Introduction

Many people with dementia have loss of bladder or bowel control (incontinence). Causes include inability to recognize when they need to go to the bathroom, forgetting where the bathroom is or side effects from medicine. Have the doctor rule out medical problems as the cause. Try the following to assist the person in using the bathroom.

Causes of incontinence

If a person with Alzheimer’s has recently started to lose control of his or her bladder and bowels, the first and most important step is to determine the possible causes. 

Medical conditions

• Urinary tract infection, constipation or a prostate problem.
• Diabetes, stroke or a muscular disorder such as Parkinson’s disease.
• Physical disabilities that prevent the person from reaching the bathroom in time.

Medications and diuretics

• Sleeping pills and anxiety-reducing drugs may relax the bladder muscles.
• Drinks such as cola, coffee and tea can act as diuretics; a diuretic increases urination.

Environment and clothing obstacles

• Make sure the person can find the bathroom.
• Clear the path to the bathroom by removing furniture or clutter; make sure the path is well-lit.
• Provide clothes that are easy to remove.
• When away from home, be sure to take an extra set of clothes in case of an accident.

Be supportive

• Help the person retain a sense of dignity. Reassure the person to reduce feelings of embarrassment.
• Say, “Something spilled on you” instead of saying, “You wet yourself.” Be matter-of-fact; don’t scold or make the person feel guilty.
• Respect the need for privacy as much as possible.

Provide reminders

• Encourage the person to tell you when he or she needs to use the toilet.
• Watch for nonverbal cues such as restlessness, making unusual sounds or faces, pacing, sudden silence or hiding in corners or behind furniture; these cues indicate the need to use the toilet.
• Use adult words, not baby talk, to refer to using the toilet.
• Learn the person’s “trigger” words or phrases for needing to use the toilet. The person may use words that have nothing to do with the bathroom (i.e., “I cannot find the light”), but to that person, it means going to the bathroom.

Make it easy for the person to find and use the toilet

• Keep the bathroom door open so the toilet is visible.
• Post a sign or a picture of a toilet on the bathroom door.
• Paint the bathroom door with a color in contrast to the wall.
• Make the toilet safe and easy to use. For example, raise the toilet seat, install grab bars on both sides of the toilet, and use nightlights to illuminate the bedroom and bath.
• Consider a portable commode or urinal for the bedroom in case of nighttime accidents.
• Remove plants, wastebaskets and other objects that could be mistaken for a toilet.
• Remove throw rugs that may cause a person to trip and fall.
  

Monitor incontinence

• Identify when accidents occur, then plan for them. If they happen every two hours, get the person to the
  bathroom before that time.
• Remind the person to use the bathroom just before his or her usual time.
• Try setting a regular schedule for toilet use. For example, help the person to the bathroom first thing in the morning, every two hours during the day, immediately after meals and just before bedtime.
• Cut down on drinks that stimulate urination such as cola, coffee, tea and grapefruit juice. However, don’t withhold fluids; this could cause dehydration, which could lead to a urinary tract infection and increased incontinence.
  

Tips for toileting

• Choose clothing that is easy to remove and to clean.
• Consider using incontinence products, such as rubber sheets on the bed or adult briefs.
• Give the person plenty of time in the bathroom to empty his or her bladder and bowels.
• Run water in the sink or give the person a drink to stimulate urination.
• Check the toilet to see if the person has urinated and/or moved his or her bowels.
• Help the person wipe and flush the toilet.
• Regularly wash sensitive skin areas and apply powder or ointment.