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Toileting
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.
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
he/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 his/her need to go to the
toilet?
- Can
the person understand the message that his/her body is
sending that it is time to go to the toilet?
- Is
the person able to find the bathroom? Can he/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 he/she prefers, but stay nearby. You
can tell him/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. He/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:
- 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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