As a caregiver for someone with Alzheimer’s who has trouble using the toilet, you might feel stressed or frustrated. Like one myALZteam member asked, “Is there a reason my loved one doesn’t want to sit on the toilet?”

People with Alzheimer’s disease often become incontinent, or unable to control the release of their bladder or bowels. This is more likely to happen in later stages of the disease, but it can also happen in the early stages.

Toileting issues can make daily life stressful both for the person experiencing them and their caregiver. Here’s a look at some common causes of toileting issues in people with Alzheimer’s and some tips for how to navigate them.

Causes of Toileting Issues in Alzheimer’s

“I think he has had troubles with toileting for longer than I knew. He would go in and come out wet all down his pants. At the time, I didn’t understand what was going on,” shared one member.

There are a few reasons why someone with Alzheimer’s might not use the toilet. One that may be particularly frustrating to caregivers is that they simply don’t want to be told what to do. One member shared, “My husband refused to stand near enough to the toilet, even when I reminded him.” If they’re incontinent, they may not have control over where or when they go. This can be because their body has trouble recognizing when their bladder is full.

There are also medical conditions that can lead to incontinence in older adults, such as urinary tract infections (UTIs), constipation, stroke, and diabetes. “When his diabetes started, my hubby went through a period of time when he couldn’t make it to the toilet on time. Thankfully, bringing the diabetes into control has resolved the urine-on-the-floor issue (for now, anyway),” one member shared.

People with Alzheimer’s may also have trouble using the toilet due to memory loss. Some people may simply not be able to remember how to get to the bathroom. “She wears a diaper as an emergency measure, but still insists on using the loo wherever that might be. If I catch her in time, I guide her to the toilet, otherwise, it happens just anywhere … it is as if she forgets where the toilet is,” one member wrote.

On the other hand, some people with Alzheimer’s may not be able to recognize the toilet. “I take my husband into the bathroom and sometimes, not very often though, help him unzip his pants. Yesterday, he peed all over the floor next to the toilet. It’s as if he doesn't know what the toilet bowl is for anymore,” one member said. Another wrote, “Last week, he had to be guided to the toilet, and he knew what to do. Now, he stands there and wets himself.”

Other reasons why someone with Alzheimer’s may have trouble using the toilet include:

• Medications that relax the bladder, such as anxiety drugs or sleeping aids
• Drinks that make them pee more, such as soda or coffee
• Hard-to-remove clothes
• Obstacles that make it physically difficult to get to the restroom

How To Help Loved Ones Use the Toilet

In addition to being a hygiene issue, having an accident can make a person feel embarrassed. As their caregiver, helping them maintain their personal hygiene can mean you’re frequently cleaning them, their clothes, and their bedsheets. Your constant efforts may make you feel overwhelmed.

Though managing incontinence can be stressful, there are different strategies you can try that may help.

Don’t Give Reasons

If your loved one is refusing to use the toilet, don’t attempt to reason with them. People with Alzheimer’s lose memory skills as well as rational thinking skills. When these skills disappear, so does the ability to analyze, understand cause and effect, and prioritize. This can make it hard for people with dementia to make good decisions for themselves.

If your family member has lost the ability to think rationally, don’t try to explain why they should use the toilet. Rather than reasoning with them, try to frame going to the bathroom as something that offers a benefit to them.

Instead of telling them they should go use the toilet, which may be irritating to them, you can try asking them to join you in the bathroom for another personal care matter. For example, they may have an interest in looking in the mirror to fix their hair or makeup. Once they’ve tended to the reason that brought them to the bathroom, they might have a different attitude about using the toilet since they’re already there.

Make It Easier To Find and Use the Toilet

Having too many things around can be distracting for people with dementia. When there’s clutter on the way to the bathroom, it can make it harder for them to decide to go. The same is true for clutter in the bathroom itself, especially around the toilet.

Removing unnecessary items can help cut down on confusion. Having fewer options visible can make the process of going to the bathroom and using the toilet easier for them to make on their own. This can also help them feel more empowered to make their own choices.

To help them find the bathroom, clear the path of clutter and make sure it’s well lit. Night lights may help at night if they’re able to get to the bathroom on their own. Make sure the door to the bathroom stays open so your loved one can see the toilet.

You can also hang a picture of a toilet on the bathroom door or paint the door a color that contrasts with the nearby wall. Take away anything from the bathroom that might be confused for a toilet, such as waste baskets or flower pots. One member noted, “I always point to the toilet. Not good results if I don’t.”

Make sure it’s as easy as possible for them to use the toilet. Consider adding a raised toilet seat and grab bars to help your loved one get on and off more easily. Adding a commode beside the bed may help simplify the process at night. Opt for clothing that’s easy to get off and on, such as pants with elastic waistbands.

Watch for Cues

Be on the lookout for any nonverbal cues your loved one may give when they need to use the toilet. When they need to go, they may:

• Make unusual faces or sounds
• Hide in corners
• Pace back and forth
• Become restless, agitated, or fidgety
• Tug on their clothing
• Touch the area around their genitals

In some cases, your loved one may use certain words or phrases to signal they need to use the toilet. As Alzheimer’s progresses, it can be hard for people to communicate effectively. Because of this, they may use a phrase that doesn’t sound like it has to do with using the bathroom, such as “I can’t find the light.”

Stick to a Toilet Schedule

You can also bring your loved one to the toilet at regular intervals. Try a toileting schedule, such as first thing in the morning, every two hours during the day, right after meals, and before going to bed. Some people tend to have bowel movements around the same time each day. Observe their schedule and remind them when it’s time to use the bathroom. If you notice that your family member has accidents around the same time, get them to the toilet earlier.

One member shared, “We had to go back to potty training and put mom on the toilet every hour. It seems to help us.”

Monitor Fluids

Cutting back on fluids might seem like it would help with incontinence, but it often does the opposite. Don’t reduce overall fluid intake unless you’ve discussed it with their medical provider. Not drinking enough fluids can lead to dehydration, which can cause other issues like UTIs, so make sure your loved one gets enough to drink during the day to stay hydrated. However, try to limit fluid intake closer to bedtime. Avoiding beverages with alcohol and caffeine may also be helpful.

Talk With Others Who Understand

On myALZteam, the social network for people with Alzheimer’s disease and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with the condition.

Is your loved one with Alzheimer’s refusing to use the toilet? Do you have any tips for managing their behavior? Share your experience in the comments below, or start a conversation by posting on your Activities page.