Alzheimer’s and Incontinence: Answers to Caregiver Questions

Q: Typically at what stage of Alzheimer’s does incontinence occur?

 A: Inevitably in the final stage of Alzheimer’s, a person will experience a loss of control over their movements, including their bowel and bladder muscles. Though, it is important to remember that every person living with Alzheimer’s experiences different symptoms, so it is not uncommon for someone in the middle stages to be incontinent.

Q: What are the causes of incontinence in people living with Alzheimer’s Disease?

A: The causes of incontinence vary depending on the person with Alzheimer’s. It could be temporary incontinence because of the medicine that was prescribed, or it could be a urinary tract infection (UTI). It could be due to the signals that are normally sent to the brain to let a person know they need to use the bathroom are no longer functioning. Also, it may be that your loved one is not able to recognize the need to use the bathroom anymore. Incontinence could be caused by the inability to locate the bathroom or they may not be able to remove their clothes in time.

Q: What should I do if my loved one constantly wets the bed?

A: Limit the amount of fluid they have at night. It may be easier for them to have a portable commode next to their bed, so they do not have to search their home or rush to the bathroom. Also, try using an overnight incontinence product like an underpad sheet or disposable absorbent underwear. If your loved one isn’t used to the idea of sleeping with an incontinence product, place the underpad sheet underneath the bed sheets to cut down on having urine soak into their mattress.

Q: My loved one forgets the location of the bathroom. What can I do to help them find the bathroom? 

A: Try leaving the bathroom door open. Using colored duct tape you can make a path that leads into the bathroom. Also, post a picture of a toilet on the bathroom door, this can help them recognize what is in the room. Install night lights in the bathroom, especially making sure to light up areas near the toilet, so if the sun goes down and the house is dark enough the night lights will go on. Changing the color of the toilet seat can help your loved one distinguish between the toilet and the floor. Make sure that the toilet is comfortable for the person. Raising the toilet itself and adding grab bars to hold on to can help.

Q: My loved one makes it to the bathroom, but once inside forgets the process. 

A: This is a challenge that many adults with Alzheimer’s experience; the best solution is for you to enter the bathroom with them to provide step-by-step instructions or for you to assist them in the process.

Q: Could it be a Urinary Tract Infection (UTI)?

A: Yes, it could be. Don’t rely on asking your loved one if it hurts when they use the bathroom, it could be considered a ‘silent’ UTI, meaning there may be no symptoms. It is best to go see a doctor right away to either diagnose or eliminate the reason for incontinence being a UTI.

Q: What are some tips for traveling with an incontinent individual?

A: Locate where the bathrooms are in a building when first arriving. If traveling by driving, be sure to make frequent rest stops to allow the person to use the bathroom. Don’t be afraid to either use the family bathroom. If that isn’t an option, you can take your care recipient that’s a member of the opposite sex into a women’s or men’s bathroom with you, using the handicap stall. Men feel more comfortable bringing their wives or mothers into the men’s restroom, while women feel more comfortable bringing their husbands or fathers into the women’s restroom. Be prepared and bring extra incontinence products, wipes, and an extra change of clothes.

Q: What signs can I look for that my care recipient needs to use the bathroom?

A: Signs for bathroom use include restlessness, tugging at pants, pacing, crossing legs, and putting hands near their genitals.

Q: What should I do if my loved one doesn’t realize they had an accident?

A: The best way to go about this is to not punish them for having the accident. Use the “I think you spilled something on yourself” approach, rather than the “why didn’t you just tell me that you needed to use the bathroom?” approach. You can have them follow you so you can help them get a new set of clothes on.

Q: My loved one keeps sticking his/her hands down their incontinence products and plays with the contents. Is there any way to prevent this?

A: Try using the incontinence log to monitor when your care recipient uses the bathroom or has an accident. By knowing what the bowel movements are you can get your loved one to the toilet before they have contents to play with. Another alternative would be to make sure you have the right size incontinence product so that they are not too loose. Also, using a belt helps to limit the amount of room that your loved one will have to put their hands in.

Q: My loved one with Alzheimer’s disease has been having accidents recently, how do I take him/her out for a while with avoiding having an embarrassing accident?

A: Don’t be afraid to ask your loved one to wear “special panties” when you two have plans to go out. You don’t want either of you to miss special events like a graduation party or a wedding because of fear of an accident. Bring extra products and a change of clothes to wear, to be on the safe side.

Q: My care recipient doesn’t want to wear incontinence products. They think of them as something young children wear. How can I get him/her to change her mind?

A: Tell them the truth. Tell them that incontinence briefs are back up just in case they don’t make it to the bathroom on time. It will make both of your lives less stressful because, for as much as you want them to be able to use the bathroom correctly, they do too. Don’t give them a choice by asking them whether or not they would like to wear them, incorporate it into their routine of getting dressed in the morning. Also, make sure to not refer to them as diapers or by their brand name, this will have a negative connotation associated that your loved one may recognize.

Q: My loved one feels the need to go to the bathroom every few minutes, why could this be?

A: One possible reason could be either your loved one is constipated or has an impaction. Another reason could be that he/she may possibly have a UTI. The problem can also be linked to urge incontinence, the frequent and sudden urge to urinate with little bladder control. They may be nervous to have an accident and would rather not chance it by not using the bathroom. It is best to schedule an appointment with a doctor to determine what the possible cause could be.

Q: On occasion, my loved one forgets to wipe after using the bathroom. It makes it harder to clean up, any solutions?

 A: You can use flushable wipes when you notice that your care recipient forgot to wipe. At some point, you are going to have to enter the bathroom with them if it gets to be an everyday problem. When you get to this point, it may be easier to give them a quick wipe when you are helping them to stand up. They may not even realize that you are wiping because they are focused on getting off of the toilet and pulling their pants back up.

Q: I’ve noticed that my loved one doesn’t wash their hands after using the restroom? What can I do to help?

A: Try giving them a squirt of hand sanitizer when they get out of the bathroom or tell them you are going to pamper them for a few minutes. Then take a warm, soapy washcloth to their hands then rub in their favorite lotion.

Q: My loved one can spend hours sitting on the toilet, why?

A: Just as you are concerned with them making it to the bathroom on time, they are discouraged by it too. They could be sitting on the toilet because they are afraid of having an accident. However, don’t overlook the possibility of constipation or a UTI. It is best to schedule a doctor’s appointment to make sure.

Q: My loved one has anxiety over using the bathroom; he/she won’t let me help them. How can I help without intruding on their privacy?

A: If they are worried about their privacy, tell them that you will turn away or leave the room once they are sitting on the toilet. It is best to continue to treat them with respect, and after a few minutes of them sitting on the toilet, come back and check in on them, looking to see if they went to the bathroom. If it’s embarrassing for you, imagine how they must feel when they have an accident that causes a mess. It is better that you assist your loved ones for their safety and to avoid a clean-up on your part.

Q: Could medicine affect my loved one’s bladder?

 A: Yes, several medications can cause muscles that control bladder and bowel movements to ease, causing incontinence, it is best to see a doctor as soon as possible to make sure that the medicine they are taking is not interfering with their ability to use the bathroom. Use the Incontinence Log to track occurrences and identify incontinence issues.

Q: What are the signs that my loved one should start wearing incontinence products?

A: Typically a loved one should begin wearing incontinence products when you notice that they are unable to reach the toilet in time, they cannot remember where the bathroom is located, can’t remember what to do when they get to the bathroom, or if they confuse objects for the toilet, like a waste basket. If multiple accidents keep occurring for any of these reasons, it may be time to use incontinence products, whether it’s an absorbent pad or an adult brief.

For information on caregivers’ picks for best products for adults with Alzheimer’s disease, caregiver testimonials, Alzheimer’s resources and blogs, and a video titled “Understanding Alzheimer’s and Incontinence”, click here to learn more.

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