Activities of daily living become more difficult with Alzheimer’s disease, particularly as the disease advances into later stages, and toileting presents a particular challenge. It is imperative that you help make going to the bathroom as easy as possible for your loved one, and control your reaction in the event of any accidents or resulting messes. Incontinence issues (loss of control of bladder and bowels) are embarrassing and, unfortunately, all too common for people with Alzheimer’s disease or related dementia.
Firstly, when dealing with issues of incontinence it is important to rule out health reasons that may have little or nothing to do with dementia. Difficulty going to the bathroom can be a sign of a urinary tract infection (UTI), dietary or hydration issues (not eating enough healthy, easily digested food or drinking enough water), prostate problems in men, or side effects from medication (sleeping pills, for example, can cause incontinence). Consult with your loved one’s doctor to be sure none of these are factors, even as you follow the following steps to make toilet use easier.
Alzheimer’s disease itself, of course, makes using the toilet more difficult. Alzheimer’s affects brain function, and signals between the brain and parts of the body break down. For this reason, someone with a full bladder may not feel the physical sensation of needing to go.
Mobility becomes a problem for people with Alzheimer’s, particularly in later stages, meaning the basic act of getting up and walking to the bathroom, taking down your clothes, and cleaning up afterward, are all harder.
Fortunately, there are behavioral steps and around-the-house tips and upgrades that can simplify toileting and cut down on incontinence and accidents.
Like bathing and showering, difficulty using the toilet can be intimate and embarrassing, and presents a real challenge for people with Alzheimer’s and their caregivers. The best way to approach toileting problems for someone with Alzheimer’s is to take the following steps toward an easier, less emotional experience.
Preventing toileting issues may be as simple as reminding your loved one to use the bathroom every two to four hours. An occasional prompt can get your loved one up and headed to the bathroom, and then it’s a good idea to check that the toilet was used, and that your loved one didn’t get distracted or have an accident.
Limit the amount of liquid your loved one drinks before bed to reduce the need for nighttime bathroom trips. (Be careful not to dehydrate, however, as dehydration can lead to problems including headaches and UTIs.) Avoid alcohol and caffeine later in the day; they not only affect sleep but also act as diuretics that might increase the need to go.
Watch for Signals
If your loved one is fidgeting, tugging clothes (especially the front of pants), or generally agitated, this could be a sign that it’s bathroom time.
Establish regular times of the day for bathroom breaks. You want your loved one going about every two to four hours. Most people have bowel movements at roughly the same time daily, often in the morning, and encouraging regularity is smart strategy. Establishing routine is vital in most aspects of caregiving, and toileting is no exception.
Going to the bathroom might take awhile. Walk away, or step out of view, and wait patiently for your loved one to finish.
Sit Instead of Stand
Men with Alzheimer’s may need to sit when they urinate, especially in the late stages of dementia when balance and falling are bigger issues.
Like with showering, needing help with the toilet can bring up feelings of embarrassment and loss of dignity. Some people find incontinence demeaning. Respect this, and don’t appear upset if you have to deal with an accident.
Respond quickly to accidents because they can cause skin irritation and discomfort. Gently wash soiled areas, and dry carefully. (For help with showering, click here.)
Make sure the bathroom is near your loved one, especially at night. As memory, coordination, and pace slow, it is important that the toilet is on the same floor as the bedroom.
Light the Way
Make the pathway to the bathroom more easily accessible by making sure there is adequate lighting. Motion sensing night lights can be helpful. So can reflective tape to mark the pathway.
Raise the Toilet
Install grab bars by the toilet, so your loved one has an easier time sitting down and standing up. It’s also recommended that someone with Alzheimer’s use an elevated toilet, which also makes sitting and standing easier.
Place a commode chair, chamber pot, or bedpan in the bedroom. This is particularly important in the late stages of dementia, when movement is more difficult.
In early and middle stages of dementia, a timer is useful for bathroom breaks. Set it to go off every two or three hours, with a note explaining what your loved one is supposed to do when it rings.
Wet wipes (also called baby wipes or moist towelettes) are better for after a bowel movement than toilet paper, especially if your loved one needs your help.
Bright, contrasting colors for the door are a simple way to ensure that your loved one remembers or notices the bathroom. Contrasting the color of the toilet against the color of the walls and floors will also help your loved one remember its purpose and have less accidents.
You can also label the door with a picture of a toilet and large block letters displaying TOILET or BATHROOM, as an additional memory aid. Place these signs at your loved one’s line of sight.
Leave the bathroom door partly open so that your loved one can see what’s inside, but be mindful of mirrors, because someone with dementia may see a reflection and believe the bathroom is occupied.
Products that can help with bathroom issues include incontinence pads that fit snugly inside underwear, and leak-proof covers for beds and chairs. These help with messes and can also reassure your loved one that panicking isn’t necessary if the need to go comes on suddenly.