Incontinence in Dementia Care: Understanding and Supporting With Dignity

What Is Incontinence?

Incontinence refers to the unintentional leakage of urine or stool (known as urinary and fecal incontinence, or double incontinence). It becomes increasingly common as dementia progresses, especially in the middle to late stages.

Why It Happens

Several factors contribute to incontinence in dementia:

• The brain may no longer recognize bodily signals or know how to respond appropriately.

• The person may not locate the toilet in time or struggle with clothing.

• Medical conditions—such as urinary tract infections, constipation, diabetes, prostate issues, or neurological disorders—can also play a role.

• Certain medications and diuretic beverages, like coffee and Coca-cola, may increase urgency.

• Environmental barriers like poor bathroom visibility or complicated clothing further complicate access.

Managing Incontinence with Sensitivity

• Seek medical evaluation first: Many underlying causes are treatable with professional care.

• Create a supportive environment:

  • Clearly mark the bathroom—use signs, contrasting colors, or bright visuals.

  • Ensure pathways are well-lit and clear.

  • Choose clothing that’s easy to remove.

• Establish a toileting routine:

  • Track eating, drinking, and bathroom use to anticipate needs.

  • Offer regular prompts to use the toilet, especially before meals, after drinks, or before bed.

• Maintain healthy habits:

  • Encourage proper hydration (but limit fluids before bedtime to reduce nighttime accidents).

  • Include fiber-rich foods and address constipation promptly.

  • Incorporate simple pelvic floor exercises and bladder training when feasible.

• Use aids when helpful:

  • Consider absorbent briefs, bed pads, or bedside commodes for backup support.

  • Choose interventions that maintain dignity—not just containment.

Preserving Dignity and Reducing Stress

• Address accidents calmly:

  • Use reassuring phrases like "Anyone can have an accident" instead of placing blame.

  • Offer privacy and respect throughout the process.

• Pay attention to nonverbal cues:

  • Look for signs such as restlessness, odd facial expressions, or attempting to hide—these may indicate the need to use the toilet.

• Get support:

  • Reach out to continence advisors or medical professionals for guidance and structured care plans.

  • Share the responsibility—inform others assisting with care to ensure consistent and compassionate support.

Caregiver Well-Being Matters Too

Caring for someone with dementia can be emotionally and physically draining. Support not only improves your resilience but also enhances the quality of care you provide. Make time for rest, seek help when needed, and prioritize your own self-care.

In Summary

• Incontinence in dementia is common and rooted in both neurological changes and treatable medical conditions.

• A combination of medical evaluation, practical environmental adjustments, structured routines, and thoughtful communication can dramatically improve both care and dignity.

• Seeking help early—and taking care of yourself—makes all the difference.