Incontinence can occur in the middle and late stages of dementia. Doctors generally define incontinence as the inability or limited ability to control when the body releases urine or stool. It can range in severity from occasional leakage to the full loss of control of these functions.

Dementia refers to the decline of cognitive function. Although there are various kinds of dementia, the most common is Alzheimer’s disease.

People with dementia can develop either urinary or fecal incontinence as their disease progresses.

This article reviews incontinence in dementia, its causes, and ways to help manage the condition.

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Dementia, such as Alzheimer’s, is a progressive disease. This means that the symptoms worsen as the condition progresses.

According to the Alzheimer’s Association, a person with Alzheimer’s disease or dementia will not typically develop urinary or fecal incontinence until they reach the mid to late stages of the condition.

A 2021 study states that urinary symptoms, such as urinary incontinence, affect more than 50% of people with dementia.

Several potential issues can lead to incontinence in people with dementia.

Cognitive decline can cause an inability to recognize when a person needs to use the bathroom. In some cases, individuals may not remember or know where the bathroom is.

When someone with dementia starts to lose control of when they urinate or defecate, caregivers can take steps to determine possible causes. In some cases, knowing the cause may help the caregiver better address the incontinence.

Some possible causes include:

Medications

Anxiety medications and sleeping pills can relax the bladder.

Medical conditions

A person with dementia may have trouble communicating when they have symptoms of a medical condition that may lead to incontinence.

Some examples include:

Dehydration

Dehydration occurs when a person does not consume enough fluids. It can lead to a urinary tract infection, which can cause incontinence.

It is important to remember that drinks, such as cola, coffee, and tea, are diuretics. These increase the amount of urine the body produces and can also lead to incontinence.

Environmental obstacles

In some cases, environmental obstacles may lead to urinary or fecal accidents.

Caregivers should ensure that:

  • the person with dementia is wearing clothes that are easy to remove and put on
  • the bathrooms are easy to locate and identify
  • they remove obstacles between the person with dementia and the bathroom

A caregiver can take several steps to help reduce the number of accidents that occur.

These may not be effective for everyone, but they can provide a suitable starting point for people looking to reduce the effects of incontinence on someone with dementia.

Demonstrate understanding

Urinary or fecal accidents may cause embarrassment. Caregivers may find it beneficial to adopt an understanding demeanor.

Some things to try can include:

  • providing as much privacy as possible
  • speaking about the accident in a matter-of-fact way and making sure to never make the person feel guilty
  • saying statements that show understanding and acceptance, such as, “anyone may have an accident.”

Make the toilet accessible

As a person’s dementia progresses, it may become harder for them to remember where the toilet is. They may also have difficulties getting to the bathroom in time to use it.

Some steps that may help someone with dementia get to the bathroom in time include:

  • removing potential hazards and obstacles that may be in the way
  • placing a portable toilet in the bedroom or making sure to light the bathroom at night
  • installing safety features, such as a high seat or safety bars

It may also be beneficial to put a picture of a toilet on the bathroom door. Caregivers should use a bright, contrasting color to paint the door or keep the door to the bathroom open.

Practice communication

Communication is not always verbal. A caregiver can encourage the person with dementia to tell them they need to use the bathroom, but they may want to look for signs such as:

  • listening for buzzwords that may indicate they need to go
  • watching for fidgeting, faces, or other indicators they need to go
  • encouraging regular bathroom breaks with verbal reminders

Plan ahead

Paying attention to a person with dementia can help when it comes to reducing incontinence.

Caregivers can try:

  • observing and trying to understand the person’s routine toilet schedule
  • reminding them to use the toilet before they would usually go
  • implementing a regular toilet schedule
  • identifying when the accidents occur and helping the person go to the toilet regularly

They should then try:

  • checking if they have used the toilet
  • helping the person wipe and flush
  • washing the sensitive skin areas

Additional tips

A caregiver help manage incontinence by:

  • considering using continence products, such as adult briefs or a continence sheath, which fits over the penis and attaches to a leg bag
  • running the tap or providing water if a person has difficulty urinating
  • using waterproof mattress covers or bed pads

A caregiver can help a person with dementia maintain bladder and bowel health with lifestyle changes.

Some things they can do that may help include:

  • providing plenty of fiber in the diet
  • encouraging drinking 6–8 glasses of water each day
  • providing a nutritious diet with fruits, vegetables, whole grains, limited fats, and lean proteins
  • avoiding caffeinated, carbonated, or alcoholic drinks

If a person is able to do so, keeping active and walking each day can help regulate bowel movements.

Dementia can lead to incontinence in the mid to late stages of the condition. A person may develop incontinence for several reasons, including declining cognitive function, medications, and environmental obstacles that prevent them from finding or reaching the bathroom in time.

A caregiver can help a person with dementia manage incontinence by being understanding, practicing communication, making the toilet accessible, and planning ahead.

It can also help by encouraging the consumption of fluids and a nutritious diet. They can also encourage them to stay physically active.