It is not uncommon for people as they age to experience problems with toileting. Physical frailty, poor memory and mobility can make getting to the toilet on time difficult.
For those living with dementia these problems can be exacerbated. As dementia progresses you may find the person you care for has problems finding the bathroom, using the toilet correctly (and on time) and problems attending to personal hygiene.
In the middle stages of the disease a person can forget the actual steps involved in toileting.
Caregivers may find themselves having to assist with everyday tasks associated with toileting. This can be uncomfortable for many caregivers, others may be too frail to help.
In the later stages of dementia a person may no longer recognise the urge to use the toilet or even forget how to use the toilet altogether.
For many people living with dementia, problems toileting can lead to incontinence. Incontinence can have many causes and it’s important any problems with continence are investigated by a GP. Often these issues can be resolved ( UTI) or managed by making a few changes to routine.
Sadly problems toileting and an increase in incontinence episodes is one of the main reasons caregivers seek residential care. In the later stages of the disease the use of incontinence aids can help to manage urinary and faecal incontinence.
There are a number of things caregivers can do about the house to encourage proper toileting.
Make access to a bathroom easy
A person living with dementia may not be able to locate, recognise or use the toilet correctly. Ensure a bedroom is close to a bathroom. Poor mobility may mean a person cannot physically get to the toilet on time. They may not sit long enough to finish toileting or forget why they were there in the first place. Try labelling a BATHROOM door or make use of a toilet sign. Leave a night light on overnight. Remove any items that may be mistaken for the toilet such as pot plants and bins. Highlighting the toilet seat in a contrasting colour can help.
Assist with undressing and personal hygiene
Problems undressing on time (unbuttoning pants) may contribute to accidents that could be avoided. Memory loss may mean a person cannot remember the tasks involved with toileting such as undressing, sitting on the toilet and personal hygiene.
As dementia progresses poor coordination and changes in vision may make sitting on a toilet difficult. A person may even be afraid of sitting on what looks to them like a big dark hole. They may attempt to get up from the toilet seat too soon. You may have to talk someone through the steps involved or physically prompt a person to sit on the toilet.
Grab rails may help a person lower themselves to the toilet. Raised toilet seats can also be beneficial to ease bending, getting on and off the toilet.
Many people are embarrassed by incontinence and attempt to hide wet or soiled clothes. It may simply be that a person requires clothing that is easier to take off and put on. Try simple things such as replacing buttons with elastic waist bands etc.
As dementia progresses a person may recognise the urge to go the toilet but not be able to communicate effectively to a carer. Take cues from a loved one. They may use another word for toilet or use body language that suggests they need to go the bathroom.
Following a toileting regime can often help avoid incontinence episodes. Avoid drinks high in caffeine close to bed time. Make sure you don’t discourage fluids to reduce incontinence episodes.
Remember to be mindful of causing further embarrassment if a person has an accident. If you feel you can’t cope seek professional advice.