Alzheimer's art

Because Alzheimer’s disease affects each individual differently, the causes of incontinence (loss of bladder and bowel control) can vary.

Urinary and fecal incontinence, common in later-stage Alzheimer's disease, can be distressing and difficult to manage. A toileting program is a must for treatment of incontinence in individuals with Alzheimer's disease.

If the affected individual is still ambulatory and able to sit on a toilet, begin timed toilet trips every two hours. A good practice factors in trips before and after meals, and prior to bedtime. You may need to purchase a bedside commode or movable toilet to accommodate your loved one’s needs.

Take the individual to use the bathroom when he or she requests to go. Be reassuring and don't rush. Always respect the individual and allow privacy whenever possible. Keep expectations realistic.

The individual may not void on each visit but may enter the bathroom as if he or she needs to go. In that case, don't allow the individual to stay in the bathroom too long or on the toilet too long. Remember to always offer praise and encouragement, too. Additionally, improving communication can limit the impact of confusion in the affected individual so you may have to orient him or her often regarding the bathroom.

The use of incontinence products is typically needed during this late stage. Adult protective briefs and absorbent pads can assist in providing optimal coverage for comfort and to protect clothing and bed linens. The caregiver needs to take extra precautions and monitor skin care of his or her loved one wearing protective briefs to avoid pressure sores, which can develop into ulcerated skin with blisters. Always consult a physician regarding severe incontinence issues.

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First, rule out any underlying medical problem, such as a urinary tract infection. Such symptoms as blood in urine, prostate problems in men, offensive smelling urine, severe constipation, side effects from medications — all can affect continence.

Also, be aware that incontinence could be due to the individual's inability to locate the bathroom and/or remove his or her clothes in time. And, as the disease progresses, signals that are normally sent to the brain to let the individual know the need to go to the bathroom no longer function.

Once any underlying issues are resolved or excluded, try using other strategies to manage this type of care.

Consider the bathroom environment and make adjustments. Look at the room layout and make sure there is an uncluttered pathway to the bathroom, making it easily accessible. Proper lighting is important. Keep in mind that big mirrors can distract, confuse and even distress the person with Alzheimer's. A bright or distinct toilet may help direct the individual to the right place.

You might try putting a sign on the door of the bathroom, labeling it "Toilet” and even adding a picture of a commode for reference.

Poor diet and inadequate food intake can also affect incontinence. Fluid intake is important to avoid dehydration, but keep in mind to decrease fluid intake before bedtime.

Questions about Alzheimer's disease or related disorders can be sent to Dana Territo, the Memory Whisperer, owner of Dana Territo Consulting, LLC, at