title: Incontinence and Alzheimer's: practical and caring solutions for daily management
description: Comprehensive guide to managing incontinence in Alzheimer's patients: understanding causes, adapted protections, intimate hygiene, preventing infections, preserving dignity, and concrete solutions for caregivers.
keywords: Alzheimer's incontinence, Alzheimer's urinary leaks, Alzheimer's protections, intimate hygiene, urinary infections, dignity incontinence, managing incontinence
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Alzheimer's, incontinence, urinary leaks, protections, hygiene, dignity, infections, practical solutions
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Reading time: 28 minutes
"Mom wakes up soaked every morning." "Dad no longer asks to go to the bathroom, he lets himself go." "She doesn't feel it when she has to go." "The smell of urine invades the house." "I don't know how to manage anymore, I'm exhausted."
Incontinence is one of the most difficult symptoms to experience in Alzheimer's disease, for the patient and the caregiver. This loss of control deeply affects dignity, generates shame and embarrassment, and exhausts those around. Multiple changes, intimate hygiene, sheets to wash every day, recurrent urinary infections: the burden is heavy, emotionally and physically.
But incontinence is not a hopeless situation without solutions. With the right protections, adapted hygiene, preventive strategies, and a lot of care, it is possible to manage this situation while preserving the dignity of your loved one.
This guide explains why incontinence occurs, how to manage it daily with concrete solutions, and how to preserve respect and dignity.
Table of Contents
1. Understanding incontinence in Alzheimer's
2. Choosing the right protections
3. Intimate hygiene and infection prevention
Understanding incontinence in Alzheimer's {#comprendre}
What is incontinence?
Involuntary loss of urine (urinary incontinence) or stools (fecal incontinence).
Common symptom in Alzheimer's, especially moderate to advanced stages.
Why does it occur in Alzheimer's?
1. Loss of recognition of bodily signals
No longer feels the urge to urinate.
The brain no longer processes bladder signals.
2. Forgetting the location of the bathroom
No longer remembers where the bathroom is.
Gets lost in the house (even if living there for 40 years).
3. Difficulty undressing in time
Apraxia: No longer knows how to unbutton pants, lower underwear.
Too slow: Accident before getting there.
4. Loss of awareness of cleanliness
Does not realize they are wet, dirty.
No longer has the reflex to change.
5. Communication disorders
Can no longer ask to go to the bathroom.
Words lost, or no longer knows how to express the need.
6. Associated medical causes
Urinary infections (common in Alzheimer's): Aggravate incontinence.
Constipation: Pressure on bladder → leaks.
Medications (diuretics, sedatives): Increase incontinence.
Prostate problems (males), prolapse (females).
Types of incontinence
Urgency incontinence
Sudden, uncontrollable urge → accident before bathroom.
Overflow incontinence
Bladder too full → constant leaks.
Functional incontinence
Physical ability (bladder OK), but cannot make it to the bathroom in time (apraxia, confusion).
Total incontinence
Complete loss of control (advanced stage).
Incontinence is NOT a choice
Your loved one is not doing it on purpose.
It's not laziness or provocation.
It's a neurological consequence of the disease.
Principle: Empathy, patience, respect.
Choosing the right protections {#protections}
Why adapted protections?
Preserve dignity (avoid visible leaks, odors).
Facilitate changes (caregiver comfort).
Protect skin (irritations, infections if maceration).
Types of protections
1. Anatomical protections (adult diapers)
For whom? Moderate to severe incontinence.
How? Complete change (like baby diaper), fastens with Velcro or elastics.
Advantages:
- Very absorbent
- Secure (good protection)
- Can be perceived as humiliating (resemble diapers)
- More difficult to put on (standing or lying down)
- Discreet (look like normal underwear)
- Preserve autonomy (can put on alone)
- Less humiliating
- Less absorbent than full changes
- More expensive
- Very discreet
- Comfortable
- Absorb little (not suitable for significant incontinence)
- Buy in bulk (cheaper)
- Compare brands (supermarkets vs pharmacy)
- Request reimbursement: Social Security (ALD Alzheimer's), mutual insurance, APA (Personalized Autonomy Allowance).
Disadvantages:
Brands: Tena, Hartmann, Abena.
2. Absorbent underwear (pants)
For whom? Mild to moderate incontinence, still mobile.
How? Look like normal underwear, put on like briefs or panties.
Advantages:
Disadvantages:
Brands: Tena Pants, Always Discreet.
3. Light protections (pads, liners)
For whom? Very light incontinence (a few drops).
How? Stick into normal underwear.
Advantages:
Disadvantages:
4. Disposable or washable pads
For what? Protect bed, chair.
Disposable: Convenient (throw away after use).
Washable: Ecological, economical (reusable).
Indispensable for protecting mattress.
How to choose?
According to level of incontinence:
Mild (a few drops)
Moderate (regular leaks)
Severe (significant, frequent leaks)
According to mobility:
Still mobile, independent → Pants (put on alone).
Bedridden, invalid → Full changes (easier to put on lying down).
According to budget:
Protections are expensive (50-100€/month).
Solutions:
Practical advice
Try several brands
Absorption, comfort, size vary.
Correct size
Neither too tight (uncomfortable, leaks) nor too loose (leaks).
Change regularly
Every 3-4h minimum, or as soon as wet.
Night protections
More absorbent (special night, up to 12h).
Intimate hygiene and infection prevention {#hygiene}
Why hygiene is crucial
Maceration (skin in prolonged contact with urine/stools):
Risk of urinary infections in Alzheimer's: Very frequent, worsens confusion.
Hygiene during changes
1. Frequency of changes
Minimum 4-5 times/day (morning, afternoon, evening, night, + if accident).
Always change as soon as wet/soiled (never allow maceration).
2. Change technique (standing or lying)
Standing (if mobile):
1. Put on disposable gloves.
2. Lower pants + protection (or open pants on sides).
3. Clean intimate parts (wipes or water + mild soap).
4. Dry thoroughly (gentle tapping, do not rub).
5. Put on clean protection.
6. Pull up pants.
7. Dispose of gloves + soiled protection in a closed bag.
Lying (if bedridden):
1. Disposable gloves.
2. Turn to the side (place clean protection halfway under buttocks).
3. Turn to the other side (remove soiled protection, deploy clean).
4. Clean + dry.
5. Put back on back.
6. Fix clean protection.
3. Cleaning products
Tepid water + mild soap (neutral pH, fragrance-free).
Thick, alcohol-free wipes (convenient, gentle).
Avoid:
Technique:
4. Drying
Essential to avoid maceration.
Pat dry (do not rub).
Intimate parts, folds (between buttocks, groin).
If very fragile skin: Hairdryer (cold/warm air), at a distance.
5. Protective creams
Barrier cream (water paste type, Bepanthen, Mitosyl):
Apply a thin layer after each change.
If redness/irritations:
Preventing urinary infections
Urinary infections = very frequent (especially women).
Symptoms:
Prevention:
1. Impeccable hygiene (frequent changes, proper cleaning).
2. Hydration:
3. Daily intimate wash.
4. Avoid constipation (pressure on bladder, urine stagnation).
5. Cranberry (cranberry): Can help (juice or supplements), ask the doctor's advice.
If infection: Consult quickly (antibiotics required).
Strategies to limit accidents {#strategies}
1. Toilet routine
Regularly take them to the toilet (even if they don't ask).
Every 2-3h: Morning upon waking, after meals, before bed, etc.
Predictable routine = Reduces accidents.
2. Visual cues
Signs with pictograms (WC) on bathroom door.
Light on (door open if accepted): They see where to go.
Clear path (no obstacles between bed and bathroom).
3. Easy-to-remove clothing
Elastic pants (no buttons, complex zippers).
Undresses faster = fewer accidents.
4. Limit drinks before bed
Reduce liquids 2h before night (but don't cut completely).
Toilet just before bed.
5. Monitor signs
Agitation, tugging on clothes = may signal urge (if can't speak anymore).
Suggest toilet at the first signs.
6. Use chamber pot (night)
If difficulty reaching the bathroom at night:
Pot/chair with hole near the bed.
Faster, safer (avoids dangerous trips at night).
7. Consult a doctor
Medical assessment to rule out treatable causes:
Sometimes, medication treatment can improve (anticholinergics, but caution with Alzheimer's).
8. Sufficient hydration
Paradox: Reducing drinks = concentrated urine, bladder irritation, worse incontinence + infections.
Maintain hydration (1.5L/day), but spread out (not all in the evening).
Preserving dignity {#dignite}
Why dignity is essential
Incontinence = shame, humiliation for the person.
Loss of control over the most intimate aspect of being.
Preserving dignity = essential for self-esteem, psychological well-being.
How to preserve dignity
1. Absolute discretion
Changes in the room, door closed (privacy).
No other people present (unless necessary).
2. Respectful language
Avoid:
Say:
3. No reprimands
Never scold, show disgust (not doing it on purpose).
If an accident: Clean calmly, without negative comments.
4. Discreet protections
Pants resembling underwear (less humiliating than diapers).
Normal clothing over (not obvious from outside).
5. Normalize
"It's normal with the disease, it happens."
De-dramatize (but don't downplay).
6. Maintain neat appearance
Even with incontinence: Clean clothes, hairstyle, shaving.
Dignity = being presentable, feeling human.
7. Respect modesty
Cover with a towel during changes.
Only expose parts to be cleaned.
When modesty disappears
Some lose all modesty (undress, touch their private parts in public).
Gentle redirection: Dress them discreetly, redirect attention.
No confrontation (no longer understands the concept of modesty).
Acceptance: Part of the disease (very advanced).
Managing caregiver exhaustion
Physical and emotional burden
Multiple changes/day (laundry, cleaning).
Intimate hygiene = difficult intimacy (especially children with parents).
Odors, accidents = exhaustion, frustration.
Feeling overwhelmed = normal.
Solutions for caregivers
1. Professional help
Care assistant: Changes, intimate hygiene (daily or several times/week).
Nurse (if prescription): Care, infection monitoring.
Relieves burden (physical + emotional).
2. Adapted equipment
Patient lifter (if bedridden, heavy): Eases changes.
Disposable pads (bed, chair): Less laundry.
Thick wipes (quick changes).
3. Psychological support
Support groups (Alzheimer's caregivers): Share, exchange solutions.
Psychologist: Manage emotions, guilt, frustration.
4. Respite
Daycare (several times/week): Person taken care of (toilet, meals), you get a break.
Temporary placement (a few days/weeks): Recover, take a vacation.
5. Accept limits
You can't do it all alone.
Asking for help = not a failure, it's realism.
When to consider placement
If situation unmanageable at home
Total incontinence + bedridden + behavioral disorders:
Too heavy a burden (physically, psychologically).
Specialized housing (EHPAD, Alzheimer's unit):
Not abandonment, but a solution for the well-being of all.
Testimonials
Martine, caregiver to her husband
"My husband had accidents several times a day. I was exhausted, I cried. I requested a care assistant, 2h/morning. She handles hygiene, change. It saved me. I no longer feel guilty, I can breathe."
Jean, son of his mother
"Changing my mother was difficult (modesty, intimacy). I requested a nurse. Now she comes every morning. Mom agrees better with her. I take care of the rest (meals, company). Everyone has their role."
Sophie, caregiver of her father
"Dad had recurrent urinary infections. The doctor said: more frequent changes, strict hygiene. I followed. No infection for 6 months! Hygiene = key."
Cognitive stimulation and well-being
The link with incontinence
Stimulate cognition = Preserve a little longer certain abilities (including recognition of bodily signals).
EDITH, adapted game program:
15 min/day: Caring complement.
Conclusion: Managing incontinence with humanity
Incontinence in Alzheimer's is a difficult reality, but not insurmountable. With the right protections, rigorous hygiene, preventive strategies and deep respect for dignity, it is possible to manage this situation while preserving the quality of life of your loved one and yours.
The solutions that work:
1. ✅ Adapted protections (pants, complete changes according to incontinence)
2. ✅ Strict hygiene (frequent changes, gentle cleaning, barrier creams)
3. ✅ Infection prevention (hydration, intimate hygiene)
4. ✅ Toilet routine (take regularly, anticipate)
5. ✅ Absolute dignity (discretion, respect, caring language)
6. ✅ Professional help (if burden too heavy)
You are not alone. Our Alzheimer's training addresses all these situations. EDITH helps maintain cognitive well-being. Free guide: Daily practical advice.
DYNSEO resources to support you:
Managing incontinence is also an act of love. Every change made with gentleness, every respectful word, every gesture preserving dignity: all of this says "You are important, you deserve respect and care." Incontinence does not define your loved one. It's a symptom. The person remains, with all their worth. Never forget it.
