In recent weeks I have had conversations with some of you about issues related to bathroom use, particularly with respect to persons with Alzheimer’s disease or other dementias. The process of going to the bathroom is something that we all take for granted, not even really thinking about it. We know when we have to go, and we go.

For some people with dementia, that simple process becomes a whole lot more complicated. Some know they need to go and need a bathroom, but have trouble remembering where it is located or have difficulty putting the steps of going into the right sequence. Others know they have to go but no longer recognize that the bathroom is the appropriate place to take care of that need. Still others loose the ability to recognize that they need to void at all.

I preface any further discussion by stating that the doctor should evaluate any abrupt change in bathroom habits. Urinary tract infections in older adults are common, and can cause major changes in behavior and cognition. In addition to behavior changes, like urinating much more often, loss of urine control, and increased confusion, very strong smelling, cloudy, or dark colored urine, or unexplained fever could also be signs that an infection is brewing and a medical evaluation is warranted.

There are a number of changes to the environment and to your approach that can be used to improve bathroom success. First off, be sure that the bathroom is clearly identifiable. As Alzheimer’s progresses, it becomes harder for a person to remember their way around, even if they have lived in the home for years. Label the bathroom door with a large print sign or picture, using terminology familiar to the person. Be sure the person is wearing clothing that they can easily manipulate when they need to go. Extra buttons, snaps, or belts may be too complicated for the person to undo in time. For the person who needs some verbal cuing, make sure phrases are short and simple, and again, use words familiar to the person (if they call it pee, say “it’s time to pee”). Be mindful of modesty needs. This is blurred as the dementia process progresses, but should always be handled thoughtfully.

As noted above, some people with dementia loose the awareness that the bathroom is the place to go. Some will try to urinate outside, or in a receptacle, like a trash can or bucket. Use cues, like signs to help remind people of the right location. Don’t get angry or hostile if they have made an error. And consider whether making an issue of it is worth it. Maybe a bucket in the bedroom is a much safer alternative to wandering down a dark hallway at night. Maybe a pot by the bed will be used more consistently than the toilet. Use a system in your home that works for all of you. Just remember when not at home, if you see that your loved one may need to void, be prepared to quickly get them to an appropriate location.

As dementia progresses, many simple tasks become increasingly difficult, and going to the bathroom is one of them. As caregivers, we can try to make accommodations to keep our loved ones as independent as possible for as long as possible. Making the bathroom easier to identify; making clothing easier to manipulate; giving instructions in simple phrases; watching for non-verbal cues that your loved one does need to go (pacing, fidgeting, fumbling with clothing) and altering the environment can all help improve bathroom success.

Christina Forbes, LGSW from the Daybreak Newsletter 3/2009