2. Helping someone to use the toilet
Key points
- Try to stick to a regular toilet routine.
- Watch out for clues that someone ‘needs to go.’
- If you need to encourage someone to use the toilet, try different ways of asking them.
- Keep clothes simple and the area around the toilet clutter-free.
- When helping someone use the toilet, use a calm voice and don’t rush.
Helping someone to use the toilet can be complicated. Different methods work for different people. Some will only work if you live in the same house as the person you’re caring for.
When to remind or help the person to use the toilet
Some people living with dementia either don’t know when they need to use the toilet (because they can’t recognise their body’s signals) or they know but can’t tell you. Two things can help:
- Keep a regular toilet-use routine.
- Learn to recognise any clues that the person needs to go.
Many people have a bowel movement (poo) at roughly the same time each day, often after breakfast or their biggest meal of the day. Encouraging toilet use at this time can be helpful.
Most people empty their bladder every 2-4 hours during the day. Again, it can be useful to watch for patterns and plan ahead. Some people find it useful to set a timer using a mobile phone, clock or smart home device. Some devices can provide spoken or written reminders.
It can also help to learn the clues that mean the person needs to use the toilet. For example, fidgeting or pacing can be a clue. Some carers have said it’s just ‘a look’ that they learn to recognise.
“I’ve got to keep remembering because he doesn’t, sometimes he says ‘I think I need the toilet’ but most of the time I have to say, ‘Do we need to take you to the toilet?’”
Wife
How to prompt toilet use
Some people do not like being prompted to use the toilet. If this happens, try using different words or a different tone. For example, some carers say that asking the person if they need to go to the toilet does not work but telling them it’s time to go does work.
Refusal to use the toilet can be very frustrating. Staying calm is important to help avoid a battle.
Making it easier to use the toilet
It’s important to make going to the toilet as easy as possible. Here are some things to think about:
- Keep clothing simple by avoiding zips or buttons if possible.
- If equipment such as handrails or a raised toilet seat might help, ask your GP for advice from an Occupational Therapist.
- Check the area around the toilet (and the route to the toilet) for dangers, including bathmats and uncovered hot pipes. Non-slip flooring can be helpful. Try to keep the bathroom uncluttered.
- Is the lighting OK? A night-light plugged in at floor level in the bedroom might help someone reach the bathroom. Also, a motion-activated, battery operated night-light in the bathroom might be helpful to avoid sudden bright light at night.
- If the person struggles to find the bathroom, make the location clear either by leaving the door open or putting a sign or picture of the toilet on the door. It might also help to keep the toilet lid up so that they can see the bowl.
- Having the toilet seat a different colour to the rest of the toilet can help. Putting a strip of coloured tape along the edge of the basin and (for a man who stands to pee) around the edge of the toilet bowl might also help some people.
“Easy access clothing, that’s important. The leggings and trousers, elasticated trousers, and things like that.”
Husband
“I’d say ‘Shall I help you to the toilet Dad?’ Rather than ‘Do you want to go?’ I found that was better because otherwise he would have said ‘No’. That way it was a case of, ‘Oh yes, might be an idea’.”
Daughter
- Keep things the same, for example buy the same-coloured toilet paper each time and keep it in the same place.
- Some people find mirrors confusing and think there is another person in the room. Remove or cover the bathroom mirror if this happens.
- If the person uses continence products, put a bin where they can easily see it near the toilet. For men, it can be a good idea to use a waterproof bin in case it is mistaken for the toilet.
“I put notices up in the bathroom saying ‘Mum, all your knickers are disposable: you cannot wash them’. But she never binned them. She would take them off, put them in the dirty linen box and then she’d try to wash them.”
Daughter
“I would say to him, I need you to stand here, I need you to hold onto the wash basin. I’m just going to run some warm water.”
Daughter
“The husband couldn’t understand why she went to the toilet and came out with wet clothes. It was that she wasn’t pulling her pants down, she was just sitting on the toilet.”
Continence nurse
How to help with toilet-use
It can be hard to know when to start helping with toilet use. Many people worry about upsetting the person they care for by talking about it, but also want to help them to keep using the toilet. To help you decide, keep a look out for signs that the person is not coping in some way. Help could be simple such as turning off taps that have been left on, or they might need more help, for example managing clothes, using toilet paper, managing continence pads, wiping, flushing the toilet or washing hands.
Things to think about
- Verbal (spoken) instructions can help with removing clothes, getting the person into the right position, wiping or hand washing. Try not to rush the person you’re caring for.
- Try to support the person to keep doing as much as they can themselves. Short, clear, spoken prompts at each stage can help with this.
- Try different ways of making the environment comfortable, such as not too cold or noisy. For example, some people find having the radio on can help them relax, but others might find it confusing.
- Using too much or too little toilet roll is a common problem. It can help if you provide the person with the right amount rather than the whole roll.
- Help maintain dignity, for example putting a hand towel over the person’s lap if you need to be with them whilst they are sitting on the toilet.
- It’s not always clear if the person has used the toilet. Sometimes, it can be helpful to check so that you know when they are likely to need to go again.
- Things might not always go according to plan. It can be hard, but remaining calm and speaking gently can help to stop the bathroom becoming a battleground.
“We’ve tried really, really hard to stick to this routine that he’s created. If we stick to what he knows then he goes to the toilet regularly throughout the day.”
Wife
“I used to get him to sit on the toilet but he didn’t want to. He wasn’t aggressive about it he just, very strong man, that he just wouldn’t oblige for me. He wasn’t going to do that, no.”
Wife