The Hidden Link Between Dementia and Incontinence

As dementia progresses, many unexpected symptoms can arise. While cognitive difficulties are a hallmark of the condition, physical abilities can also decline, sometimes causing confusion and embarrassment. One symptom often overlooked is incontinence.

Between 60–70% of people with dementia will experience some degree of incontinence^[i]. This can be difficult to discuss, particularly for someone who struggles to express themselves. Understanding the connection between dementia and incontinence can help caregivers provide the right support.

What is Incontinence?

Incontinence is the unintentional leakage of urine or fecal matter. There are several types:

• Urinary incontinence: The inability to control urine flow. This can range from occasional leaks to complete loss of bladder control. It affects 3–6 million people in the UK^[iii], most commonly women over 50.
• Fecal incontinence: Difficulty controlling bowel movements, from minor leaks to complete loss of control. Less common than urinary incontinence but affects both genders equally.
• Double incontinence: When both urinary and fecal incontinence occur due to issues with the muscles and nerves controlling the bladder and bowel.

What Causes Incontinence?

Incontinence can develop due to a mix of genetic, environmental, and age-related factors. Common causes include:

• Urinary tract infections (UTIs)
• Pregnancy and childbirth
• Menopause
• Prostate problems
• Neurological conditions, such as Parkinson’s disease or diabetes

Aging can weaken muscles controlling the bladder and bowel, while cognitive decline in dementia may impair bathroom awareness. In some cases, incontinence is treatable, so medical advice is important.

Dementia and Incontinence

People with dementia are more likely to experience incontinence than others of the same age. Cognitive deficits may lead to:

• Forgetting to use the toilet
• Failing to recognize the need to go
• Inability to reach or use the toilet properly

This is called functional incontinence—the urinary and digestive systems work normally, but the brain cannot coordinate bathroom use effectively^[iv].

Signs of Incontinence in Dementia

Look out for these signs:

• Delayed response to the need to use the toilet
• Inability to reach the toilet in time
• Difficulty communicating the need to go
• Misunderstanding cues from caregivers
• Using inappropriate places for toileting
• Forgetting how to manage clothing for toileting
• Refusing help or avoiding the toilet due to embarrassment
• Distracted or unmotivated behavior preventing bathroom use

At Which Stage of Dementia Does Incontinence Occur?

Incontinence can occur at different stages depending on the type and progression of dementia:

• Alzheimer’s: More likely in middle to later stages when confusion increases^[v].
• Vascular dementia: Can occur at any stage due to judgment and awareness challenges.

Not every person with dementia will develop incontinence, but the risk increases with cognitive decline.

How to Help Someone with Dementia and Incontinence

1) Seek Medical Advice

Consult a GP to rule out treatable causes and discuss management strategies.

2) Be Understanding About Accidents

Remain patient and compassionate. Use suitable skin cleaning products, like MoliCare soft skin care tissues, to help the individual clean themselves and change pads or underwear.

3) Make the Bathroom Accessible

Remove obstacles, keep doors open with lights on, and consider using photo labels to help recognition.

4) Ensure the Bathroom is Safe

Install grab bars and night lights to prevent falls and increase confidence.

5) Schedule Regular Bathroom Breaks

Set consistent toilet trips after waking, after meals, and before bed. Learn non-verbal cues like pacing, fidgeting, or pulling at clothing.

6) Choose Flexible Clothing

Opt for elastic waistbands and Velcro fasteners instead of buttons or zippers to make toileting easier.

7) Consider Diet and Lifestyle

• Drink 6–8 glasses of water daily (unless restricted)
• Eat high-fibre foods, fruits, and vegetables
• Limit caffeine, carbonated, spicy, or acidic foods
• Reduce fluids before bedtime
• Encourage regular exercise

Summary

Incontinence in dementia can be challenging for both the individual and caregivers. Understanding the signs, causes, and ways to manage accidents can improve comfort and reduce stress for everyone involved. Compassionate support, accessible facilities, and medical guidance are key to effective management.

Sources

• [i] Bladder & Bowel UK
• [ii] NCI Dictionary of Cancer Terms
• [iii] All About Incontinence
• [iv] RACGP Guide
• [v] Alzheimer's Association