Alzheimer’s and Incontinence: Strategies for Families and Caregivers

When you care for or support someone with Alzheimer’s disease and incontinence, you may have questions. You may wonder how to manage this challenge. But armed with courage, respect, and practical ideas, you can support the person through this.^1-3

Learn about what is going on

Incontinence means someone urinates (pees) or has a bowel movement (poos) without meaning to. This is not their fault. In fact, studies link incontinence to mid- to late-stage Alzheimer’s disease. The brain and the bladder (pee collector) or bowel (poo collector) may mix up their messages. The brain might tell those structures to urinate or have a bowel movement when the person does not mean to.^1,2,4

Other issues can lead to incontinence. Your doctor can treat some of these. Others, you can manage with practical actions.^1,3-5

Take them to the doctor when incontinence starts

The doctor can help uncover and treat some causes, such as:^1-4

• Urinary tract infection – Germs get into the urethra (pee tube). This causes an infection and an uncontrollable urge to pee. The doctor can prescribe antibiotics (germ-killing drugs).
• Constipation – Feces (poo) gets stuck in the colon (poo pipe) and hardens. It can press on the bladder, causing leaks. Or it can block the anus (poo hole) causing soft, runny feces to leak out around it. The doctor can recommend laxatives (poo softeners).
• Enlarged prostate in men – The structure around the urethra grows and pushes against the bladder. The doctor can prescribe drugs to reduce the prostate’s size.
• Drugs for Alzheimer’s, sleep, worry, and water loss – These can make you urinate a lot. The doctor can reduce the dose or change the drug.
• Drinks that cause urination – Caffeine drinks like cola, coffee, and tea. You can offer water, sparkling water, juice, decaf coffee, or herbal tea instead.

Consider their struggles to understand their incontinence

For a person with Alzheimer’s disease, many other problems can lead to incontinence. Consider these possibilities:^1,3,5,6

• Their muscles do not work well – they cannot get up or walk.
• They cannot tell you they have to go.
• They do not understand when you ask them if they need to go.
• They cannot find the bathroom or toilet.
• They cannot undo their pants or pull down their underwear.
• There are things blocking the path to the bathroom.
• They do not have any warning before they urinate or have a bowel movement.

Take steps to reduce incontinence episodes

Using the above ideas, you can become a detective. Notice and write down situations when your loved one cannot hold it. Share your notes with the doctor. Consider:^1-5

• Having a bathroom schedule, such as every 2 hours
• Making a well-lit, clear path to the bathroom
• Marking the bathroom door with a brightly colored sign
• Marking the toilet with the same bright color to help them recognize it
• Providing a high-seat toilet for easy sitting
• Placing a portable commode next to them
• Helping them dress in easy-to-remove clothes, like elastic-waist pants

Make a plan to handle accidents

Because incontinence accidents are likely, you will need a plan for handling them. Be ready by:^1-5

• Having a portable clean-up kit with wet wipes, a change of clothes, fresh protective pads, and a plastic bag for soiled clothes.
• Planning your response. Use a calm, reassuring voice and kind words. You can say things like “It is okay, we will get you cleaned up. I know it is not your fault.” Never use anger or shame toward the person with Alzheimer’s.

Keep the skin clean and dry after accidents

Cleanliness is critical after incontinence. Remember to:^1,3-5

• Remove soiled underwear and clothes right away.
• Clean the skin with wet wipes.
• Keep feces germs out of the urethra by wiping from front to back.
• As soon as possible, wash the skin with gentle soap and water. Pat dry.
• At night, remove and wash wet or soiled mattress covers, sheets, and pajamas right away.
• In later stages of Alzheimer’s, the person may try to get their feces out with their hands. Watch for this, stop it, and scrub their hands and nails with soap and water right away.

Keep up with general health and fitness

You can encourage a healthy diet and lifestyle. This helps with overall well-being and avoiding constipation. Every day, help the person with Alzheimer’s:^1,2,4

• Exercise for 30 minutes, outside if possible.
• Drink 6 to 8 8-oz glasses of noncaffeinated, nonalcoholic fluid. Instead of limiting the person’s drinks, schedule them. And stop them 2 hours before bed.
• Eat whole grains, lean protein, and 5 servings of fresh fruits and vegetables.

Keep yourself healthy

Your health and sense of well-being give you the strength you need for caregiving. Self-care is your weapon against burnout and depression, which can happen to caregivers. So, take a short break every day. Ask a friend to sit with the person you care for.^3-5

What is the take-away?

Caring for someone with Alzheimer’s disease is challenging, to say the least. Dealing with incontinence may seem like too much with all your other concerns. But together with the doctor, you can plan how to handle it. With your care, your loved one can minimize incontinence, stay clean and healthy, and feel understood.^1-6