Dementia Care: Incontinence and Toileting Difficulties 

When providing dementia care for the elderly, it's crucial to understand that difficulty using the toilet can stem from various causes beyond incontinence. Therefore, before assuming the person is incontinent, it's important to explore other potential reasons for their difficulties. 

Carers and relatives should try to be empathetic and attentive to the person's unique needs and their non-verbal cues for communicating their need to use the toilet. This approach can ensure that the person receives timely support while preserving their dignity. When providing elderly help at home, you should only resort to using incontinence pads when necessary, as they can be uncomfortable and embarrassing for the person.

Incontinence is a potential cause of difficulty using the toilet for people with dementia but make there can often be other reasons, such as:

  • Difficulty finding or recognising the toilet

  • Trouble communicating the need to go to the toilet

  • Inability to get to the toilet or undo clothing in time

  • Difficulty with one or several stages of the process of successfully using the toilet

  • Physical problems like urinary tract infections or medication side effects

  • Giving up trying to use the toilet because they have not been receiving the help they need

  • Incontinence can be a direct symptom of dementia

Dementia friendly bathrooms

Creating a safe and dementia-friendly bathroom is crucial for elderly people in need of care, try some of these tips for improving the environment: 

  • Ensure clear signage or leave the toilet door open to help individuals locate the toilet easily

  • Install handrails, bath seats, and non-slip bath mats in contrasting colors to ensure visibility, especially for those with poor eyesight

  • Hang door signs at an appropriate height for older people and ensure they are visible from multiple viewpoints

  • Choose contrasting colours for the toilet seat and pan to aid recognition. Colouring the toilet water can also help some people

  • Use bright lighting for visibility, but be mindful not to create glare

  • Use traditional designs with a lever flush for cisterns, as push-button designs may confuse people with dementia. For concealed cisterns, add simple 'push to flush' signs

  • Ensure the toilet paper holder or dispenser is easily reachable and a different colour from the walls

  • Select a simple toilet paper dispenser to make it easier for individuals to use

Establishing a toilet routine

Creating a regular toilet schedule should help avoid some accidents, here are some tips to get a good routine: 

  • Remind the person about toileting when they wake up, before meals, during coffee or tea breaks, and before bedtime

  • Use automatic reminders on a smartphone to prompt them to use the toilet or check if their incontinence pad requires changing

  • For faecal incontinence, establish a fixed time to use the toilet each day and support your loved one to stay long enough to have a bowel movement, which may help them regain bowel control

  • Try to use the toilet a few minutes after a meal to facilitate bowel movements. For example, some people may find it helpful to use the toilet after breakfast

Assisting with toilet use in dementia care

Forgetting to go to the toilet can obviously be a problem for people with dementia so help them by: 

  • Providing frequent reminders for those with urinary incontinence, prompting them every two to four hours to use the toilet

  • Provide encouragement and assistance when requested

    Check that they have used the toilet and have not been distracted or forgotten. This practice can help some people reduce accidents over time
  • Prompt them to use the toilet in a considerate manner to avoid patronising, irritating, or upsetting them

  • Observe signs that they may need to use the toilet, particularly if they are unable to communicate clearly. These indications may include restlessness, pacing, standing up and sitting down, or pulling at their clothing

Managing and reducing accidents

Maintaining personal hygiene and using the toilet are deeply private matters. For people struggling with incontinence, the loss of control can harm their dignity and self-confidence. It can be challenging for people to come to terms with the fact that they require assistance in such an intimate area of their lives, particularly when that help comes from a close friend or family member.

When accidents occur, it is vital for carers and loved ones to remember that it is not the person's fault, set aside any embarrassment, and avoid reacting with anger or frustration. 

Here are some ways you can reduce accidents:

Put a bright sign on the bathroom door that includes both words and a picture, to help the person find the toilet. Leave the door open when not in use to show that it's vacant.

Check the position of mirrors in the bathroom as they can confuse the person with dementia, making them think someone else is in the room.

Make sure the path to the toilet is clear, with enough light, especially at night. Also, help the person identify the toilet by using a contrasting colour, such as a black seat on a white base

Ensure privacy in the toilet but check if the person can manage the locks. If not, disable them or ensure you can open them quickly from the outside.

Clothing with elasticated waistbands or Velcro fastenings can make it easier for the person to undress and use the toilet.

Install handrails and a raised toilet seat to assist the person with mobility issues. Sitting down to use the toilet can also help some men who struggle with balance or aiming.

Consider using an aid such as a commode if getting to the toilet is a challenge. However, make sure the person recognises it and knows how to use it.

Frequent night time bathroom visits

Frequent night time bathroom visits can be a common issue that can be even more challenging for those with dementia or incontinence. As a carer or family member, it's essential to address this issue with compassion and patience. Here are some tips to help alleviate this issue:

  • Installing motion-sensor lights or night lights in the bedroom, hallways, and bathroom. These should be set on a timer to avoid sudden darkness

  • Keeping a urinal bottle or commode near the bed for easy access at night

  • Avoiding drinking anything two hours before bedtime, while ensuring the person drinks enough fluids during the day to prevent dehydration

Assistance while outside the home

Remaining active and socialising is essential for those with dementia, but incontinence can make it challenging to be out and about. However, there are strategies to help improve confidence and manage accidents:

  • Plan ahead by identifying accessible restrooms in advance

  • Be prepared by wearing a lightweight pad attached to undergarments and carrying additional clothing, pads, and a bag for soiled items
  • Obtain a Radar Key, which allows disabled individuals, including those with dementia, to independently access thousands of locked public restrooms throughout the country. Disability Rights UK sells Radar Keys 

Maintaining personal hygiene

Helping the person with dementia maintain good personal hygiene after using the toilet is essential to prevent infections and skin irritation, here are some tips: 

  • Be aware of the person's preferences for cleaning themselves

  • Encourage the person to wipe from front to back and wash their hands after using the toilet

  • Incontinence can cause skin irritation and increase the risk of pressure ulcers

  • In the event of an accident, assist the person with washing and changing into clean clothes and pads
  • Soiled clothes, pads, and bedding should be washed immediately or soaked in an airtight container

  • Dispose of used pads in an appropriate container as soon as possible

  • Moist toilet tissues may be suitable for minor accidents, but they can irritate the skin

  • Keep the person's hands and nails clean if they try to remove feces manually

If managing incontinence becomes too overwhelming, it's advisable to discuss the matter with your GP, a community nurse, or a continence advisor. It's essential not to allow incontinence to disrupt your relationship.

If you need more information on products that can aid with continence, speak to an occupational therapist. You can ask your GP or social services to refer you, and such products are also available at independent living aid and equipment stores.

Do you require additional assistance with managing incontinence or toileting? 

You might find it beneficial to join Care Begins at Home, where you can connect with individuals who are facing similar challenges and exchange helpful tips and strategies. The group is also staffed with experienced elderly care professionals who can offer guidance and support.