Urinary incontinence is a distressing but very common problem in people with mid to late-stage Alzheimer's disease. There are lots of things you can do to help.

1^st-Exclude diseases and conditions that could be causing urinary incontinence

Remember, people with Alzheimer's can get sick too. Urinary incontinence may just be a symptom of an underlying health problem so will require evaluation by a doctor followed by appropriate treatment. This may cure it. Examples of symptoms that require medical investigation include;

• blood in urine.
• prostate problems in men.
• offensive smelling urine (could be a urine infection, dehydration, diabetes or other kidney problem).
• weight loss could be a sign of other serious diseases.
• severe constipation.
• pain when passing urine, back pain, any pain (for instance headaches could be due to kidney failure).
• Prescribed drugs can have side effects that affect continence.

2^nd-Urinary incontinence can be multi causational

Urinary incontinence in people with Alzheimer's is sometimes due to a combination of factors. Once you have excluded disease as a cause of their incontinence think about:

• improving effective communication to try to limit the impact of confusion caused by Alzheimer's disease.
• room layout and easy bathroom access. Good lighting is important. Big mirrors can confuse someone with Alzheimer's. A bright or distinct toilet seat may help to direct the person to the right place.
• is the ‘patient' able to call for assistance?
• minimize physical problems caused by limited mobility and exercise, long periods of bed care. This could include use of walking aids, more exercise, effective pain control and others you identify.
• bad diet and amount of fluid intake will also affect toilet programs and incontinence.
• poor clothing choices can inhibit their ability to use the bathroom.

3^rd-Incontinence Treatment Program Rules for People with Alzheimer's

A toileting program is not difficult but there are some rules that will help make it more successful.

• be consistent and keep to as rigid a timetable as is practicable.
• always take them to the bathroom if they request to go.
• factor in any regular toilet trips you have previously established in their routine that give good results.
• never shout or hurry them. Talk to them with respect. Be reassuring.
• allow privacy whenever possible.
• help minimise confusion during bathroom trips.
• orientate people with Alzheimer's. So for example say,"Dad I'm taking you to the bathroom/ restroom / lavatory (whatever is most familiar to the person). "Mrs Jones we are at in the bathroom/ washroom / etc now, try to go".
• do not expect a result (voiding) on each visit and do not keep them in the bathroom or on the toilet too long.

4^th-Begin Incontinence Treatment Program

Begin your timed toilet trips every 2 hours. (This does seem quite a lot but this can be changed over time once you establish the best toileting program for that individual.)

• factor in bathroom trips before and after meals, and just prior to bedtime. Night toileting should be maintained on a regular time basis too, but it is more practical to decrease the bathroom visits to every 4 hours.
• praise any positive results.

5^th_ And Finally!