How to get someone with dementia to use the bathroom? A compassionate guide

According to the Alzheimer's Association, 1 in 3 seniors dies with Alzheimer's or another dementia. As dementia progresses, caregivers often face the challenging task of learning how to get someone with dementia to use the bathroom effectively and with dignity. This guide offers practical, empathetic strategies to navigate toileting issues, reduce accidents, and maintain your loved one's comfort and respect.

Quick Summary

This guide provides compassionate strategies for caregivers addressing toileting challenges in individuals with dementia. It covers creating consistent routines, adapting the environment for safety and clarity, and interpreting non-verbal cues to prevent accidents. Practical tips on managing incontinence and promoting dignity are also included.

Key Points

• Establish a Toileting Routine: Create a regular schedule for bathroom trips, such as every two hours, to prevent accidents and provide predictability.

• Adapt the Environment: Improve bathroom visibility with signs, contrasting toilet seats, and motion-activated nightlights to help your loved one locate the toilet easily.

• Interpret Non-Verbal Cues: Watch for signs like fidgeting, pacing, or tugging at clothes, as these may signal the need to use the toilet.

• Communicate Calmly: Use gentle, simple language and avoid reasoning with your loved one, as this can increase their anxiety and resistance.

• Use Adaptive Clothing: Switch to clothing with elastic waistbands or Velcro closures to make dressing and undressing quicker and easier.

• Investigate Medical Causes: For sudden changes in toileting habits, consult a doctor to check for underlying issues like a urinary tract infection.

• Promote Dignity: Handle accidents with kindness and avoid expressing frustration, focusing on preserving your loved one's self-respect.

Understanding the Root of Toileting Difficulties

Toileting issues in dementia are rarely an act of defiance. They are a symptom of the disease's progression, which impacts an individual's cognitive and physical abilities. Several factors can lead to accidents or refusal to use the bathroom, including:

• Cognitive Confusion: Memory loss can cause a person to forget what a toilet is for or where it is located. They might mistake a trash can or plant for the toilet.
• Impaired Communication: The individual may not be able to express their need to use the toilet in time.
• Fear and Anxiety: The bathroom can be a scary place. Mirrors may be mistaken for strangers, water can make unusual noises, and the hard, cold surfaces can feel threatening.
• Physical Limitations: Mobility issues or difficulty with fine motor skills (like managing clothing fasteners) can make using the toilet difficult or impossible without assistance.
• Medical Issues: A urinary tract infection (UTI) or constipation can suddenly worsen toileting problems. Consult a doctor for any sudden changes in behavior.

Creating a Proactive Toileting Routine

Establishing a predictable schedule is one of the most effective strategies for managing incontinence. Rather than waiting for your loved one to communicate their need, build regular, scheduled trips into their daily routine.

How to Create and Implement a Toileting Schedule

1. Monitor and Track: For a few days, keep a simple log of when your loved one eats, drinks, and uses the toilet, as well as when accidents occur. This can help identify natural patterns.
2. Schedule Regular Breaks: Based on your observations, create a routine. Common times for toilet trips include first thing in the morning, before and after meals, and just before bedtime. A schedule of every two to four hours is a common starting point.
3. Use Gentle Reminders: Avoid asking, "Do you need to use the bathroom?" as it can prompt a simple "no." Instead, use positive, matter-of-fact statements like, "It's time for our bathroom break," or "Let's walk to the bathroom now."
4. Be Patient: Never rush your loved one. Give them ample time to empty their bladder and bowels completely. Rushing can cause anxiety and increase resistance.

Adapting the Environment for Safety and Clarity

A dementia-friendly bathroom is crucial for promoting independence and reducing confusion. Simple modifications can make a significant difference.

Key Environmental Modifications

• Visual Cues: Use a clear sign with a picture of a toilet on the bathroom door. Paint the door a contrasting color to help it stand out.
• Increased Visibility: Keep the bathroom door open so the toilet is visible. Ensure the room is well-lit at all times, with nightlights illuminating the path to and inside the bathroom. Motion-activated lighting can also be very helpful.
• Bathroom Aids: Install grab bars next to the toilet and in the shower. A raised toilet seat can make sitting down and standing up easier. For individuals with limited mobility, a bedside commode offers a closer option.
• Reduce Confusion: Remove any objects that could be mistaken for a toilet, such as trash cans or flower pots. A contrasting colored toilet seat can also help a person with depth perception issues distinguish the toilet from the floor.
• Safety Features: Remove locks from the bathroom door to prevent your loved one from locking themselves in. Use non-slip mats and consider anti-scald devices on faucets.

Practical Caregiving Comparison: Toileting Strategies

Strategy	Early-Stage Dementia	Mid-Stage Dementia	Late-Stage Dementia
Routine	Gently remind them of their established schedule; may need less frequent prompting.	Regular, scheduled trips are essential (e.g., every 2 hours); watch for non-verbal cues.	Full reliance on caregiver for scheduled toileting; may require assistance at all times.
Communication	Use clear, simple language; ask if they need assistance to preserve dignity.	Use short, direct sentences; offer simple choices like, "Let's go to the bathroom now".	Use gentle, soothing tones; physical guidance and demonstration may be necessary.
Environment	Implement visual cues and safety measures to prevent future confusion.	Ensure contrasting colors, remove clutter, and use motion-sensor lights.	Consider a bedside commode for easier access, especially at night.
Clothing	Adaptive clothing may not be needed yet, but plan for easier options later.	Switch to loose-fitting clothes with elastic waistbands and Velcro fasteners.	Rely on easy-access clothing or incontinence briefs for hygiene management.
Managing Accidents	A gentle, reassuring approach is key to minimize embarrassment.	Remain calm and reassuring; avoid expressing frustration.	Focus on maintaining cleanliness and dignity without shame.

Communicating with Respect and Dignity

Your approach can significantly influence your loved one's cooperation. Remember that their resistance often comes from fear, not stubbornness.

• Speak Calmly and Positively: Maintain a respectful and calm tone. For example, say, "Let's go to the bathroom," rather than, "You need to go to the bathroom."
• Interpret Non-Verbal Cues: Pay attention to signs like restlessness, pacing, fidgeting, tugging at clothes, or touching their genital area. These may signal the need to use the toilet.
• Avoid Arguing: Trying to reason with a person experiencing cognitive decline is ineffective and can cause greater agitation. Instead, distract them or try again later.
• Create a Reason: Frame the toilet trip around another activity, such as tidying up before a meal or getting ready for a walk.

Managing Incontinence Products and Hygiene

As dementia progresses, incontinence is common. Using the right products and maintaining proper hygiene are essential for preventing skin infections and discomfort.

Best Practices for Incontinence Management

• Choose Appropriate Products: A variety of absorbent products are available, including disposable briefs, protective underwear, and pads for furniture. Find products that are comfortable and fit well.
• Promote Skin Health: Change soiled products as soon as possible. Use barrier creams and gentle, unscented soaps to keep the skin clean and dry, preventing irritation and bedsores.
• Respect Privacy: Handle hygiene tasks with dignity and respect. If your loved one is sensitive about changing, try to manage it in the most discreet way possible.
• Hydration is Key: While it may seem counterintuitive, restricting fluids during the day can cause dehydration and increase the risk of UTIs. Encourage regular fluid intake throughout the day, but limit liquids in the evening to reduce nighttime accidents.

Conclusion

Successfully navigating toileting issues in someone with dementia requires patience, empathy, and adaptability. By establishing consistent routines, creating a safe and accessible environment, and approaching the situation with compassion, caregivers can help reduce accidents and preserve their loved one's dignity. Remembering that these challenges stem from the disease itself, not from a person's lack of will, is crucial. If problems persist or worsen, consulting a healthcare provider can help rule out underlying medical issues and provide further guidance.

Dementia: Signs, Symptoms, and Treatment | National Institute on Aging

Frequently Asked Questions

What if my loved one refuses to go to the bathroom?

Avoid arguing or reasoning, as this can cause agitation. Instead, try to distract them and approach the topic again later. You can also reframe the request around a different activity, like tidying up before lunch, to gently guide them to the bathroom.

How can I tell if my loved one with dementia needs to use the toilet?

Watch for non-verbal cues, such as restlessness, fidgeting, pacing, or tugging at their clothing. Some individuals may also make unusual sounds or have a subtle change in their facial expressions that indicates a need to go.

What is the best type of clothing for someone with dementia?

Opt for clothing that is easy to remove and has simple fasteners, such as pants with elastic waistbands or adaptive clothing with Velcro instead of buttons or zippers. This reduces frustration and makes toileting quicker and more manageable.

Should I limit fluids to reduce nighttime incontinence?

While you should encourage regular fluid intake throughout the day to prevent dehydration and UTIs, it can be helpful to limit liquids for a couple of hours before bedtime. Avoid drinks with caffeine, which can increase urination.

How do I make the bathroom safer and easier to find?

Install grab bars, use a raised toilet seat, and ensure the path is well-lit and clutter-free. Place a sign with a picture of a toilet on the door and consider using a contrasting-colored toilet seat to improve visibility.

What should I do when accidents happen?

Stay calm and reassuring, and never scold your loved one. Maintain their dignity by cleaning them as soon as possible, using a matter-of-fact approach. Keep absorbent pads on furniture and beds to minimize mess.

When should I consider using incontinence products?

Incontinence may become more frequent in later stages of dementia. If you observe repeated accidents despite a regular schedule, introducing absorbent briefs or protective pads can be a respectful way to manage the situation and protect against skin irritation.