– Toileting and incontinence with dementia

As people get older they are more likely to suffer from incontinence (accidental leakage of urine or faeces) for a number of reasons including urinary tract infections, weaker bladder muscles or enlarged prostrate.

People suffering from dementia can also have problems with incontinence, especially as the disease progresses, because dementia can lead to the inability to recognise the need to use the bathroom or can result in problems locating the bathroom. Dementia can also lead to problems maintaining hygiene.

This page looks at why using the toilet can become difficult for people with dementia, often leading to accidents.  The consequences of incontinence and poor hygiene and what can be done to help and support people with dementia to use the toilet and maintain their dignity.

Why going to the toilet may becomes difficult

  • Not reacting quickly enough to the sensation of ‘needing to go’.
  • Not being able to communicate the need to go.
  • Not being able to locate the toilet.
  • Not being able to get to the toilet due to mobility issues.
  • Not being able to loosen clothing.
  • Unsure of the steps required to using the toilet i.e. lift toilet seat, need to wash hands.
  • Not wanting to ask for help due to embarrassment.

Consequences of incontinence & poor hygiene

  • Increase risk of skin problems and rashes.
  • Increased risk of urinary infections (leading to an increased risk of incontinence).
  • General feeling of discomfort.
  • Feelings of shame and embarrassment.
  • Secretive behaviour, such as hiding soiled underwear.
  • Potential for stomach upsets due to poor hygiene (i.e. not washing hands after using the toilet).

What can be done to support people to use the toilet?

There are a number of ways you can help someone use the toilet and maintain personal hygiene. It goes without saying that any help provided should be done as discretely and tactfully as possible.

  • Ask regularly whether the toilet is required.
  • Watch out for visible cues that they need to go, agitation, fidgeting, tugging on clothing, touching genitals.
  • Make sure toilets are well signposted with clear and recognisable signs on doors.
  • Keep the bathroom door open so they can see the toilet.
  • Make sure the bathroom area is free from clutter and trip hazards.
  • If required fit grab bars or use a toilet frame to help them get onto / off the toilet.
  • Consider easily removable clothing such as elasticated trousers, no belts, catches or zips.
  • Gently remind them of the steps they need to take (e.g. lift toilet seat, pull down underwear).
  • Don’t rush them; allow them time to empty their bladder / bowels.
  • If necessary be ready to hand the person some toilet roll.
  • Have wet wipes ready, which can sometimes be easier and more effective (although watch out for signs of irritation).
  • Help them redress, they may often try and walk away without pulling their pants back up, which is a trip hazard.
  • Remind them to wash their hands. If they are unwilling to do so, wait until they have sat down and use a warm wet flannel to wash their hands.

Toileting in the advanced stages of dementia

Almost invariably, people with dementia will develop incontinence as the disease progresses, largely due to problems with mobility, deteriorating cognition and motivation. Avoiding accidents becomes more and more difficult and incontinence pads may reduce some of the stress and pressure in getting to the toilet in time. Large dry wipes (which can be dampened with warm water) are also useful for helping people to wipe afterwards.

However even in the advanced stages of the disease, in my experience, people would still prefer to use the toilet where possible, and often get upset, agitated and embarrassed if they don’t make it in time. In other words, I believe that pads should be used as a precaution against accidents and not as an excuse to avoid helping someone to the toilet, even though it may be a difficult and time consuming exercise. In any case, in my experience, changing the pad after an accident is more difficult and time consuming than helping someone to the toilet in the first place.

Once a few months before Mum died, I was visiting when Mum suddenly said she needed the loo, so I asked one of the carers to help me get her to the toilet. He was about to say “there is no need, she is wearing a pad” when I stopped him and asked him to think very carefully about what he was about to say. Needless to say we went to the toilet!!!!

For more information the Alzheimer’s Society has produced a very useful fact sheet.

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