Dementia Continence Issues

Overview

Dementia is a group of brain conditions that affect memory, thinking, and daily life. Continence means being able to control when you pass urine or open your bowels. Incontinence means accidental leakage of urine or stools. As dementia progresses, the brain may not send or receive the signals needed for bladder and bowel control. The person may not notice the urge to go, may forget where the toilet is, or may not be able to ask for help in time. This is a health problem, not a behaviour problem, and it is not the person’s fault.

Yes. Bladder and bowel control problems become more common as dementia gets worse. They are not a sign that the person is being difficult or lazy. They are a sign that the brain and body need extra support.

People living with dementia are most often affected, especially older adults. Younger people with dementia can also have continence problems. Family carers and care staff are affected too, because they help with toileting, cleaning, and reassurance.

Symptoms

Common symptoms

• Passing urine without meaning to, during the day or at night
• Bowel accidents or leaking stools
• A sudden, strong need to pass urine that is hard to hold
• Going to the toilet very often
• Not noticing the need to go, or not recognising the feeling
• Forgetting where the toilet is or what to do there
• Refusing help with toileting, or becoming upset when taken to the toilet
• Hiding soiled clothes or bedding out of embarrassment or confusion

Symptoms in children

• Dementia is very rare in children, so this topic is not usually about children.
• If a child has bladder or bowel control problems, speak to a children’s health professional. It is usually not related to dementia.

Symptoms in older adults

• Continence problems are more common with older age, frailty, and dementia.
• Older adults may also have arthritis, weakness, or vision problems that make reaching the toilet harder.
• Constipation is common and can make both bladder and bowel accidents worse.
• Night-time accidents and falls when rushing to the toilet are more likely.
• Skin rashes and soreness can develop quickly if wet or soiled skin is not cleaned and protected.

Causes

Main causes

• Dementia damage in brain areas that control bladder and bowel habits
• Memory and thinking changes: forgetting the toilet, not recognising the urge, or not knowing how to ask
• Mobility problems, arthritis, or weakness making it hard to reach the toilet in time
• Constipation, which can press on the bladder and cause leakage or bowel accidents
• Urine infections or other infections
• Medicines that affect bladder control or make the body produce more urine — ask a pharmacist or doctor to review them
• Drinking too little or too much, or drinks with caffeine or alcohol
• Physical bladder or bowel problems, such as an enlarged prostate or pelvic floor weakness
• A confusing toilet environment: poor lighting, locked doors, no signs, or clothes that are hard to undo

Risk factors

• More advanced dementia
• Older age and frailty
• Limited mobility or needing help to walk
• Constipation
• Urine infections
• Diabetes
• Prostate problems
• Pelvic floor weakness
• Medicines that affect bladder or bowel control
• Poor access to a toilet or help
• Not drinking enough fluids

When to see a doctor

See a doctor urgently if:

• The person cannot pass urine at all and has pain or swelling in the lower belly
• There is blood in the urine or stools
• There are signs of infection: fever, shaking chills, burning when passing urine, or feeling very unwell
• There is no bowel movement for several days with vomiting or a swollen belly
• The person has a sudden big change in confusion or behaviour along with new incontinence
• Skin in the pad area is broken, very red, or painful

Book a routine appointment if:

• Any new leakage of urine or stools
• A change in toilet habits, such as going much more often or at night
• The person seems uncomfortable or upset around toileting
• You want help with a toileting plan, pads, or skin care
• You are a carer and feel overwhelmed by cleaning and toileting needs

Diagnosis

A GP or nurse will ask about the person’s bladder and bowel habits, medicines, drinking, mobility, and daily routine. They will look for treatable causes such as constipation, infection, or medicine side effects. They may ask you to keep a simple bladder diary for a few days. This assessment should be private and respectful.

Tests that may be done

• Urine sample test to check for infection
• Bladder diary showing when urine or stools are passed and how much is drunk
• Blood tests to check general health and look for other causes
• Medicine review with a doctor or pharmacist
• Physical examination of the tummy, and sometimes the bottom
• Memory and thinking review if not already done
• Ultrasound scan or referral to a continence service if needed

What to expect at your appointment

You may see a GP, practice nurse, district nurse, or continence specialist. They should ask what matters to the person and the carer, and make a practical plan. It can take more than one visit to find the best mix of support.

Treatment

Treatment focuses on finding and treating anything reversible, then building a daily plan that protects dignity and skin. This may include treating constipation or infection, reviewing medicines, setting a toileting routine, making the toilet easier to find and use, and using pads or bedding protection. A continence nurse can give practical advice.

Self-care at home

• Offer regular toilet trips, such as every two to three hours, rather than waiting for the person to ask.
• Watch for signs the person needs the toilet, such as pulling at clothes, restlessness, or heading to the door.
• Make the toilet easy to find: keep the door open or clearly marked, use night lights, and remove clutter.
• Choose clothes that are easy to pull down, such as elastic waistbands instead of tight buttons and zips.
• Keep the person drinking regular fluids unless a doctor has told you to limit them.
• Prevent constipation with fibre, fluids, and gentle movement, and ask for help if stools are hard or infrequent.
• Clean and dry the skin gently after accidents, and use a barrier cream or protective product if advised.
• Use pads, bed protection, and washable bedding to reduce cleanup and embarrassment.

Medical treatments

A clinician will first treat reversible causes such as constipation, urine infection, pain, or medicine side effects. They may refer the person to a continence nurse for a toileting plan, bladder habits, and product advice. Some medicines can calm an overactive bladder, but they are not right for everyone and can cause confusion, falls, or other side effects in people with dementia. A catheter may be used only when needed and with careful planning. The aim is comfort, dignity, and fewer accidents, not perfect control.

When is surgery considered?

Surgery is not a treatment for dementia-related continence problems themselves. It may be considered for a separate physical problem, such as an enlarged prostate or pelvic prolapse, after a careful discussion about benefits and risks. For many people with dementia, non-surgical support is safer and more helpful.

Living with this condition

Build a simple toileting routine and make it part of the day, like meals and bedtime. Use calm, respectful words and give the person time. Avoid arguing about accidents. Keep spare clothes, pads, and cleaning supplies nearby so you can respond quickly and privately. A written plan can help family, friends, and care staff do things the same way.

Lifestyle tips

• Keep a regular daily routine for meals, drinks, toilet trips, and sleep.
• Make sure the path to the toilet is clear, well lit, and safe.
• Use signs or pictures on the toilet door if the person forgets where it is.
• Avoid too much caffeine or alcohol, which can irritate the bladder or make urine come more often.
• Stay physically active within the person’s ability to help bowel habits and mobility.
• Ask for a continence review if pads or products are needed.
• Protect the skin with gentle cleaning and barrier products if advised.

Diet and exercise

Regular fluids and fibre help prevent constipation, which can make leakage worse. Offer water, squash, tea, and other drinks through the day unless a doctor has advised limits. Include fruit, vegetables, whole grains, and beans if the person can eat them. Gentle movement, such as walking to the toilet or chair exercises, can help bowel habits and strength. Avoid cutting out fluids to reduce accidents, because strong urine can irritate the bladder and cause infection.

Mental health and emotional wellbeing

Continence problems can cause shame, anxiety, and social withdrawal for the person with dementia. Caring for someone with these problems can be exhausting and isolating. If you or someone you care for feels hopeless, has thoughts of self-harm, or is in crisis, contact your local emergency number or a local crisis service right away. It is okay to ask for help.

Prevention

You cannot always prevent continence problems in dementia, but you can lower the chance of avoidable accidents. Treat constipation and infections early, review medicines regularly, keep the toilet easy to reach, and help the person stay active and hydrated.

Vaccines

There is no vaccine for dementia-related continence problems. Recommended vaccines for older adults can help prevent some infections that make incontinence worse; ask your clinician which vaccines are right.

Screening programmes

There is no specific screening test for this problem. Regular dementia reviews, medicine checks, and asking for a continence review when leakage starts can catch problems early.

Complications

If left untreated

• Skin breakdown, sores, and infection in the pad area
• Urine infections
• Constipation and, rarely, bowel blockage
• Falls when rushing to the toilet
• Social withdrawal, embarrassment, and loss of dignity
• Carer stress and exhaustion
• Hospital stays or extra care needs

Long-term outlook

Many people improve with a simple toileting plan, treatment of constipation or infection, and the right products. Dementia does change over time, but good care can protect comfort, dignity, and quality of life. Ask for help early, and review the plan as needs change.

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