Managing Alzheimer’s Incontinence with Support and Dignity

If an individual suffers from Alzheimer’s, incontinence can have a severe emotional toll, affecting their quality of life and wellbeing if not approached sensitively. In this blog, you’ll learn about managing incontinence with support and dignity to help reduce its impact on the person living with Alzheimer’s – and you as a caregiver.

Understanding incontinence in individuals suffering with Alzheimer’s

Incontinence is the involuntary loss of bowel or bladder control or both, and often happens in Alzheimer’s as the condition deteriorates in the mid to late stages.

It’s important to note that incontinence is not an inevitable part of the condition if managed correctly. Making small changes to medication or lifestyle can delay or prevent incontinence, or at least help to manage it better.

Some of the reasons for incontinence in Alzheimer’s patients include:

Memory, reasoning and language – people with Alzheimer’s may forget where the toilet is or cannot tell you they need to go.

Age-related problems – the average age of people with dementia in the UK is 65 and over. Reduced mobility and lack of coordination can prevent them from quickly reaching the toilet or removing their underwear.

Underlying issues – medications and medical conditions such as constipation and urinary tract infections can cause incontinence.

Recognising the emotional impact of incontinence

Urine or faecal incontinence is an indignity that can leave people with Alzheimer’s feeling distressed, embarrassed, anxious and fearful of further accidents.

They may be unable to express their need to go to the toilet, which can escalate from frustration to agitation and aggression. Creating a supportive and empathetic environment helps to provide dignified care for the individual and means less distress for you.

Studies show that a personalised continence care plan that considers the person’s needs can reduce accidents and enhance their dignity.

To help a person living with Alzheimer’s, it’s important to understand:

● The person’s needs, understanding, likes and dislikes.

● Their mobility function. Can the individual go to the toilet? Do they know what a toilet looks like? Would the use of aids assist in going to the toilet?

● Diet and fluids – a balanced diet and exercise can help to prevent constipation.

● Encourage fluids as limiting them could cause dehydration, which could lead to a UTI and increased incontinence.

● Environment, e.g. signposting to the toilet, removing mirrors (especially in bathrooms) and patterns which may cause disorientation.

Challenges faced by caregivers and patients

Alzheimer’s robs people of their mental capacity and practical abilities, which profoundly affects them and their caregivers. As the symptoms worsen, it’s challenging to know what to do.

Incontinence can cause feelings of shame, so it’s crucial to talk sensitively with the patient:

● Use careful language – avoid words like ‘toileting’, which feels impersonal. A matter-of-fact manner can alleviate embarrassment and keep things calm.

● Look for cues – signs that the patient needs the loo may be nonverbal, including hiding, fidgeting, or being silent.

● Learn their trigger phrases – the person may use personal expressions like ‘I need to go out’ or ‘I can’t find the light switch’ when they want the toilet.

Strategies for effective incontinence management

Developing a routine will help to manage incontinence in Alzheimer’s patients effectively.

● Create prompts – set an automatic reminder to encourage the person to go to the toilet every two hours and check whether their pad needs changing.

● Note patterns of behaviour – learn the patient’s habits and anticipate when they need the toilet, such as when they wake up and before bed.

● Assess skin – ensure it is kept clean/dry. Check regularly to ensure that there isn’t excessive exposure to urine and faeces as this may cause skin damage.

● Self-care and personal hygiene – keep wipes, sanitiser, a disposal bin, and disposable gloves close by you in the bathroom.

Providing adequate hydration (around eight glasses of fluid daily) will prevent dehydration and constipation in people with dementia. Maintain a healthy bladder and bowels by ensuring they avoid caffeine and alcohol and eat a balanced diet that includes fibre-filled foods.

If the constipation is severe, seek advice from a healthcare professional.

Read our lifestyle tips.

How to choose the right incontinence product

When incontinence episodes occur, absorbent continence pads are an essential aspect of care and are available as a precaution against individuals soiling their clothes.

The type of continence products you need will depend on the individual’s type and level of incontinence, and the individual’s ability.

For example, if the individual is passing small amounts of urine, or a dribble, a smaller product may be beneficial rather than a larger product which may cause distress to the individual.

When it comes to selecting an all-in-one product, it is important to select the correct size. Please measure the individual’s waist and hips and use the larger of the two sizes to select a product size. If a product is too large, it increases the risk of leakage.

Our product finder tool can help you find the right product for you.

Our continence products include:

● Incontinence pads for women and men

● Pull-up pants – unisex

● All-in-one or belted briefs for women and men

● Shields for men

● Fixation pants used with pads

● Surface protection for bedding and furniture

Consider the person's preferences but be guided by what you want the product to do.

Maintaining dignity and comfort

Modifications to the home can enhance the privacy and independence of individuals with Alzheimer’s.

Clearing the route to the bathroom and placing a picture of a toilet on the door may aid memory. It can also help to keep the door ajar and a light on at night.

Make life easier by installing a raised toilet or one with grab rails and add a commode or portable urinal in the person’s room for convenient night-time use.

Support resources for caregivers

Seek medical advice from your GP, local continence service, or Alzheimer’s nurse specialist. They will be able to advise on management and treatment plans.

There are other helpful organisations, including the Alzheimer’s Society and Dementia UK, that may also be useful to you.

A person who has Alzheimer’s and develops incontinence may feel anxious and depressed. This can be distressing for the person, their caregivers, and their families. But with the correct support, care for their dignity, and well-designed products, you can alleviate many problems that lead to incontinence.