In some people with dementia, the nerve pathways that communicate with the brain and inform that the bladder or bowel is full and that also control emptying, are damaged, interfering with a person's ability to:

• recognize the need to go to the toilet
• find the toilet
• recognize the toilet and use it properly
• communicate the need to go to the toilet
• coordinate the toileting actions/post-toilet hygiene.

As dementia develops over time, incontinence may be more prevalent and more difficult to manage since the cause is a symptom of the underlying disease.

Although the brain changes of dementia can lead to incontinence, other medical conditions such as infection, constipation, hormonal changes and prostate enlargement. can also cause incontinence problems in people with dementia.

Source: BrainFact.org - www.brainfacts.org

A Urinary Tract Infection (UTI) is caused mainly by bacteria and affects part of the urinary tract. A bladder infection (cystitis) affects the lower urinary tract whereas a kidney infection (pyelonephritis) affects the upper urinary tract. UTIs can exacerbate dementia symptoms ranging from agitation and restlessness to hallucinations or delusions making it essential for caregivers to understand how to prevent and recognize UTIs in these patients

Women are more likely to suffer from a UTI than men, especially during the menopause. However, people with diabetes, kidney disorders or a weakened immune system are also at risk for UTIs.

Unlike younger adults who experience painful urination, increased need to urinate, lower abdominal pain, back pain on one side, fever and chills, older adults respond by showing increased signs of confusion, agitation or withdrawal. 

Thus, for senior people who have dementia, these behavioral changes may come across as signs of advanced aging and a UTI could become unrecognized and untreated, eventually spreading to the bloodstream and becoming life-threatening.

Commonly used medicines could be the cause of incontinence, or at least be a contributing factor of urinary leakage worsening, and in some cases, the drugs should be adjusted or stopped.

• High blood pressure drugs (Such as: Cardura (doxazosin mesylate) , Minidress (prazosin hydrochloride), Hytrin (terazosin hydrochloride),  can relax the muscles in the bladder neck, making urine flow more easily and leading to an increase of urine leakage in people experiencing urinary incontinence.
• Also, antidepressants, sleeping pills, and anxiety-reducing drugs (Such as: Norpramin (desipramine), Pamelor (nortriptylene), Cogent (benztropine), Elavil (amitriptyline) Haldol (haloperidol), Risperdal (risperidone)  can worsen symptoms of overflow incontinence by relaxing the bladder muscles and impairing the ability of the bladder to contract.
• Diuretic pills (Such as:Bumex (bumetanide), Lasix (furosemide), Aldactone (spironolactone), Theophylline, and all the "thalazides" (such as hydrochlorothiazide), which are among the most common first-line medications for hypertension). These drugs stimulate the kidneys to flush excess water and salt out of the body, making you have to go to the bathroom more frequently.
• Some drinks such as cola, coffee and tea, which can act as diuretics, increase urination, worsening incontinence

Speak with your loved one’s physician to identify if the medications maybe causing the incontinence and on deciding a course of action to prevent it from continuing. To read about the medications your loved one is prescribed to assess if it may be causing incontinence as a side-effect - go to www.webmd.com and search for the drug. 

Make sure to take good notes about your loved ones condition so that you can share them with the doctor when the time is right. Initially, the physician will need the following information below in order to better assess the patient. 

• Number of times per day the person is incontinent?
• Is it urinary incontinence or faecal incontinence or both?
• When did the problem start?
• Are the person’s clothes saturated or whether is the person just producting a trickle?
• Is there any increase in confusion or any change in behavior?
• Does the person have fever or pain when going to the toilet?
• List of the patient’s current medication.

At the visit with the physician, the caregiver will describe how incontinence is affecting the patient’s life, including an overview of their daily routine (see questions above). 

Generally, the doctor will ask some questions like the ones suggested by the National Association for Incontinence:

• How much water does the patient drink every day?
• What foods is the patient eating?
• Does the patient have any control over urination?
• Is the problem better or worse during the daytime or at night?
• Is it linked to a physical condition (inability to move quickly, for example)?
• When did the incontinence first appear?
• Is the patient upset by their incontinence?
• How many episodes does the patient have and in what time period?
• Does the patient understand the signal or urge to urinate or are they unaware of the need?
• Is there a burning or painful sensation when the patient needs to urinate?

Based on the answers to the questions and information provided by the caregiver, the physician will work to diagnose the cause of the incontinence. They will then order exams to rule out underlying medical conditions (see section:) which may require the patient to pee in a cup or get blood work done. The doctor may review the list of medications he patient is currently on and may make a judgement on readjusting them or not. 

Incontinence is not a disease, but rather a symptom due to an underlying medical condition, such as a changes in the brain caused by the dementia, urinary tract infection, prostate gland trouble, side effects of medication or other bowel conditions. 

The decision to treat incontinence will depend on the cause and severity of the condition and will be based on the best course of action for the patient. The treatments range from antibiotics, anticholinergics, surgical intervention to simply adapting to the incontinence with the use of diapers.

It can be difficult to find a suitable treatment option and it may be necessary to use a rule out method whereby a treatment is tested, then ruled out as ineffective and then the doctor selects another treatment option that treats the incontinence.  

It must be noted that recently,  it was discovered that anticholinergic medications that treat incontinence interfere or counteract with the medications that are also treating dementia. This means that for dementia patients, the treatment of incontinence with medication is worse than finding alternative solutions such as dietary changes.

The following measures will help to manage and monitor the bladder and bowel control in order to make a significant improvement within a relatively short period of time:

1. CONTACT YOUR LOVED ONES PHYSICIAN 

To rule out underlying medical conditions that may be causing the incontinence. It is essential to communicate this issue at early stages so the patient’s healthcare team can help to control and manage the situation and to reduce the frustration and/or embarrassment that is involved. A medical exam is required in order to evaluate the severity and cause of incontinence. See: Incontinence & The Doctor Section to read about what to tell the doctor and what the doctor will do to find out what the issue is.

2. GET A BATHROOM ROUTINE IN PLACE

A loved one’s incontinence will begin to be a part of a caretaker’s life. Taking preventative measures and getting into a routine that is supportive to your love ones needs will help you get through this:

• Keep a log of your loved one’s toileting. Download this Potty Log to keep track of when your loved one goes to the bathroom. Hang the log in the bathroom so that the caregivers do not forget to fill it in. 
• Using the log, try to identify the accidents and when they occur. Notice patterns in their bathroom needs by reading the log after recording their bathroom use for several days.
• Try to plan ahead of them, in order to be prepared. If according to the log it happens every two or three hours, try to take your loved one to the bathroom before that time or remind the person to use the bathroom before their usual time. Take your loved one to the bathroom as soon as they wake up.  Make sure they emptied their bowels and bladder before bedtime.You can set a timer or alarm on your phone to remind you to take them to the bathroom.

3. GENTLY REMIND THEM TO GO TO THE BATHROOM

To prevent some accidents, you will want to encourage your loved one to go to the bathroom or to try and give you some notice in advance. Keep the following in mind when doing this:

• Encourage them to tell you when they need to use the toilet.
• Be aware of the situation that may trigger the accident.
• Try to understand some attitudes and phrases that happen when your loved one wishes to use the bathroom.

4. ADAPT THEIR CLOTHES

Chose clothes that are easy to wash and to take off such as zip up sweaters, velcro shirts, pants with velcro, and shoes without laces. Thus, it will be easier to prevent some accidents and to change the clothing. You can also modify their existing clothes to made them incontinence friendly. There are ways to simplify them:

• Use velcro tapes instead of button ups or zippers. Several companies (including us) make what is called adaptable clothing which is designed for these circumstances. You can also purchase clothing velcro kits which allow you to quickly iron on velcro for easy access.
• Dementia Aide: Bear Hug Onesie - Designed for those transitioning to incontinence, zips in the back to relieve dressing induced agitation and caregiver burden. This was a game changer for our family and hope it will be the same for your family. Watch the video below to see how it works!! You can buy it directly from our website by clicking the button below the video.

• Amazon: No-Sew Button
• Trousers or wraparound skirts should have an elastic band.
• Avoid clothes that need constant ironing.
• Use protective pads in their undergarments.

5. MAKE IT EASY TO GET TO THE BATHROOM AND TOILET

Getting to the bathroom and toilet should not be a big deal. However, for someone suffering from dementia and that is incontinent, it could be a very difficult task. There are some tips one can consider, in order to make it easier to get to the toilet.

• Clear the path to the bathroom: Remove all unnecessary things and furniture out of the pathway to the bathroom or the toilet.
• Keep the bathroom doors open: The bathroom door should always be opened. The toilet should be visible with the door open.
• Use signs & markers on the floor & doors: It is crucial that the toilet is easy to find. Place glow-in-the-dark signs, markers or tape on the bathroom door or on the floor that could direct your loved one directly to the bathroom in time to prevent an accident.
• Use lights to guide them to the bathroom & toilet:
• Motion sensor lights from the bedroom to the toilet are a good choice, since they allow your loved one to get to the toilet without having problems with the switches.
• The bathroom should be well illuminated, make sure to keep the light of the bathroom on and that the toilet is clearly visible.
• Remove door locks: Be sure there is no chance of your loved one locking themselves in or out of the bathroom. To ensure this, remove all door locks.
• Use contrasting colors in the bathroom: The toilet, floor and toilet seat should not have the same color as this makes it hard for a person with dementia to distinguish where the toilet is.
• Modify their bed: The bed should not be too high, so your loved one won’t have difficulties getting out of bed to go to the bathroom.

6. MAKE IT EASY TO GET ON AND OFF THE TOILET

Once your loved one has made it to the bathroom, getting them to the toilet and to stay on there is the next challenge:

• Modify the bathroom to be dementia friendly by:
• Installing bar handles to make it easier to sit down and to stand up. There are plenty of products out there to assist the sitting up and down.
• Remove or cover big mirrors - your loved one may think he or she is being watched and may lose their focus. We use children posters from Walmart and curtains for dad. 
• Let them stand up or sit down as much as they want if they get restless. Do not force them or get angry.
• Other tips for when they're on the toilet:
• Stimulate and keep them calm by running the water or playing music. 
• Respect their privacy: Give your loved one the privacy he or she needs. There are people that can be more embarrassed than others

7. PREPARE FOR NIGHT TIME ACCIDENTS

Dementia patients may have the urge to use the bathroom more often at night, especially for people on medication. They may experience disorientation and stressful situations, such as waking up and not knowing where the bathroom is. Some tips that may help you as a caregiver are:

• While maintaining your loved one hydrated throughout the day, make sure they ingest no fluids at least two hours before bedtime.
• The last thing you should do before taking your loved one to bed is getting him or her to the bathroom to prevent accidents.
• Bed protecting pads and mattress protectors are a good investments. There are some that are washable and others that are disposable. In any case, they should help you keep the bed clean.
• Night lights or motion sensors are a good option in order to decrease disorientation and help your loved one get to the bathroom faster. For more info on safety concerns, read out 11 Top Safety Concerns for a Person with Dementia. 
• Keep commodes or urinals (bottles designed for men and women) on hand in case of an emergency with little notice. 
• Protect the floor: As there are protective pads for beds, there are also protective and absorbent floor pads. These are for putting under the commode or the portable toilets in order to protect the floor. Usually, they are machine washable and they are not slippery, avoiding unfortunate incidents, such as falls. Another option is using protective carpet plastic that is typically used when painting a room. It is relatively cheap and easy to replace. 

8. PREPARE FOR ACCIDENTS IN PUBLIC

Incontinence is a serious problem that may occur at some point in our lives. However, it is not a reason for isolation. There are many ways one can continue to get out and go to public places. You simply have to be prepared:

• Be sure to plan in advance. Have some extra protective underwear (do not call them adult diapers), protective and absorbent pads and clothing. Always keep extra clothing (including shoes and socks) nearby in case of any emergency. 
• Search for the easiest-to-access toilets and make sure you sit near them; When an accident happens, do not panic. It is a normal situation, so you should deal with it with confidence.

How Do I Know We're Ready for Diapers?

When accidents become a daily occurrence, it will be time to consider switching to adult diapers.  The need for the transition may start with your loved one not being able to find the bathroom or the toilet, or perhaps they may not be able to take their clothes off in a timely manner like they used to. 

If you've worked through all of the options in the Incontinence at Home section to no avail - your loved one is ready for diapers. While it is hard to accept, this is not a failure of yours or theirs. No one is at fault here and there is no need to panic. This is a part of the disease and switching to diapers will bring your loved one dignity. It is simply a change and we spell out below how to best address it.

What To-Do & How To Do It:

1. PURCHASE ADULT DIAPER CHANGING ESSENTIALS 

• Diapers: It will be a trial and error game to find the best diapers for your loved one. You can purchase adult diapers at major pharmacies, retail stores, and supermarkets such as CVS, Target, Walmart, Publix.. You can also purchase them online through sites such as Amazon. Purchase several brands, sizes and types and try out what works best for your loved one.
• Gloves: Protect your hands from urine or feces by wearing disposable gloves. Keep a garbage bag or can close to you while you are cleaning your loved one so that you can toss out gloves or wet wipes as you go through the process of cleaning them. 
• Wet-wipes: To clean your loved ones private parts after they've been soiled, use wet-wipes to ensure there is no residue left behind. Like the diapers, you will also want to test out different brands to see which you like best for your loved one. 
• Disposable Wash Cloths: Disposable wash cloths are great to have on hand when the wet wipes are not cleaning the person well enough. Wetting the cloth with warm water and starting the cleaning process with these first, followed by the wet wipes to finish off is ideal for heavily soiled incidents. 
• Butt Rash Ointments: If a soiled or wet diaper is left on your loved one for an extended period of time, they may develop a skin rash or sores. Purchasing a butt rash ointment to protect them while the rash and sores heal is extremely important so that your loved one is not in pain. 
• Scent Sprays: Cleaning someone's behind is typically not a very enjoyable scent experience. Keeping scent sprays such as  Poo Pourri, Febreze and others handy will improve the experience for the caretaker. 

2. ADAPT THEIR CLOTHING

After deciding to introduce diapers in order to make the task of changing diaper changing easier, caregivers can chose clothes that are easy to wash and take off, preventing accidents and giving dignity of life.

• Use velcro tapes instead of button ups or zippers. Several companies make what is called adaptable clothing which is designed for these circumstances. You can also purchase clothing velcro kits which allow you to quickly iron on velcro for easy access.
• You may need to change their wardrobe  entirely to clothing that they cannot take on and off by themselves while they get accustomed to the diaper. 
• Trousers or wraparound skirts should have an elastic band.
• Avoid clothes that need constant ironing.

3. GET A DIAPER CHANGING ROUTINE IN PLACE

Changing your loved ones diaper and keeping them dry is essential to their health. Wet skin can cause rashes and wounds that exaggerate if a good diaper changing routine is not enforced.

In a hospital setting, nurses are taught to check the patient for a soiled or wet diaper every 2 hours, even when the person is sleeping. This timing is ideal, however, if you are the sole caregiver - this can be extremely overwhelming or demanding and highly unrealistic. To minimize the soiled or wet diaper exposure time - you must work to get a bathroom routine where your loved ones bowel movements become somewhat predictable and you can work a diaper change into their schedule. To do so, follow these instructions:

• Keep a log of your loved one’s diaper changes. Download this Potty Log to keep track.  
• Using the log, try to identify patterns of when your loved one goes to the bathroom. Notice patterns in their bathroom needs by reading the log after recording their bathroom use for several days.
• Try to plan ahead of them, in order to be prepared. If according to the log it happens every two or three hours, try to change your loved ones diaper at those times. 

4. PREPARE FOR ACCIDENTS IN PUBLIC

Incontinence is a serious problem that may occur at some point in our lives. However, it is not a reason for isolation. There are many ways one can continue to get out and go to public places. You simply have to be prepared:

• Be sure to plan in advance - carry extra supplies at all times. Always have extra diapers, wet wipes, gloves and ointments with you when out in public as well as a change of clothes in case they get dirty. Leaving a bag or backpack with extra supplies in the car is always a smart preventative measure. 
• Identify the family bathrooms ahead of the accident. Try to avoid having to rush during an emergency by identifying the closest family bathroom. 

What To-Do & How To Do It

1. PURCHASE ESSENTIAL TOOLS TO ASSIST

• Diapers: It will be a trial and error game to find the best diapers for your loved one. You can purchase adult diapers at major pharmacies, retail stores, and supermarkets such as CVS, Target, Walmart, Publix.. You can also purchase them online through sites such as Amazon. Purchase several brands, sizes and types and try out what works best for your loved one.
• Gloves: Protect your hands from urine or feces by wearing disposable gloves. Keep a garbage bag or can close to you while you are cleaning your loved one so that you can toss out gloves or wet wipes as you go through the process of cleaning them. 
• Wet wipes: To clean your loved ones private parts after they've been soiled, use wet-wipes to ensure there is no residue left behind. Like the diapers, you will also want to test out different brands to see which you like best for your loved one. 
• Butt Ointment:  If a soiled or wet diaper is left on your loved one for an extended period of time, they may develop a skin rash or sores. Purchasing a butt rash ointment to protect them while the rash and sores heal is extremely important so that your loved one is not in pain.
• Incontinence or Protective Pad: A protective pad underneath the person prevents the need to change the bed sheet everytime there is an accident in the bed. 
• Draw Sheet or Folded Sheet: To easily maneuver the person on the bed, draw sheets or a folded bed sheet is essential.
• Medical Bed: Insurances sometimes cover a medical bed and other essentials. If your loved ones insurance does not cover it, you can search for low cost medical beds on Craigslist. 
• Scent Sprays: Cleaning someone's behind is typically not a very enjoyable scent experience. Keeping scent sprays such as Poo Pourri, Faberge and others handy will improve the experience for the caretaker. 

2. ADAPT THEIR CLOTHING

• Try to avoid using pants by using gowns instead that open from the back to make it easier to take the diapers on and off.
• Use Velcro tapes instead of button up or zippers for pants and shirts
• Change the buttons and zippers for Velcro tapes or track suits
• Trousers or wraparound skirts should have an elastic band

3. GET A DIAPER CHANGING ROUTINE IN PLACE

Changing your loved ones diaper and keeping them dry is essential to their health. Wet skin can cause rashes and wounds that exaggerate if a good diaper changing routine is not enforced.

Be sure to not neglect your loved one’s hygiene and to watch out for bruises located on the pressure point.

In a hospital setting, nurses are taught to check the patient for a soiled or wet diaper every 2 hours, even when the person is sleeping. This timing is ideal, however, if you are the sole caregiver - this can be extremely overwhelming or demanding and highly unrealistic. To minimize the soiled or wet diaper exposure time - you must work to get a bathroom routine where your loved ones bowel movements become somewhat predictable and you can work a diaper change into their schedule. To do so, follow these instructions:

• Keep a log of your loved one’s diaper changes. Download this Potty Log to keep track.  
• Using the log, try to identify patterns of when your loved one goes to the bathroom. Notice patterns in their bathroom needs by reading the log after recording their bathroom use for several days.
• Try to plan ahead of them, in order to be prepared. If according to the log it happens every two or three hours, try to change your loved ones diaper at those times. 

4. MOVING THE PERSON ON THE BED TO CLEAN THEM

• Have the necessary changing products nearby (cloths, wet wipes, gloves, diapers, water, new draw sheet..). 
• Place a draw sheet or a folded bed sheet for easy maneuverability of the bed-ridden person lessening the strength needed to change the persons diaper.

• Follow the steps in this video for changing a bedridden person:

5. KEEP THE BED CLEAN

Keeping the bed clean while the person is bedridden may not be easy at first. Here are instructions on how to do this without exerting too much strength:

1. Have the clean sheets by you.
2. Roll your loved one on his or her side, untuck the used sheet and fold it until it reaches your loved one’s body.
3. If there is an incontinent pad, remove it.
4. Put the clean sheet and tuck the corners under the mattress – If you use a protective pad, place it on the sheets. Unfold it until it almost reaches the used sheet.
5. Roll your loved one towards you, over the clean sheets; be careful not to hurt him or her.
6. Go to the other side of the bed, and unfold the rest of the sheet.
7. Tuck the sheet under the corners of the mattress.
8. Use disposable or washable protective and absorbent pads.

Cleaning Urine

After a urinary incontinence accident, you will need

• Vinegar
• Water
• Clean white cloths
• Carpet Product such as Resolve Spray

Follow the instructions in this video, and add a step of using the carpet product to clean urine from carpet. 

Cleaning Poop

After a feces incontinence accident in carpet, you will need:

• Vinegar
• Water
• Clean white cloths
• Carpet Product such as Resolve Spray

Follow the instructions in this video, and add a step of using the carpet product to clean feces from carpet.