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The brain is extraordinarily complex. It is made up of several distinct parts, each with its own function. While these parts are separate, they must work together to complete the simplest task. As Alzheimer’s disease affects each area of the brain, certain functions or abilities can be lost. One link in the chain of events may be missing and the person will need help or a coping mechanism to complete the task. It is important for caregivers to remember that changes in a person’s behaviour may be related to the disease process.a motor vehicle safely.

Where to Begin

Alzheimer’s disease will affect every part of a person’s daily routine, including bowel and bladder control. A person with Alzheimer’s disease may have accidents, soiling or wetting him/herself. There are strategies that may help to prevent these incidents, saving extra work and embarrassment.
It is important to begin by exploring the possible reasons for the accident. Finding a specific cause for the problem will guide your solution or prevention strategy. However, the reason for one accident may not apply to similar situations. Patterns may become clear if you keep a diary, noting what has happened just before, or at the time of, an accident. Keep in mind that, due to the disease process, no matter what strategies are used, accidents can still occur.

Consider the person

• Is there a medical problem that should be treated such as a bladder infection, constipation, loss of bladder tone, weakening of control muscles, decreased bladder capacity or prostate problems for men?
• Could she be taking medication or drinking large amounts of coffee, tea or colas, which might be contributing to a frequent need to go to the bathroom, thus increasing the risk of an accident?
• Is urine released with the pressure of a sneeze, cough or laugh?

Consider the disease

• Is the person able to communicate her need to go to the toilet?
• Can the person understand the message that her body is sending that it is time to go to the toilet?
• Is the person able to find the bathroom? Can she recognize the toilet (or could a wastebasket be mistaken for the toilet)? Does the person’s confusion increase at night, requiring an adaptation to the environment, such as a night light?
• Is the person able to undress in time?
• Is the task too complicated? Is the person able to go through all the steps that are needed, for example, finding the toilet, undressing, etc.?

Consider the setting

• Is the bathroom too far away?
• Is it difficult to get up from a low bed or a deep chair?
• Is there privacy in the bathroom?
• Are the bathrooms and hallways well lit?
  

What to try

If you can find a reason for the accidents, it becomes easier to find an approach that will help prevent them in the future. If, despite your best efforts, you are not able to determine a specific reason, try the following strategies:

Around the house

• Make the toilet easy to find: clearly mark the path on walls and/or floors; ensure there are no obstacles; label bathroom doors with words or pictures or both.
• Use a contrasting coloured toilet seat. Coloured tape around the perimeter of a toilet or coloured water may prevent accidental misses due to perceptual or visual losses.
• Use a commode or a urinal in the bedroom.
• Put lids on waste paper baskets and other containers that may be mistaken for toilets.

As the caregiver you can

• Watch for visible cues that the person needs to use the bathroom. For example, the person may get restless, make unusual sounds or faces, or pace around the room.
• Give the person simple instructions.
• Give reminders to go to the toilet regularly -- e.g., every two hours, in the morning upon getting out of bed, at bedtime or before going out.
• Choose easy-to-remove clothing, such as velcro closings or elastic waists.
• Direct the individual to the front of the toilet before removing clothes.
• For men, try putting a decal inside the toilet bowl to have something to “aim at.”
• Give a cue to get started, such as running water or certain words. Try to ensure that the bladder is completely emptied.
• Leave the person alone if she prefers, but stay nearby. You can tell her that you are “just outside the door if anything is needed.”
• Distract the person if staying seated is a problem by giving favourite items to look at or hold.

For safety’s sake

• Provide good lighting.
• Install hand rails beside the toilet to make sitting down and getting up easier.
• Install a raised toilet seat, to make getting on and off easier.

If accidents continue

Once it has been determined there are no medical or medication problems causing the accidents, some of the above ideas might keep the person dry and clean. If accidents continue to occur, products such as disposable underwear, panty liners (for women) or protective bedding might be helpful. These may be useful at certain times or in specific situations. Use them only if necessary. Even when wearing pads, take the person to the bathroom on a regular basis.

Day to day

In the event of an accident it is important not to get angry or draw attention to what has happened. This can cause embarrassment and/or more upset. Cleaning up after a parent or spouse is not pleasant. Remember that accidents are caused by the disease; they are not the person’s fault. She may be as distressed as you. Try to maintain the person’s dignity with encouragement. Remain calm. It is important to remember that you are doing the best you can.

In addition...

We are learning more about Alzheimer’s disease and its care everyday much of it from caregivers like yourself who find solutions to problems and share them with others. You can call your local Alzheimer Society to find resources in your community. You can also exchange ideas by visiting the Forums. There is information. There is help. You are not alone.

Resources:
1. The Alzheimer Journey, Module 4, Understanding Alzheimer Disease: The link between brain and behaviour, video and workbook series, the Alzheimer Society of Canada, 2002.

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