How can we get my father with dementia to be more aware of his incontinence?

7 answers | Last updated: Oct 01, 2016
A fellow caregiver asked...

My Dad is suffering from dementia. He is 84 years old. He has begun bed wetting. His comprehension is bad. He does not realize he wet the bed, then when he wakes up, he puts on his pants over his urinated body. Mom is angry and depressed because she can not seem to get him to take a shower. When she tells him he wet the bed he says it's "sweat"! He does not smell the urine, but everyone else can. We think sometimes he goes in the bathroom, but forgets why he is in there and wets himself, then comes out of the bathroom (wet) and sits on the couch. Any suggestions? We live on Long Island, NY. Are there any places we can go for support?

Expert Answers

Ron Kauffman is a certified senior advisor (CSA), senior lifestyle radio host, syndicated newspaper columnist, and the author of Caring for a Loved One With Alzheimer's Disease. In addition, Kauffman is also the primary caregiver for his mother, who has Alzheimer's.

My sympathies for your situation and struggle regarding your dad. Unfortunately, with dementia, your dad isn't truly aware of the consternation he's causing your mother or the fact that his clothes and body may smell.

First, I suggest that you and your mom contact the local Alzheimer's Association to seek out any support groups in your area. Your mom's reactions of anger, while understandable, are not going to be helpful to her and are already taking a toll on her with depression and are possibly impacting her physical health.

As for your dad, based on his level of denial of the problem, I suggest several steps be taken: 1. Make an appointment with a doctor he knows and trusts. This could be his primary physician, neurologist or urologist. Prior to the appointment explain to the doctor his problem and ask for his help in introducing your dad to Depends or whichever brand of incontinence product you or the doctor prefers. He should then tell your dad that there's a ""┬Žnew treatment and he's recommending and that your dad begins to use them immediately." 2. Without any fanfare or notice, remove all of your dad's underwear and replace it all with the Depends type product. Do this so that he must put on the incontinence "pull-ups" that look like boxer shorts but will provide some protection. Don't make a big deal out of this, and if he asks where his underwear is, this is one of the situations where a "white lie" is appropriate. You may simply tell dad that this is what the doctor wants him to wear, and leave it at that. No arguing. 3. To protect his bedding (mattress & box spring) purchase a plastic mattress cover, and on top of that place a stain resistant mattress pad. When you make up the bed, the top sheet should also be covered with a product similar to Chux, which are absorbent sheet-like products with a waterproof side that draw urine away from the patient and helps protect the linens and mattress. You can also place a Chux on the sofa to protect it from his incontinence. Chux are available from most large drug stores or pharmacies as well as from sellers of disposable medical equipment and products. You might also ask the Alzheimer's Association for a referral for incontinence products and support groups. These groups can provide you with a great deal of information and personal experiences as to how to deal with this problem. 4. Personal hygiene is critical with incontinent patients, and the Alzheimer's Association may have some suggestions as to what to say and how to cajole your dad into showering on a daily basis or at least after he's had an incident that warrants a shower. If your dad has a favorite treat, TV show, snack or activity, it may be possible to entice him to shower in exchange for allowing him what he wants. With dementia patients it is often more about what works than about offering a democratic vote to the patient in such matters.

I can't emphasize strongly enough how important it is for your mother and you to seek the support and information available from the local Alzheimer's Association regarding his dementia, and support groups dealing with incontinence. Your dad's condition will continue to worsen with time and knowing what behaviors to expect and how to deal with his mental debilitation ahead of time is crucial. So too is having a support group you can lean upon so you don't feel totally alone or feel that no one understands your challenges.

You may also want to start thinking about getting outside help for dad as a way to provide respite for mom. Here again, the Alzheimer's Association may be of tremendous assistance. Dementia is a disease that impacts the entire family, and the more you know about dealing with it, the better you will be able to plan, cope and be supportive of your dad's needs. Best of luck.

Community Answers

Me.... answered...

My Mom did just about the same thing. She used to go while she was walking to the bathroom and in bed. I wanted to pull my hair out at times. Our house was large enough to give her her own bathroom, living room, bedroom. I had dutch doors put in and locked the bottom half with double sided keyed deadbolts. She was very child like at this point and was fine with it. Her rooms were right next to our living room and bedrooms. I had new carpet put in that had sealed carpet padding under it. I would clean her carpet 3 to 4 times a week to help keep the smell down. Keeping her home was more important to me than anything. I know if she went into a rest home they would have just filled her up on meds and she would have passed away sooner. It was alot of work for 5 years, but I don't have any regrets about being able to keep her home and seeing the joy that my kids gave her up the the very end of her life. Good luck to you and your family!

Pretty lady answered...

Dear Helpful, Thank you for your help. At least I don't feel so alone. I appreciate you sharing your experince with me.

Kduncan answered...

The Dr's idea of switching his underwear to depends and blaming it on the Dr is great!. Just make sure he never finds any of his older underwear. Pts with advanced alzhimers cannot be "re-taught" toileting skills or any other skills they have lost. We were always amazed that my mother-in-law was no lnoger able to dress herself, use a knife and fork, toilet herself, didn't remember us, etc. But she could still tie her shoes and did so without any urging. The intreging organ!

Lvkdra answered...

We have a stocky, stroke survivor 90 yr old with us since '97. She's incontinent too. By keeping a schedule we tell Mom when it's time to get to bathroom, time to eat, time to do what ever. Since it's time to do it there is usually no rebuttal. If she says "no, I'm fine", we give 1/2 cup of something to drink then wait a few minutes, and say it's time now to get there. She gets 10 mg oxybutnin at night just before bed so that during the day she has some ability to stay dry. Our biggest problem has been her own body's schedule of when the #2 is going to come. Luckily, 98% in the toilet. Shower discussion, is like this.... if you have any urine on you that's not in the diaper - you get washed, or take a shower, no ifs or butts allowed...I treat her pleasantly cooperatively, if any hesitation then I pretty much act like a Whispering Sargeant that does not take any guff. She gets it and she is pretty good about it. I hope you can introduce some ideas that can help make it easier on all of you.

Paulette911 answered...

My sister who was diagnosed with dementia almost 3 years ago at age 55 has progressively gotten worse. Especially now since she was in the hospital last month for 2 weeks with pneumonia. I had her on a schedule of every 2 hours going to the bathroom with no problem. Even during the night I would wake her up every 2-3 hours to go pee just so she wouldn't have to lay with the urine on her or have an accident and make a mess. Like I said, all was fine until she had to go to the hospital where I couldn't be with her 24/7 and insure that she had the attention to this detail. She was allowed to just lay in bed and go until the aide changed her. It became very discouraging to me because my sister didn't understand how to use the nurse call button to help her nor did she have the rightness of mind to answer correctly any questions the staff may have had if I wasn't there. She more often agreed with anything they said. If they asked her if she was feeling any pain she would say yes whether she did or not. If they asked if she was hungry or if she had already eaten,she would say yes, whether she was or had. It was very frustrating to me when I would get there and find out the discrepancies. Even though I tried to stress her incapacities to all the staff, her mental condition was not taken seriously enough, which I am sure caused her at least an additional 5 day stay. Because one of her lungs had collapsed and they didn't begin fluid removal soon enough. Now that she is home she does literally nothing for herself. Even when following behind her to help with toileting, showering, eating, etc., she forgets or doesn't realize what she is doing. She may put on one sock and forget she has another foot. she may pull her outer pants down to sit on the toilet when told to, but doesn't pull down her pull-up as well and may sit down and pee with it on if not caught beforehand. At times she even forgets how to eat and swallow. If not watched carefully she may not swallow her pills that she takes and will hold them in her mouth. At this point I have no helpful suggestions for others who may have these problems with loved ones, but it has given me a chance to vent. It is becoming very stressful and frustrating than ever before and I know it will only get worse. I pray daily for God's help with patience and forgiveness.

A fellow caregiver answered...

The other problem anonymous has but was not answered is when her father goes into the bathroom he forgets why he went in and pees himself or the floor. I have the same problem with my dad, he wears depends but goes to urinate in the bathroom, forgets , walks out and pees all over. We do have 24hr aide and my mom has dementia as well, however they are both constantly cleaning up after him, the odor in the house is sometimes unbearable. No problems with no.2. Any suggestions ?