How to get someone with dementia to use the toilet? A Comprehensive Guide for Caregivers

Oct 13, 2025 5 min read •

senior care Healthy Aging dementia

According to the Alzheimer's Association, as many as two-thirds of people with dementia will eventually experience incontinence, which can be challenging for both the individual and their caregiver. Learning how to get someone with dementia to use the toilet involves patience, specific strategies, and adapting the environment to support their needs.

Quick Summary

Helping someone with dementia use the toilet requires a compassionate approach, focusing on routine, environmental modifications, and non-confrontational communication. Identifying subtle cues, using visual aids, simplifying clothing, and limiting nighttime fluids are key strategies to manage toileting challenges successfully.

Key Points

Establish a Consistent Routine: Implement a regular toileting schedule, such as every two hours, to reduce accidents and provide a sense of predictability.
Watch for Nonverbal Cues: Pay attention to signs like fidgeting, restlessness, or tugging at clothing, as these may signal the need to use the toilet before an accident occurs.
Modify the Bathroom Environment: Enhance visibility with bright lighting and contrasting toilet seats, install safety features like grab bars, and remove confusing items like trash cans.
Simplify Clothing: Choose garments with elastic waistbands or velcro closures instead of zippers and buttons to make undressing easier and less stressful.
Maintain Calm and Respect: Use gentle, direct language and avoid reasoning or scolding. Always treat the person with dignity and respect, even when accidents happen.
Consider Nighttime Strategies: Use a bedside commode and limit fluid intake in the evening to reduce the risk of nighttime falls and accidents.
Rule Out Medical Issues: Consult a doctor to check for underlying medical causes like UTIs that could be contributing to toileting difficulties.

Understanding the Root Causes of Toileting Difficulties

Before implementing new strategies, it's essential to understand why a person with dementia may have trouble with toileting. The challenges are not simply about forgetting; they are often a complex mix of physical, cognitive, and environmental factors.

Cognitive and Physical Factors

Loss of recognition: The person may no longer recognize what the toilet is for or may mistake other objects, like a wastebasket, for the toilet.
Difficulty with sequencing: Following the multi-step process of using the toilet—from finding the bathroom to managing clothing—can become overwhelming.
Communication issues: The person may not be able to express their need to use the bathroom, or their verbal cues may be unclear.
Mobility challenges: Physical limitations, balance issues, and fear of falling can make navigating the bathroom difficult and intimidating.
Urinary tract infections (UTIs): UTIs are common in older adults and can cause a sudden onset of incontinence and confusion. A medical assessment is always recommended for new or sudden changes in toileting habits.

Creating a Successful Toileting Routine

Consistency is a cornerstone of effective dementia care. A structured routine can reduce confusion and anxiety surrounding bathroom visits.

Establishing a Schedule

Set a regular toileting schedule and adhere to it consistently. For many, a schedule of every two hours works well. Consider these timing tips:

First thing in the morning.
After every meal or drink.
Before leaving the house.
Right before bedtime.

Watching for Nonverbal Cues

As verbal communication declines, caregivers must become adept at reading nonverbal cues. These can signal the need to use the toilet before an accident occurs.

Agitation or restlessness: Fidgeting or pacing can indicate discomfort.
Pulling at clothes: Tugging at pants or undergarments is a clear sign.
Hiding in corners: This behavior may be a throwback to childhood instincts for privacy.
Touching the genital area: A direct physical sign of a need to go.

Modifying the Environment for Better Success

The bathroom can be a source of confusion and fear. Simple modifications can transform it into a safe, accessible, and cue-rich space.

Enhancing Visibility

Clear the path: Ensure a clear, unobstructed path to the bathroom. Clutter can be a distracting obstacle.
Lighting: Use bright, motion-activated lights in the bathroom and along the route to guide the person, especially at night.
Visual cues: Place a large, clear sign on the bathroom door with a picture of a toilet. Using a toilet seat in a color that contrasts with the rest of the bathroom can help the person visually identify it.
Eliminate distractions: Remove anything that could be mistaken for a toilet, such as trash cans or flower pots.

Improving Accessibility and Safety

Grab bars and raised seats: Install grab bars next to the toilet and in the shower. A raised toilet seat with handles can make sitting and standing much easier.
Non-slip surfaces: Use non-slip mats or decals in the shower and on the bathroom floor to prevent falls.
Remove door locks: Consider removing bathroom door locks to prevent the person from accidentally locking themselves in.

Practical Tips for the Act of Toileting

Simplifying Clothing

Easy on/off: Choose clothing with elastic waistbands, velcro closures, or simple pull-on styles. Avoid buttons, zippers, and complicated fasteners.
Adaptive clothing: Specially designed adaptive clothing is available to make dressing and undressing easier for those with limited mobility.

Communication and Assistance

Use simple language: Avoid complex reasoning or questioning. Instead of asking, "Do you need to use the toilet?" try a simple, direct statement like, "It's time to go to the bathroom now."
Offer respectful assistance: Help with clothing as needed, but encourage independence where possible. Narrate the steps clearly and calmly.
Maintain dignity: Provide as much privacy as possible. If assisting, use a towel as a visual barrier and maintain a respectful tone.

Table: Comparison of Toileting Strategies


Strategy	Best for...	Potential Challenges	How to Address
Routine Scheduling	Early to mid-stage dementia	Individual resists or forgets schedule	Set a gentle, non-confrontational reminder; connect it to a daily activity like after a meal.
Environmental Cues	Any stage of dementia	Individual ignores or doesn't notice cues	Make visual cues highly contrasting and prominent; point and guide if necessary.
Clothing Adaptation	Mobility issues or dexterity loss	Individual resists new clothes	Phase new, simpler clothing in gradually; frame it as a comfortable upgrade.
Monitoring Fluid Intake	Nighttime incontinence	Risk of dehydration	Reduce fluids mainly before bed, but ensure adequate hydration throughout the day.
Bedside Commode	Late-stage dementia or poor mobility	Individual resists using it	Introduce it calmly and explain its purpose; offer privacy with a screen or curtain.

Managing Common Toileting Issues

Refusal or Resistance

If the person resists going to the toilet, do not force or argue. Instead, try distracting them and then redirecting. Suggest a different reason for going to the bathroom, such as, “Let’s go wash our hands,” or “Let’s go look in the mirror.” Once there, gently guide them toward the toilet.

Using Incontinence Products

If accidents become more frequent, quality incontinence pads or protective underwear can offer a helpful backup. Introduce them naturally and matter-of-factly, as if they are a standard part of their underwear. This can reduce anxiety and embarrassment. Ensure skin care is a priority to prevent irritation and infection.

Addressing Nighttime Concerns

For nighttime accidents, consider placing a commode or urinal next to the bed to reduce the distance and associated fall risk. Limit fluids in the two hours before bed, but do not restrict overall daytime fluid intake, which could cause dehydration and UTIs.

The Importance of Caregiver Self-Care

Caring for someone with dementia can be physically and emotionally draining. Managing toileting issues is particularly stressful. It is vital to seek support and remember that accidents are part of the disease, not a failure on your part or theirs.

Consider joining a caregiver support group to connect with others who understand the challenges. The Alzheimer's Association offers a wealth of resources and support for caregivers Find local support services and resources here.

Conclusion

Successfully helping someone with dementia use the toilet is a process that requires a flexible, patient, and compassionate approach. By focusing on routine, modifying the environment, using simple communication, and adapting to the person's changing needs, caregivers can significantly reduce stress and embarrassment for both parties. Remember to rule out medical issues with a doctor and utilize available support resources. Each day may bring new challenges, but with the right strategies, you can provide dignified and effective care.

Frequently Asked Questions

The best approach is to establish a consistent schedule, such as reminding them every two hours, especially after meals and before bedtime. Linking it to another daily activity, like going to the bathroom after breakfast, can also be effective.

To reduce nighttime accidents, try limiting fluids two hours before bed. Using a bedside commode can also be helpful, as it minimizes the distance to the toilet and reduces fall risk. Ensure a clear, well-lit path to the bathroom.

If they refuse, avoid confrontation or reasoning. Instead, distract them with another activity and then gently redirect them to the bathroom. You might say, “Let’s go wash our hands,” or “Let’s look in the mirror,” to get them into the bathroom first.

Make the toilet and bathroom highly visible. Use a brightly colored toilet seat that contrasts with the floor and a large sign with both a picture and words on the bathroom door. Ensure the path is well-lit and clear of clutter.

Yes, install grab bars next to the toilet and in the shower for stability. Consider a raised toilet seat with arms to make sitting and standing easier. Use non-slip mats to prevent falls.

Choose clothing that is easy to remove, such as pants with elastic waistbands or adaptive clothing with Velcro closures. Avoid complicated buttons, zippers, and belts that can be frustrating and difficult to manage.

You should contact a doctor if there is a sudden change in toileting habits, as this could indicate a urinary tract infection (UTI) or other medical issue. Symptoms like increased confusion, fever, or pain should be evaluated promptly.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.