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Understanding Incontinence & Dementia

While incontinence can become more common with aging, dementia can exacerbate this process. As dementia progresses, older adults can struggle to complete their activities of daily living, including toileting. Keeping clean can help prevent seniors with dementia and incontinence from getting skin or urinary tract infections. To manage incontinence symptoms and provide seniors with dementia the dignity and high-quality care they deserve, it's important to understand incontinence and how it relates to dementia. 

Understanding Incontinence

Incontinence is the unintentional release of urine or stool due to a loss of bladder or bowel control. It can be frustrating and inconvenient, and depending on the severity, it may disrupt everyday life.

Despite how common it is, incontinence is not always indicative of age. It's frequently due to an underlying condition, such as dementia or another neurological disorder, or some sort of injury or damage to the pelvic floor.

Incontinence is classified based on the presentation of symptoms and causes. It includes:

  • Stress incontinence: This form of incontinence is the most common and relates to leakage caused by physical exertion such as exercising, coughing, laughing, or doing strenuous tasks. It's common in women who have had children, people who have had pelvic surgery, or those who have chronic conditions, including diabetes, asthma, constipation, and obesity.
  • Urge incontinence: This form of incontinence causes sudden, intense urges to urinate and bladder spasms that cause involuntary urine leaks. It is commonly caused by neurological disorders, infections in the pelvis, and diabetes.
  • Overflow incontinence: This form of incontinence is caused by not fully emptying the bladder, often due to a blockage, weakened bladder muscles, or nerve damage.
  • Mixed incontinence: Mixed incontinence presents with both stress and urge incontinence symptoms. 
  • Functional incontinence: Functional incontinence is caused by an inability to reach a toilet on time due to some sort of obstacle, such as a mobility issue or degenerative disease. 

Incontinence in older adults with dementia can be caused by other factors. Age and dementia both increase the risk of incontinence, as can the following medical conditions: 

  • Urinary tract infections
  • Constipation
  • Prostate gland problems
  • Certain medications
  • Digestive system conditions, such as irritable bowel syndrome

Relationship Between Dementia and Incontinence

People with dementia are more likely to develop incontinence, have accidents, or struggle to use the restroom, compared to people without the condition who are the same age. The incontinence can range from mild leakage to completely emptying the bladder. It may also include unintentional bowel movements, known as fecal incontinence, though this is less common.

How Dementia Affects Urinary and Fecal Control

Because dementia affects cognitive function overall, it can cause those affected to lose control of many aspects of their lives. Cognitive dysfunction can affect people's ability to control their bowels and bladder. It can also affect their ability to understand, act upon, and manage their bathroom needs, leading to accidents.

In healthy people, the central nervous system sends signals that the bladder is full to the pontine micturition center. The signal then goes to the bladder to encourage urination.

The central nervous system is also responsible for sending signals that contract the bladder to allow for the voluntary release of urine. It does this by coordinating with the autonomic nervous system, which is responsible for involuntary bodily functions.

People with dementia can develop brain lesions, such as the amyloid plaques and neurofibrillary tangles, commonly found in people with Alzheimer's disease. This can impact the brain's ability to control urination and lead to incontinence. As the condition progresses, it's possible to lose fecal control as well, leading to additional fecal incontinence.

Prevalence and Statistics

It's estimated that between 60% and 70% of people with Alzheimer's disease, the most common form of dementia, will develop incontinence. An estimated 53% of people with all types of dementia have incontinence, a number higher than average when compared to adults without dementia.

Behavioral and Cognitive Factors Contributing to Incontinence

As dementia progresses, it often leads to behavioral changes. Because of this, not all causes of incontinence in people with dementia are caused by physical conditions. Behavioral or cognitive factors, such as the following, may also contribute to incontinence.

  • Being unable to react quickly enough to a urinary urge 
  • Being unable to communicate their need to relieve themselves
  • Being unable to understand a reminder or prompt to relieve themselves
  • Being unable to recognize or use a toilet, or potentially relieving themselves in inappropriate places
  • Being unable to or forgetting to remove clothes or perform other tasks necessary to use a toilet
  • Refusing to accept help with toileting
  • Not attempting to use or locate a toilet
  • Attempting to hide evidence after an accident

Managing Incontinence in Individuals With Dementia

Evaluation and Diagnosis

Before accepting incontinence as a part of your loved one's dementia, it's important to have them evaluated and diagnosed first. A doctor may be able to recommend medical treatments that could stop the incontinence symptoms, treat underlying causes, or prevent them from getting worse. 

Nonpharmacological Interventions

Depending on how advanced an individual's dementia is, nonpharmacological interventions could manage incontinence symptoms. A caregiver might be able to manage environmental modifications and lifestyle interventions, but some interventions, such as bladder training or physical therapy, require an individual to follow instructions. That may not be possible if dementia has advanced too far.

Pharmacological Options and Their Considerations

Sometimes, doctors prescribe medications to help manage incontinence. This can include medications, such as acetylcholinesterase inhibitors. Some medications, such as oxybutynin, are not recommended for people with both incontinence and dementia due to adverse cognitive effects.

Assistance Devices and Aids

Sometimes, the best way to manage a loved one's incontinence is with assistive devices or aids. These can include:

  • Incontinence underwear
  • Incontinence pads
  • Male continence sheaths
  • Absorbent bed pads
  • Waterproof mattress protectors

Caregiver Tips and Support

Caregiving for someone with dementia and incontinence can be stressful. It can be difficult to keep up with messes or help a loved one make it to the toilet on time, especially if they are reluctant or uncooperative. Implementing these tips can help alleviate some of the stress.

  • Creating a supportive environment: People with dementia can become confused with their routines or needs. Creating a supportive environment can go a long way in managing the situation. Treat accidents with compassion, reminding your loved one that they could happen to anyone. 
  • Communicating effectively: By developing effective communication strategies with your loved one, you may be able to eliminate the number of accidents. Pay attention to pacing, restlessness, hiding in corners, and other nonverbal cues they may need to relieve themselves.
  • Promoting dignity and independence: Help your loved one maintain as much dignity and independence as possible. Make sure their path to the bathroom is clear and they wear clothing they can remove as needed. Consider setting alarms or reminders for them to use the toilet. Another option to help maintain dignity is to use quality incontinence products such as Nexwear's collection of underwear and pads. These products help contain urine leaks and accidents while also fitting underneath clothing discreetly.
  • Seeking professional help and caregiver support groups: If incontinence is difficult to manage, seeking out professional help may be the right choice. Likewise, caregiver support groups can help you feel a little less alone during your caregiving journey. Sometimes, being able to talk to other people who get what you're going through can be enough to give you the encouragement to get through difficult times.

Preventive Measures

In some cases, there is no cure for incontinence. However, preventative measures can help mitigate the risk of accidents and leakage. 

  • Lifestyle modifications to reduce incontinence risk: Certain lifestyle factors, such as obesity, smoking, and being sedentary, can increase the risk of incontinence. Working to prevent or reduce these can limit leakage.

  • Exercise and physical activity benefits: For women in particular, incontinence can be caused by weakened pelvic floors. With regular physical activity and exercise, women can strengthen their pelvic floor.
  • Hydration and diet recommendations: Staying hydrated and avoiding trigger foods can reduce incontinence leaks. Stick to water rather than drinks with added sugar, caffeine, or alcohol. Generally, 6-8 glasses per day is enough to prevent dehydration, which can irritate the bladder. Spicy and acidic foods can also irritate the lining of the bladder and contribute to incontinence. 
  • Maintaining good hygiene practices: Good hygiene can reduce the risk of incontinence by reducing the likelihood of developing UTIs. Change pads or underwear frequently, and make sure your loved one is clean and dry.

Addressing Emotional Impact

Your loved one with dementia may feel an emotional impact due to their incontinence. They may feel embarrassed or frustrated at their inability to control their bladder or bowels. They may hide the signs, such as stashing away soiled clothing in the back of a closet, but forget to deal with it later. They may also withdraw from those around them to avoid embarrassing themselves further or refuse assistance. It's important to address their concerns and validate their feelings while assuring them you are there to help.

Caring for people with dementia and incontinence is tough for both the caregiver and the one in need of care. Support groups can be a major source of comfort for both patients and for caregivers, who also need to avoid burnout by finding support. 

Part of the process of addressing the emotional impact may also include seeking professional counseling. This can offer caregivers the support and tools they need to handle difficult moments, while caring for a loved one.


Incontinence is common in the elderly and even more common in those with dementia. That's why it's so important to understand how to manage the condition proactively and recognize when it's time for support. Nexwear's products offer support you can trust with incontinence underwear and pads that are both discreet and reliable. If your loved one with dementia is experiencing symptoms of incontinence, these products can help protect dignity and independence. Shop Nexwear today!