Dementia incontinence: what to do, what to say, what to buy

Dementia incontinence is usually handled with four things: a bathroom schedule, clothes he can get off fast, the right products, and a calm, matter-of-fact voice. But if the accidents started suddenly, call his doctor first. A urinary tract infection, constipation or a medicine can cause new incontinence, and the doctor may be able to treat it. Once you've ruled those out, the steps below make the days, and the laundry, more manageable.

The National Institute on Aging says most people with Alzheimer's will have incontinence at some point. It can happen at any stage, but it's more common later on. Knowing that won't make the 4 a.m. sheet change easier. It might make it feel less like something you caused.

Sudden incontinence: call the doctor first

New or sudden accidents are a medical question before they're a dementia question.

The National Institute on Aging lists causes a doctor may be able to treat: certain medicines, a urinary tract infection, an enlarged prostate, diabetes and caffeine. The Alzheimer's Association adds constipation, stroke and Parkinson's disease, and says sleeping pills and anxiety medicines can relax the bladder. The Alzheimer's Society notes that constipation is a very common cause of bowel accidents.

UTIs need special attention in someone with dementia. MedlinePlus lists urinary tract infections among the common causes of delirium, a sudden confusion that comes on over hours or days. So a UTI may show up as a bad week of confusion, falls or agitation, with the accidents almost an afterthought.

Ask the doctor to check his urine, and bring a list of every medicine and supplement he takes.

Why dementia incontinence happens

If the doctor finds nothing treatable, the cause is usually the disease. The Alzheimer's Society lists the ways it gets in the way. He may not notice his bladder is full, or may not get there in time. He may not be able to tell you he needs to go. He may not be able to find the bathroom or recognize the toilet, or may forget what to do once he's there. He may also turn down help because he's embarrassed, and hide wet clothes.

That last one matters. A pile of wet underwear behind the dresser is shame, not spite.

How to deal with incontinence in dementia day to day

Start with the schedule. It does the most.

1. Go on a schedule, not on request. The Alzheimer's Association suggests first thing in the morning, every two hours during the day, after meals and before bed. The National Institute on Aging says every two to three hours, and to show him the way. Don't ask "Do you need to go?" He'll say no.
2. Learn his signals. The Alzheimer's Association lists restlessness, pacing, odd sounds or faces. He may also tug at his pants.
3. Make the bathroom easy to find. Leave the door open and the light on so he can see the toilet from the hall. The National Institute on Aging suggests a big sign that says "Toilet" and a colorful toilet seat.
4. Make it easy to use. Grab bars and a raised seat help, according to the Alzheimer's Association.
5. Dress for speed. Elastic waists, no belts, no fly buttons. The National Institute on Aging recommends loose, comfortable clothing that's easy to remove.
6. Watch the caffeine. The Alzheimer's Association names cola, coffee and tea as drinks that increase urination. Switch to decaf.
7. Don't cut fluids on your own. The Alzheimer's Association warns that limiting fluids can cause dehydration and lead to a UTI. The National Institute on Aging suggests fewer drinks after 6 p.m. if nights are the problem. Ask his doctor which fits him.
8. Keep things moving. Fiber, fluids and a daily walk help with constipation, which the National Institute on Aging links to changes in bowel habits.

When he refuses to wear Depends

This is one of the most common fights, and the word is often the problem. A grown man hears "diaper" and refuses. These help:

• Never say diaper. Call them underwear, briefs or "the new ones."
• Buy pull-ups that look like regular underwear, in a color he'd wear.
• Swap the drawer. Remove his old underwear and fill the drawer with the pull-ups. Lay a pair out with his clothes in the morning.
• Try a pad inside his own briefs first, if his accidents are small.
• Let someone else say it. Some men accept a doctor's or nurse's advice more easily than a daughter's.
• Try other brands and sizes. The Alzheimer's Society says the right type and absorbency should feel comfortable, without chafing or leaking. If they bunch or itch, he'll pull them off.

If he refuses to be changed, stop and try again in 15 minutes, or fold the change into a shower. A warm room, warm wipes and a towel over his lap go a long way. The guide on getting a parent with dementia to shower has more on this.

Take Angela, whose dad threw every package of adult briefs in the trash. She stopped buying the ones with the big label, bought plain gray pull-ups and put them in his drawer as his only underwear. He grumbled for a week, then stopped noticing.

What to say about accidents

The Alzheimer's Association advises staying matter-of-fact and not scolding. Keep the tone you'd use to say it looks like rain.

The fourth line is a small therapeutic fib. The guide on therapeutic lying explains when that's kind.

Skin, cleanup and nights

Wet skin breaks down fast. The National Institute on Aging says to clean his skin after every accident with mild soap, rinse, let it air dry if you can, and then apply moisturizer or petroleum jelly. Tell his doctor or nurse about any red or open spots.

Make cleanup quick:

• Keep a kit in the bathroom: briefs, wipes, gloves, a trash bag, a change of pants.
• Use a waterproof mattress cover and washable bed pads. The Alzheimer's Society notes that waterproof covers shouldn't touch his skin directly, because they can cause chafing.
• Put night-lights along the path from bed to toilet. A bedside commode can save the walk.
• Check his usual hiding spots for wet clothes every day, without comment.

When it's time for more help

Incontinence care is heavy, physical and constant. If you're changing sheets most nights, lifting him, or feeling sick about touching your own father, that's a sign you need more hands, not more patience. An aide for morning care, an adult day program or a few nights of respite can give you back your sleep.

Ask his doctor about a referral to a specialist, such as a urologist, if accidents keep increasing. If you can't keep him clean and dry at home anymore, it's one of the signs covered in the guide on when it's time for memory care.

Questions caregivers ask

What stage of dementia is incontinence?

There's no fixed stage. The National Institute on Aging says it can happen at any stage but is more common in the later ones. A sudden start at any stage is a reason to call the doctor.

Is dementia incontinence worse at night?

Often, yes. He's sleepy, it's dark, and the bathroom is harder to find. A trip before bed, a lit path, and absorbent overnight products help. Ask his doctor before you cut evening drinks.

Does incontinence mean the end is near?

Not by itself. The National Institute on Aging says incontinence can begin at any stage, so it doesn't tell you on its own how much time is left. If you're trying to understand where he is in the disease, the guide to the stages of dementia and his doctor are better guides than any one symptom.