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This is a subject that can be awkward to discuss.  But it’s something that caregivers often have questions about – anything and everything related to toileting.  There’s no taboo subjects here, just real advice for your real life, so let’s just flush this out (bad joke!).  As dementia progresses and individuals age, incontinence is a struggle.

What causes incontinence?
If your loved one has dementia, they might not notice the urge to go.  They might not be able to find the restroom, or maybe they can’t get to the restroom in time.  Or your loved one might not know how to perform the basic steps for toileting.

It is important to rule out medical reasons.  There are many things that could cause incontinence – urinary tract infections, prostate trouble, medication side effects, etc.  Be sure to let your loved one’s physician know about incontinence issues.  Your physician can determine if the incontinence is treatable.

Practical Tips for Dealing with Incontinence

Set a toileting routine.

Remind your loved one every 1.5-2 hours to go to the restroom.  Set alarms for yourself.  Try phrases like:
“Honey, it is time to go to the bathroom.”
“Let’s run to the bathroom before we sit down to lunch.”
“Let’s get up and stretch our legs.” (as you walk to the bathroom)

Watch fluid intake.

Hydration is important, so don’t restrict fluids.  But be careful about the type of fluids your loved one is drinking and the time of day they are drinking.  Caffeinated beverages can increase the need to urinate.  Drinking later in the evening can cause nighttime incontinence.  In the evenings, offer a small cup of water rather than a large glass of tea or juice.

Watch for signs.

Even if your loved one can no longer tell you that they need to go to the restroom, they may get restless.  They may start pulling at their clothes or grimacing.  Watch your loved one’s body language.  Provide prompting when you notice the signs.

Evaluate your loved one’s clothing.

Clothing can be a barrier to proper toileting.  Your loved one may not know how to unbutton/unzip pants or how to undo a belt.  Maybe your loved one thinks she needs to take off her dress before going to the bathroom and can’t get it done fast enough.  Instead, try pants with an elastic waist and skip the belt.

Use disposable briefs/underwear. 

Notice that we do not say “diaper” or “pull up.”  A baby wears those items, and your loved one is an adult.  Using age appropriate terminology makes a difference.  When it is time for your loved one to start wearing disposable briefs/underwear, it is a good idea to hide or get rid of their regular underwear.  Out of sight, out of mind.  There are many kinds of disposable briefs to choose from – different sizes and absorbency levels.  Start with buying smaller packages to find the right fit.

Keep a spare change of clothes.

Keep a bag in the car with an extra pair of pants, a shirt, socks, shoes, and disposable products.  Better safe than unprepared.  Also be sure to bring a spare change of clothes when traveling (on planes, etc.).

Inspect your bathroom with dementia eyes.

• Is everything white or lightly colored (including the toilet)?  Your loved one may not be able to see the toilet.  Install a contrasting color toilet seat, so it’s easier to spot.
• Are there lots of decorative pieces, bottles, and toiletries?  It could be that the bathroom is visually overwhelming.  Put things away to limit distractions.
• Do you have dark rugs on a light floor?  Vision changes with dementia can make those rugs look like holes in the floor.  And rugs can be a fall hazard.  Consider getting rid of rugs.
• Is there anything to hold on to, or is the toilet very low?  Install grab bars or an elevated seat if needed.
• Is it easy to find the bathroom?  Make sure that the bathroom and pathway to the bathroom are well lit.  And keep the door open, so the toilet is visible.

If your loved one is toileting in odd places, inspect your home with dementia eyes.

Your father might pee in the fake Ficus because it reminds him of peeing on a tree when working outside.  You grandmother may pee in a trashcan because when she was a child, they didn’t have indoor plumbing and sometimes peed in a bucket.  If your loved one is toileting in odd places, remove the items or put a lock on a closet or room door.  You can also try putting a restroom sign on the bathroom door.  Sometimes a visual reminder can help.

Make the bed with easy clean up in mind.

Use a waterproof mattress protector.  Then, use disposable or washable bed pads that your loved one can sleep on.  You can put the pads on top of the sheets OR you can layer bed pad, then fitted sheet, bed pad, then fitted sheet.  Replace soiled pads and take off layers as needed.  This way you don’t have to remake the whole bed in the middle of the night.

Ensure proper hygiene.

Good hygiene is important to good health.  Poor personal hygiene can lead to UTIs, skin breakdown, and infections.  It’s important that your loved one stay as dry as possible.  Change disposable pads/briefs multiple times per day as needed.  Ensure your loved one wipes well.  Flushable wipes can be helpful.  You may need to assist with toileting to ensure your loved one is clean and dry.  Watch for rashes and areas of irritation and contact your physician or pharmacist for recommendations.  Untreated rashes can become a larger health issue.

Be supportive!

Your loved one is not trying to irritate you.  Your loved one is struggling and may be embarrassed about the incontinence.  Be respectful.  Instead of, “You peed on yourself?” or “You wet your pants again?” say, “Anyone can have an accident.” or “I am sorry that happened. Let me help you.”  Don’t scold or make the person feel guilty.  Use appropriate language, such as pee, toilet, commode.  Don’t say potty or tee-tee.  Ensure their privacy as much as possible and help to preserve their dignity.