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    Dementia Symptoms & Caregiver Strategies: Managing Toileting and Incontinence in Cognitively Impaired Adults

    Many people who have cognitive impairment can experience incontinence (a loss of bladder or bowel control). There are many causes, as well as ways to help manage incontinence. How you respond can help your loved one retain a sense of dignity.

    Causes of incontinence

    Incontinence can be caused by many factors, including an inability to recognize the need to use the restroom, forgetting where the bathroom is located, medications, stress, certain physical conditions, clothing that is difficult to remove and constipation.

    If a person with cognitive difficulties has recently started to lose control of his or her bladder and bowels, the first and most important step is to determine possible causes.

    If incontinence is a new problem, consult with the doctor to rule out potential causes such as a urinary tract infection, weak pelvic muscles or medications. Also consider medical conditions, medication side effects and obstacles that may be causing or contributing to the problem.

    Medical conditions that can cause incontinence:

    • Urinary tract infection, constipation or prostate problem
    • Diabetes, stroke or a muscular disorder such as Parkinson's disease
    • Physical disabilities that prevent the person from reaching the bathroom in time
    Medications and diuretics that can cause incontinence:
    • Sleeping pills and anxiety-reducing drugs that may relax the bladder muscles
    • Drinks such as cola, coffee and tea, which can act as diuretics; a diuretic increases urination
    Environment and clothing obstacles that can contribute to incontinence:
    • Not being able to find the bathroom
    • Obstacles on the way to the bathroom, such as furniture or clutter
    • Clothing that is difficult to remove

    How to respond

    Be supportive

    • Reassure the person to reduce feelings of embarrassment. For example, say "Looks like it’s time to change clothing" instead of "You wet yourself."
    • Be matter-of-fact; don't scold or make the person feel guilty.
    • Respect the need for privacy as much as possible.
    • Do not withhold fluids. This can cause dehydration, which can lead to a urinary tract infection, increased incontinence and agitated behavior. You may, however, want to limit fluids before bed.
    Provide reminders
    • Encourage the person to go regularly, and to tell you when he or she needs to use the toilet.
    • Use adult words, not baby talk, to refer to using the toilet.
    • Learn the person's "trigger" words or phrases for needing to use the toilet. The person may use words that have nothing to do with the bathroom (i.e., "I cannot find the light"), but to that individual, it means going to the bathroom.
    Make it easy to find and use the toilet
    • Clear the path to the bathroom by moving furniture.
    • Keep the bathroom door open so the toilet is visible.
    • Make the bathroom standout. For example, place colored rugs on the bathroom floor and lid covers or post a sign of a toilet on the bathroom door.
    • Make the toilet safe and easy to use. Raise the toilet seat, install grab bars on both sides, and use nightlights to illuminate the bedroom and bath.
    • Consider a portable commode or urinal for the bedroom in case of nighttime accidents.
    • Remove plants, wastebaskets and other objects that could be mistaken for a toilet.
    • Remove throw rugs that may cause a person to trip and fall.
    • Consider using glow-in-the-dark tape to create a direct line or path to the toilet.
    • Paint or place a picture of a toilet on the bathroom door
    Tips for managing incontinence
    • Identify when accidents occur, then plan for them. If they happen every two hours, get the person to the bathroom before that time.

    • Remind the person to use the bathroom just before his or her usual time.
    • Try setting a regular schedule for toilet use. For example, help the person to the bathroom first thing in the morning, every two hours during the day, immediately after meals and just before bedtime.
    • Choose clothing that is easy to remove and to clean.
    • Consider using incontinence products, such as rubber sheets, incontinence pads on the person's bed, padded undergarments or adult briefs.
    • Give the person plenty of time in the bathroom to empty his or her bladder and bowels.
    • Run water in the sink or give the person a drink to stimulate urination.
    • Check the toilet to see if the person has urinated and/or moved his or her bowels.
    • Watch for nonverbal cues such as tugging on clothing, restlessness, facial expressions, pacing, sudden silence or hiding behind furniture. These cues may indicate the need to use the toilet.

    Incontinence can be a very challenging issue for caregivers with loved ones dealing with cognitive impairment. Try to be patient and remember it’s as important to take care of yourself as it is of your loved one.

    Cognitive Impairment can have many causes. The patient’s doctor should be consulted to determine a specific diagnosis and treatment options. But whatever the cause, the symptoms are often alike, and the Caregiver Strategies are often similar.

    The information in the resources listed above was compiled by the Ray Dolby Brain Health Center through clinical experience and commonly available published materials. For information on additional Caregiver Strategies, go to: