Possible solutions  for problems such as urinating on the floor or losing bladder control

Urinating on the floor

Dementia can affect a person’s ability to find their way to the bathroom and identify the toilet and/or toilet seat.

You should not blame the person living with dementia for this behaviour, nor punish them as this type of response will cause them and yourself stress. Modifying your house may help them use the bathroom.

Let’s look at an example

Salima  is taking care of her husband, Ahmad, since he developed vascular dementia several years ago. Ahmad is able to go to the toilet himself without assistance, but recently, Salima  finds Ahmad urinating on the floor outside the toilet.

1. Check your understanding
Prevent urinating on the floor.

What do you think is the right response for Salima?
Please select the correct answer.


Tip

    Below are some tips in case the person you care for experiences difficulties using the toilet.

  • Put an image of a toilet on the toilet door to help them find it.
  • Provide directions to the toilet if they are unable to find it.
  • Provide adequate nightlights in the hallway between the bedroom and the toilet.
  • Use contrasting colours for the toilet seat.
  • Change the person’s trousers to some that are easier to remove.
  • Provide step-by-step instructions to the person if they forget how to use the toilet.
What other factors may contribute to urinating on the floor or losing bladder control?

Contributing factors Recommended solutions
A long distance to go to the toilet in the house
  • Direct the person you care for to the toilet
  • Provide a bedside commode at night
  • Use nightlights in the bedroom and the house
Public toilet that is at a distance from the house
  • Provide a commode for them to use in the house
Not being able to find the toilet
  • Put a picture of a toilet on the toilet door
Not enough colour contrast of the toilet seat
  • Replace the toilet seat with a different colour to increase the contrast
Not enough lighting in the hallway
  • Provide adequate lighting in the hallway
Not enough lighting in the toilet
  • Provide adequate lighting in the toilet
Contributing factors Recommended soWafations
Narrow toilet doors that do not allow the walker or wheelchair to pass
  • Modify the door opening to allow a walker or wheelchair to pass
Visual impairment
  • Direct the person you care for to the toilet during the day
  • Provide a bedside commode at night
Unable to undo trousers
  • Change trousers to ones that are easily undone and removed
  • Assist the person you care for to pull on and do up trousers


Forgetting what to do in the toilet
  • Remind the person you care for of the activities they need to do
  • Provide step-by-step instructions for them to use the toilet
Urinating in public places

Dementia affects the person’s ability to explain their needs, for example needing to go to the bathroom. Additionally, dementia can affect a person’s judgement of what is normal or not in public.

You could help prevent these accidents (incontinence) by maintaining a regular, daily schedule to assist the person you care for to go to the toilet. Identifying how often they used the toilet before they had dementia might be helpful. You can also identify whether the person you care for needs to go to the bathroom by the way they behave, e.g. if they become agitated, stressed, anxious or restless.
 
Let’s look at an example

Mubarak is taking care of his mother Esther, who received a diagnosis of dementia 5 years ago. Mubarak usually takes his mother shopping in the neighbourhood as she enjoys meeting people.

Recently, Mubarak notices that his mother has lost bladder control during the day.
2. Check your understanding
Dealing with losing bladder control.

What do you think is the right response for Mubarak?
Please select the correct answer.


To improve bladder or bowel control, it may help to fill out a toilet diary.

Toilet use diary
Time Number of trips to the toilet Number of times lost control of bladder or bowel What possible causes did you observe?
06:00-09:00



09:00-12:00



12:00-15:00



15:00-18:00



18:00-21:00



21:00-00:00



0:00-03:00



03:00-06:00