Toilet problems and continence

5. Tips for carers: reducing accidents

Help with using the toilet at home

The following ideas may help someone to find, recognise and use the toilet more easily.

  • Help the person to identify where the toilet is. A sign on the door, including both words and a picture, may help. It needs to be clearly visible, so place it within the person’s line of vision and make sure the sign is bright so it’s easy to see. You can also help the person to know when the toilet is vacant by leaving the toilet door open when it’s not in use. Check the location of mirrors in the bathroom. The person with dementia may confuse their reflection for someone else already in the room, and not go because they think the toilet is occupied.
  • Make it easier for the person to find their way to the toilet. Move any awkwardly placed furniture and open any doors the person may find hard to open themselves. The room and the route to the toilet should be well lit, especially at night. Movement sensor lights in the bedroom and bathroom can also help at night time. These are available from shops selling independent living aids and equipment, or through an occupational therapist – ask the GP or social services.
  • Make it easier for people with mobility problems to use the toilet. Handrails and a raised toilet seat may help. An occupational therapist can give free advice on these, or you can ask someone at a local independent living shop.
  • Help the person to identify and use the toilet. A contrasting colour (for example, a black seat on a white base) can make it easier to see. Some men who have poor mobility or balance, or who can no longer direct their penis when urinating, may find it easier to sit rather than stand.
  • Choose clothing with fastenings that will be easier for the person to undo when using the toilet. Trousers with an elasticated waist are often easier than zips. Some people find ‘adaptive clothing’ with Velcro fastenings easier to use than zips or buttons.
  • If getting to the toilet becomes too difficult because of mobility problems, an aid such as a commode may be useful. This will require the person to recognise the commode, know how to use it and be willing to use it. PromoCon (see ‘Other useful organisations’) and independent living shops provide information on commodes and other aids. Alternatively, you can ask the occupational therapist, community nurse or social services.
  • Ensure the person has privacy in the toilet, but check that they don’t have difficulty managing locks. Some people with dementia struggle with this. To avoid the person locking themselves in, disable the locks or check that you can open them quickly from the outside (for example with the edge of a coin).

Some of these products are available from Alzheimer’s Society’s online shop. Go to shop.alzheimers.org.uk

Help when out and about

Toilet problems and incontinence can make it harder to be out and about. Being more confident and able to cope with accidents is important, because toilet problems can lead to giving up activities or becoming socially isolated. There are several ways to make travelling or being out and about easier for the person with dementia.

  • Plan in advance – for example, find out where accessible toilets are.
  • Be prepared – for example, fit a light pad (the kind that attaches to underwear) and carry spare clothing and pads, as well as a bag for soiled items.
  • Buy a RADAR key. This gives disabled people – including people with dementia – independent access to thousands of locked public toilets around the country (see ‘Other useful organisations’).

Remembering to go to the toilet

Giving the person with dementia regular reminders about using the toilet is a common way to help reduce accidents. For someone with urinary incontinence, the carer should ask regularly (every two to four hours) whether the person needs the toilet. The person should also be given encouragement and assistance if they ask for help. It is important to check that they have used the toilet, and not forgotten or become distracted.

There is evidence that, over time, this can help some people reduce the number of accidents they have.
You should be sensitive when prompting the person to use the toilet, to avoid patronising, annoying or upsetting them. Watch discreetly for signs that the person wants to go to the toilet, especially if they cannot communicate this clearly. These signs may include fidgeting, pacing, getting up and down, or pulling at their clothes.

Developing a routine

For someone who regularly wets themselves, it may be helpful to develop a timetable that offers a reminder for going to the toilet. For example, the timetable could list when the person wakes up, before each meal, at coffee or tea times, and before bed. An automatic reminder – for example, on a smart phone – can also be useful in prompting a person to use the toilet or to check if their pad needs changing.

For faecal incontinence, it is often possible to make the person continent again by going to the toilet at a set time each day, and helping them to stay long enough to have a bowel movement.

At night-time

Many older people wake during the night to urinate. A person with dementia may wake disorientated and be unable to act quickly enough to find (or get to) the toilet. Ideas that might help include:

  • motion sensors for lights or night lights in the bedroom, hallways and bathroom
  • a urinal bottle (designed for men and women) or commode next to the bed at night
  • not drinking anything for two hours before going to bed – but ensuring that the person drinks enough during the day to avoid becoming dehydrated.