THE SITUATION

For individuals with Alzheimer’s disease or a related dementia, the process of using the toilet typically requires more and more assistance as the brain disorder progresses. Caregivers might have to adjust a strategy that worked just one day before or totally shift gears if incontinence—the inability to control bladder or bowel functions—sets in. But just like other activities of daily living with multiple steps that pose challenges for people with Alzheimer’s disease, there are strategies caregivers can use to manage the process, lessen frustration and, at the same time, preserve the individual’s privacy and dignity.

THE SOLUTION

  • Set a routine. Prompt your loved one to go to the bathroom every few hours. Establishing a routine earlier in the disease process may make things easier later on. Bladder retraining is a technique that may help lengthen the periods between bathroom usages for some individuals. For example, start by having the person use the bathroom every two hours. In time, increase the interval by another 15 minutes, then 30 minutes more and so on.
  • Look for cues. As communication skills decline, people with Alzheimer’s disease may give off certain auditory or visual signals that they need to use the toilet, such as making facial expressions, pulling on clothing, producing unusual sounds or squirming in a chair.
  • Make the toilet easier to find. Since people with Alzheimer’s disease may have difficulty distinguishing the bathroom from other rooms or the toilet from a garbage pail, it helps to clearly identify the room and the toilet. Tips include marking a path to the toilet along the floor or wall, posting an illustrated sign on the bathroom door, putting a lid on a waste basket, and making the toilet stand out by installing a toilet seat with a contrasting and bright color or painting the wall behind the toilet a different color. In addition, keep the pathway to the bathroom well-lit and free of clutter.
  • Take one step at a time. Like for other activities of daily living, use simple language and offer step by step directions. For example, point to the bathroom and ask the person if he or she needs to use it. Give directions, such as “lift the lid, pull down your pants, sit down,” etc. If you feel the person can perform these steps independently and safely, provide privacy by offering directions while standing outside of the bathroom.
  • Increase a person’s comfort level. The bathroom should have the proper temperature. Cover a mirror if that is a source of fear for a person with dementia. A raised seat or handrails by the toilet can make sitting down and getting up easier and safer. Keep familiar items or props on hand to use as either a source of comfort or, at times, a distraction to ease the person into the situation.
  • Simplify clothing. Select clothing that is easy to remove. Adaptive clothing with features like Velcro straps and elastic waistbands and without buttons and zippers works best.
  • Control fluid intake. Adequate fluid intake is essential for general health, and the overall limiting of liquid intake may actually result in accidents because the bladder can become irritated and cause leakage. However, avoid or cut back on caffeinated drinks since they can irritate the bladder. Limit fluids for several hours before bedtime to decrease toileting problems during the night.
  • Watch for patterns and changes. Do accidents occur at a certain time of day, after certain foods are eaten or prescription drugs are taken, or following a particular activity? Has there been a rapid onset of incontinence? Keep a diary to track patterns, and discuss any issues and changes with a healthcare professional. Sudden onset of incontinence might indicate an underlying medical condition, such as a urinary tract infection or nerve damage.
  • Make adjustments, as necessary. Wearing protective liners in undergarments or adult incontinence products may help relieve a person’s anxiety about having a potential accident. Likewise, keeping a portable commode near a person’s bed can help during the night. For individuals who become incontinent, disposable underwear is available in various sizes and absorbencies. Waterproof sheet protectors and bed pads are useful in keeping someone’s bed sanitary.

— WRITTEN BY SPENCE PACKER

PREPARE IN ADVANCE

Pack an extra set of clothing when leaving the house in case of an accident. Have adult incontinence products handy at home just in case there is a rapid change in toileting needs.