Continence management - What you can do to help

This information is for carers of people with dementia. If the person with dementia has difficulties with continence there is a lot that can be done to help or even prevent the problem. 

If you require further information about continence or other issues regarding dementia call the freephone Dementia Helpline 0808 808 3000. 

What you can do to help

If the doctor rules out any medical reasons for the incontinence then the cause is most likely to be the person's dementia. If this is the case there are ways in which to manage the incontinence to ensure that the person remains as independent as possible with as few accidents as possible.

• Toileting routines

  • Remind the person to go to the toilet or take them to the toilet at regular intervals.
  • Monitor when the person is incontinent and try to work out the best times to take him or her to the toilet. This will usually be 15 to 20 minutes before the bladder needs to be emptied.
  • Usually taking the person to the toilet before and after meals and before bedtime will help. 
  • Faecal incontinence can sometimes be managed by taking the person to the toilet at a set time, if their habits are regular.

• Observing behaviour

  • If the person is fidgeting, getting up or down or pulling at clothes it may be because he or she wants to go to the toilet.

• Helping in the toilet

  • If the person is having trouble urinating try giving him or her a glass of water or running the tap.
  • If the person is restless and will not sit on the toilet, let him or her get up and down a few times. Music may have a calming effect or try providing something to hold or look at to distract the person while he or she is on the toilet.

• Finding & using the toilet

  • A 'toilet' sign or picture on the door of the bathroom will remind the person where it is - or leave the door to the bathroom open all the time, so that the person can see the toilet. If you use a sign, make sure it is in the person's line of vision and not too high or low on the door.  Remember that pictures will be more helpful to some people with dementia, while others may find it easier to recognise words such as Toilet or Ladies or Gents.  You may need to experiment to see what works best for the person you care for.
  • Make sure that there are no obstacles in the person's way or doors which are hard to open. 
  • A clear path to the bathroom with suitable lighting day and night will help.
  • Make sure that the toilet is easy to identify. Sometimes having the toilet seat a different colour to the toilet helps. 
  • Make sure the toilet is easy to use: perhaps handrails or raising the level of the toilet could help. An occupational therapist can advise on this.

• Clothing

  • If the person finds his or her clothes hard to remove or unfasten, try Velcro fastenings and elasticised waists. 

• Drinks

  • Help the person to avoid having too much to drink before going to bed. However, ensure that he or she has had enough to drink during the day: 6-8 glasses. If someone doesn't drink enough, constipation or urinary infections could occur.
  • The person should avoid too much caffeine such as coffee, tea and coca cola – caffeine can irritate the bladder and the person may need to urinate more urgently and more often.

• Aids and equipment

  • If it becomes too difficult for the person to get to the toilet a commode may be useful. Your community nurse will be able to advise you. 

• Hygiene and skin care

  • Incontinence can lead to skin irritation and may make the person feel uncomfortable. If the person has become wet or soiled, help him or her to wash with mild soap and warm water and dry carefully before putting on fresh pads and clothes.
  • You may need to use a simple barrier cream to help keep the person's skin dry (eg zinc or castor oil cream). This must be applied in a thin layer, especially if using incontinence pads, as the cream will affect how well the urine is absorbed by the pad. Do not use talcum powder.
  • Put used pads in an appropriate container. Soiled clothes and sheets should be put in an airtight container until they can be washed.