Toileting and Incontinence

During the middle and later stages of Alzheimer's disease or another dementia, people may begin to experience incontinence.

Incontinence is the inability to control one's bladder and/or bowel elimination. Usually, bladder incontinence is experienced before bowel incontinence.


Reasons for Incontinence

Depending on the person, a variety of issues may arise related to toileting and incontinence as their disease progresses. Here are some examples of why a person with dementia may experience incontinence or difficulty using the toilet:

  • The person may be unable to locate the washroom easily. Perhaps they are easily disoriented.
  • Some people with dementia may urinate in wastbaskets or flowerpots as their shape and size are similar to a toilet.
  • The person with dementia may be unable to communicate their need to use the washroom.
  • They may simply forget to use the toilet, or how to do so.
  • They may be unable to understand and interpret the bodily sensations which indicate that it is time to use the toilet.
  • There are several steps involved in using the toilet (locating the bathroom, undressing, using toilet paper, etc.) as dementia progresses, it can become increasingly complicated for the person to carry out a series of steps.

Tips and Strategies

Below are some ideas for prevent incidents related to incontinence and to support the person as using the toilet becomes more difficult.

  • Determining why the person is experiencing incontinence is the first step towards reducing the stress associated with this symptom.
  • Always consult the person's doctor as soon as you notice incontinence. There may be other reasons for the problem which can be treated, such as a urinary tract infection.
  • Keep a diary of when and where accidents are occurring. You may be able to identify certain situations when the person may need additional support with toileting.
  • Be aware of any signals which may indicate the person's need to use the washroom, such as fidgeting, getting up and down, or pulling at their clothes.
  •  Make sure the bathroom is easy to find. For example, hang a picture of a toilet of the door to guide the person in the right direction. Install a small light to stay on in the washroom at night.
  • Remind the person to use the washroom, especially after meals and before bed. Do this in a gentle and sensitive manner.
  • Provide the person with clothing that is easy to remove, such as trousers with an elastic waist instead of a button and zipper.
  • Many drug stores carry supplies such as rubber sheets, incontinence pads or undergarments, and commode chairs. These items can lessen the impact of incontinence on daily life.
  • Consider changing the colour of the toilet seat. A black seat paired with a white toilet bowl may be easier for the person to see.
  • Remember that people with dementia still react to their surroundings, and are able to experience embarrassment. Make the situation as comfortable and private as possible.