Alzheimer's Foundation of America


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Education and Care

Activities of Daily Living:  Incontinence

Proper use of the toilet requires a complex mixture of motivation, internal cues, visual recognition and motor skills—all of which diminish with dementia. Therefore, as the disease progresses, many people develop incontinence, or loss of bladder or bowel control. Typically, an individual first develops episodic urinary incontinence that slowly progresses over a period of years to total loss of bladder control. A similar pattern is seen with bowel control, which becomes impaired in the latter stages of dementia. The rapid onset of incontinence suggests a behavioral or medical change, and should be evaluated by a physician.

Possible problems:
  • Medical problems, such as enlarged prostate glands and urinary tract infection, or medication side effects.

  • An individual cannot remember where or what the bathroom is.

  • Loss of verbal skills makes them unable to express their needs.

  • Clothing is hard to remove in time.

  • Individuals are not able to perceive internal signals for urination.
  • Tips:
  • Treat the individual with respect and dignity.

  • Be understanding and reassuring when accidents occur.

  • Establish a routine; for example, take the person to the bathroom every two hours while they are awake.

  • Try to respond quickly to an individual's request for the bathroom.

  • Watch for non-verbal cues, such as facial expressions or tugging on clothing.

  • Put up signs (with illustrations) to indicate the bathroom door.

  • Use easy-to-remove clothing, such as those with elastic waistbands.

  • Avoid caffeine and other stimulants in the evening.

  • Continue to let ambulatory individuals use the bathroom, even if they are managed with adult continence products, until such efforts are counter-productive, e.g., the individual fights during attempts to place them on the toilet.

  • Do not give liquids a few hours before bedtime.

  • Place a commode in the bedroom at night for easy access.
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    For more information, connect with the Alzheimer’s Foundation of America’s licensed social workers. Click here or call 866.232.8484. Real People. Real Care.