What should you do when someone with dementia is incontinence?

According to the Alzheimer's Association, incontinence is a common issue as dementia progresses and can be distressing for everyone involved. Knowing what should you do when someone with dementia is incontinence? requires a blend of patience, empathy, and strategic planning to maintain comfort and dignity.

Quick Summary

Managing incontinence in dementia involves a multi-faceted approach, focusing on routine, environment, and communication to reduce accidents and preserve dignity. Effective strategies include scheduled toileting, simplifying clothing, using appropriate products, and adapting the living space while maintaining a calm and reassuring attitude.

Key Points

• Consult a Doctor First: Rule out underlying medical conditions like UTIs or medication side effects before assuming incontinence is purely dementia-related.

• Establish a Toileting Routine: Create a regular schedule for bathroom visits, such as every two hours or after meals, to build a predictable habit and prevent accidents.

• Adapt the Environment: Make the bathroom highly visible and accessible by adding contrasting signage, nightlights, and removing obstacles.

• Use Appropriate Products: Employ easy-to-remove clothing and high-quality absorbent products like pads or briefs for managing accidents and protecting skin integrity.

• Communicate with Compassion: Maintain a calm and reassuring demeanor when accidents happen to preserve the individual's dignity and ease their potential embarrassment.

• Track Fluid Intake: Monitor daily fluid consumption and limit intake before bedtime to help reduce nighttime accidents, while ensuring they stay hydrated.

• Prioritize Caregiver Well-being: Remember to seek support from support groups or respite care to prevent caregiver burnout and maintain your own health.

Understanding Incontinence in Dementia

Incontinence in people with dementia is often not a simple bladder or bowel issue, but a symptom of their cognitive decline. Brain changes can interfere with a person's ability to recognize the urge to go, remember where the bathroom is, or successfully use the toilet. This can be emotionally distressing for the individual, leading to feelings of embarrassment, anxiety, and frustration. For caregivers, it adds a significant layer of challenge to an already demanding role. Addressing the issue with patience and understanding is crucial for the person's emotional well-being.

Consult a Medical Professional First

Before implementing any management strategies, the very first step is to consult a medical professional. This is because continence problems can also be caused by other, treatable medical conditions, such as a urinary tract infection, constipation, or medication side effects. A doctor or a continence nurse can perform a full assessment to rule out these possibilities. Bring a log of incontinence episodes, including the time and day, to help with the diagnosis. Addressing any underlying medical issues could resolve the problem entirely or make it significantly easier to manage.

Practical Strategies for Managing Incontinence

Establishing a Predictable Routine

Routine is a powerful tool in dementia care. A predictable schedule for toileting can help a person with dementia manage their incontinence better by creating a consistent habit.

• Scheduled Toileting: Try taking your loved one to the bathroom at regular intervals, such as every two hours, or after meals and before bed. This can be more effective than waiting for them to signal their need, as they may not be able to do so effectively.
• Observing Patterns: Note when accidents happen. If they consistently occur at certain times, you can schedule a bathroom trip just before that time.

Modifying the Environment for Better Accessibility

Simple changes to the home can make a significant difference in preventing accidents.

• Clear Pathways: Ensure the path to the bathroom is clear of any obstacles, rugs, or clutter that could cause trips or falls.
• Easy Identification: Make the bathroom easy to find. Keep the door open, add a large, contrasting-colored sign with a picture of a toilet on the door, or paint the door a contrasting color.
• Increased Visibility: Use motion-sensored nightlights to illuminate the path from the bed to the bathroom at night.
• Safety Features: Install grab bars next to the toilet and a raised toilet seat to make it easier for the person to get up and down safely.
• Commode for Accessibility: A bedside commode can be a useful alternative for those with reduced mobility, especially during the night.

Using Adaptive Clothing and Products

Choosing the right products can help manage incontinence and preserve dignity.

• Easy-to-Remove Clothing: Opt for clothing with elastic waistbands, Velcro closures, or simple pull-down styles. Avoid complex buttons, zippers, or belts that can be difficult to manage quickly.
• High-Quality Incontinence Products: Absorbent products like pads or disposable briefs can provide a layer of security. Ensure you have a regular changing schedule to prevent skin irritation and infection.
• Protective Bedding: Use waterproof mattress covers and absorbent bed pads to protect bedding and simplify cleanup after nighttime accidents.

Communication and Compassion

How you communicate and react is essential for preserving the individual's dignity.

• Remain Calm and Reassuring: Accidents are inevitable. Your calm and compassionate response will help ease their embarrassment and anxiety. Avoid scolding or showing frustration.
• Use Simple, Direct Language: Use short, clear phrases like “Let’s go to the bathroom now,” rather than complex questions.
• Watch for Non-Verbal Cues: Pay attention to restlessness, pacing, or fidgeting, as these may signal the need to go.

Comparison of Incontinence Management Approaches

Approach	Best for...	Pros	Cons
Scheduled Toileting	Early to mid-stage dementia patients who still follow routines.	Reinforces natural body rhythms; reduces dependence.	Can be stressful if the routine is met with resistance; requires consistent effort.
Environmental Modifications	Any stage of dementia where physical barriers are an issue.	Non-intrusive; improves safety and independence.	Requires an initial investment in equipment and changes to the home layout.
Absorbent Products	Advanced dementia or when accidents are frequent.	Provides security and simplifies cleanup; useful for outings.	Can cause skin irritation if not changed regularly; can be upsetting for the individual to wear.
Behavioral Cues	Early to mid-stage, communicative patients.	Encourages self-initiated toileting as much as possible.	The person may not always respond to cues; requires close observation.

Additional Considerations and Caregiver Support

Caring for someone with incontinence can be draining. It's vital to remember your own well-being. Seek support from healthcare providers, online support groups, or respite care services. Talk openly with your loved one's doctor about challenges and for further guidance tailored to their specific needs. By combining practical strategies with empathy, you can manage this challenge while prioritizing the dignity and comfort of the person with dementia.

Visit the Alzheimer's Association website for more resources on dementia care.

Frequently Asked Questions

Why does a person with dementia become incontinent?

A person with dementia may become incontinent for several reasons. Cognitive decline can affect their ability to recognize the urge to urinate or have a bowel movement, remember where the bathroom is, or communicate their needs effectively. Other factors, like underlying infections, medication side effects, or mobility issues, can also play a role.

How should you respond to a dementia patient's incontinence accidents?

The most important thing is to respond calmly and with compassion. Do not scold or express frustration, as this can cause embarrassment and anxiety. Reassure them that accidents happen and that you are there to help. Focus on cleaning them up quickly, maintaining their dignity throughout the process.

What kind of incontinence products are best for someone with dementia?

The best products depend on the individual's mobility and level of incontinence. Options include absorbent pads for light leakage, disposable briefs (adult pull-ups) for more control, and protective bed and chair pads. Look for products that are highly absorbent and comfortable to prevent skin irritation.

How can I make the bathroom easier for a person with dementia to use?

Make the bathroom more accessible by ensuring a clear path to the door and using high-contrast colors for the toilet seat and walls to aid visibility. Motion-activated nightlights can help with nighttime trips, and grab bars can improve safety. A picture of a toilet on the door can serve as a visual cue.

Is it helpful to restrict fluids to manage incontinence?

It is not recommended to heavily restrict fluids, as this can lead to dehydration and other health issues. Instead, manage fluid intake by encouraging drinks throughout the day and limiting them in the evening, a few hours before bedtime, to reduce nighttime accidents.

What role does diet play in managing incontinence for someone with dementia?

A balanced diet high in fiber can prevent constipation, which can worsen bowel incontinence. Additionally, avoiding bladder irritants like caffeine and alcohol can help with urinary issues. Consult with a doctor or dietitian for specific dietary recommendations.

How can I get a dementia patient to cooperate with a new toileting routine?

Introduce the new routine gently and consistently. Instead of asking if they need to go, use direct statements like, “Let’s go to the bathroom now.” Look for non-verbal cues and use positive reinforcement. If they refuse, you can try again later, as their mood and cooperativeness can change.