionalize an older person. Obviously, it’s still very much a taboo kind of condition that people don’t talk about.

Q  |  What causes incontinence?

A | In later life the most common underlying cause is something we call urgency incontinence, which is an inability to suppress the sensations of bladder emptying, [and] can occur suddenly at any time even when the bladder’s not full. There can be a combination of underlying bladder disorders but also a failure of the brain to be able to suppress that sensation.

Q  |  How is this issue compounded for people with dementia? 

A | A person with dementia may have underlying urgency incontinence, but with the impairment of cognition, perhaps they don’t have the ability to recognize the need to toilet normally, to precipitate the right action to find the toilet or to recognize the toilet.

Q  |  Are there specialist services in Edmonton, where you are located, that would be helpful? 

A | Yes, there are specialist continence services available throughout the city. The main clinics are located either at the Glenrose Hospital, which provides a multi-professional specialist conference clinic and a women’s health continence clinic based at the Misericordia Hospital and at the Royal Alexandra Hospital. Other clinics tend to be run by single medical specialists and are maybe less appropriate for those with either dementia or their care partners.

Q  |   Is there anything care partners should know before visiting a specialist?

A | Most clinics need a general practitioner referral.

Q  |  What can care partners do to manage incontinence issues? 

A | It’s often about maintaining successful toileting. So that might mean a combination of making sure that the environment is conducive to the individual being able to recognize and to get to the lavatory and that there are no obstacles or things that look like they might be urinals in the house. Things like prompted voiding, suggesting that people go to the lavatory, giving clear instructions and taking people to the toilet regularly can help.

Q  |  Are store-bought pads an effective option? 

A | Yes, but people do tend to overuse them and change them too often. Most of them have got more capacity to absorb than people think. Often people are concerned about smell, but actually that’s seldom a problem. They are more expensive than menstrual products, which many women use for light to moderate incontinence and that’s largely because they’re so very absorbent. But for dependent individuals, the largest incontinence pads can hold up to a litre of urine without making your skin wet.

Q  |  Are there any new technological advances to help people with dementia deal with incontinence? 

A | There are a couple of products that can be used in different situations. [That includes] a pad with a sensor to help people construct a voiding habits calendar, which allows you to institute a prompted voiding program. We’re [Wagg’s research group] currently testing those and there’s one on the market from Australia. There are also pads that signal when they’re full to a caregiver by SMS messaging. [ ]