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Toileting and Incontinence
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The individual diagnosed with Alzheimer's disease may have lost his/her ability to recognize or respond to the signals that tell him/her when it is time to go to the bathroom, where the bathroom is located or what to do when in the bathroom. Caregivers and family members may have awkward or embarrassed feelings when helping with toileting. It is important to remember that this is normal and that in time these feelings will be overcome. It is important to be matter-of-fact, reassuring, and calm when confronted with these duties that are probably unpleasant for both of you.

  1. In the early stages of the disease, a sign with large simple letters saying BATHROOM is helpful.
  2. From the beginning it is important to set up a schedule for the toileting procedure.
  3. Watch the diagnosed person carefully for signals that he/she may exhibit. A common sign is restlessness, a sudden change in behavior when no other cause is evident, suddenly stopping eating for no apparent reason, and pulling at clothing.
  4. Be sure to respect the privacy of the person with Alzheimer's disease (AD).
  5. Assist with the removal or adjustment of clothing as the situation dictates.
  6. Help the person with AD get into the correct position if needed.
  7. Use a grab bar on the wall if it is close or attach an aluminum arm frame to the back of the toilet. These items are available through the home-health equipment companies.
  8. If the person with AD does not know what to do, give some cues.
  9. Be sure to calmly talk the person through each step.
  10. Restriction of fluid intake 2 hours prior to bedtime is a good policy.
  11. Do not give coffee, tea and other liquids with caffeine because it tends to activate incontinency.
  12. Encourage a high fiber diet and avoid using laxatives.
  13. Try to determine a regular bowel habit and do not forget to take the person to the bathroom daily at the time determined.
  14. It is important to dress the person with AD in manageable clothing.
  15. The placement of a portable commode or a urinal bottle near the bed at night can be helpful.
  16. Night lights and bright tape on the floor leading to the bathroom can help the person with AD find his/her way to the bathroom.
  17. Keep a record for at least one week of the times the individual is wet and dry. Also keep a record of medication and liquids that are taken. From this information, you can find a pattern, for example if the AD patient is wet every 4 hours, then take the diagnosed person to the bathroom every 3-1/2 hours.
  18. Reduce or eliminate the giving of alcohol and grapefruit juice because they have a diuretic effect.
  19. Do not over limit the intake of liquids. Give eight glasses of liquid daily.
  20. Do not toilet every hour; this can cause bladder damage. A minimum of toileting every two hours is recommended.
  21. Toileting the first thing in the morning, after meals and bedtime should be standard procedure.
  22. It is important to praise successful performance in the bathroom. Do not punish failure or inappropriate urination because the AD patient may interpret this as a praise or positive reinforcement.
  23. Give the person a distraction such as a magazine or a knotted pair of socks which will occupy him/her while sitting.
  24. If the diagnosed individual is hyperactive, allow him/her to get up and down from the toilet a few times while you tell him/her and show him/her with gestures that he/she is to sit on the toilet.
  25. Construct a toilet stall with a safety bar, such as the safety bars found on amusement rides, which crosses the person's lap as he/she sits on the toilet. A broom or a mop handle can be cut and sized. The bar will prevent the individual who is unstable or ambulatory from getting up and falling, provides a support to lean on, and is a passive restraint for the hyperactive individual.
  26. A cloth restraint can be used on the diagnosed person, if necessary, however, be sure that the restraint is not fastened to the plumbing, because a very agitated person could pull the whole structure away from the wall or floor.
  27. Skin problems with the person with AD, who is incontinent, can develop very easily. A good commercial product to use is UniWash for cleansing purposes. (Available through pharmacies such as Giant.) It dissolves residues from body wastes and deodorizes as it cleanses. For any sore spots that occur, UniDerm skin conditioner works well. It is a greaseless, deep moisturizer which helps the dry, chapped and irritated skin.
  28. Another method of treating skin problems caused by urea burns is cleansing with water and Castile soap (olive oil and sodium hydroxide). Apply hydrocortisone cream until inflammation has receded. Treat skin problems associated with fungal overgrowth by cleansing with water and Castile or another mild soap, and apply Nystatin (Mycostatin) cream or powder.
  29. Do not let the diagnosed individual remain in wet or soiled diapers. Changing needs to be done immediately to protect from skin breakdown.
  30. Use of a medium sized or large baby pamper can be used as a liner inside diapers or panties. This can be a life saver when there is a messy diaper or panty.
  31. Check with home health supply companies for the variety of diapers and cotton pants that have inserts which work well for the person with AD.
  32. Use a one piece outfit for sleeping if there is a problem with the person with AD trying to remove diapers at night and making a mess.
  33. For the person with AD who attempts to remove his/her diapers, or if the diapers will not stay in place, cut the legs off a pair of panty hose and place the panty portion of the hose over the diapers. It is comfortable and the diapers stay put.
In the Northern Virginia Chapter Service Area, for more information about Toileting and Incontinence, please contact the Chapter's telephone Helpline at (703) 359-4440 or 800-207-8679. Outside Northern Virginia, please contact your local Chapter.

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Last updated: March 1, 1999

Please return to https://www.alz-nova.org or
call 800-207-8679 or (703) 359-4440
for more information about services in Northern Virginia.

© 1997 - 2000 Alzheimer's Association, Northern Virginia Chapter. All rights reserved.

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