Dementia and incontinence

There are many different types of dementia, and everyone experiences dementia differently.

When someone lives with dementia, they may experience changes that affect toileting. For example, they may forget to go to the toilet or have trouble finding or using the toilet.

These changes reflect the effects of dementia, not a lack of effort or care.

With support and practical steps, it is possible to maintain dignity, wellbeing and quality of life.

Causes of incontinence with dementia

Difficulties with memory, movement and thinking can cause changes in bladder and bowel control.

Common causes of incontinence in people with dementia include:

• Reduced awareness of urges: Dementia can affect how the brain recognises and responds to signals from the bladder or bowel.
• Memory and planning changes: A person may forget where the toilet is, how to use it, what the urge means or when they last used the toilet.
• Mobility or coordination changes: Slower movement or balance issues may make it harder to reach the toilet.
• Communication challenges: It may be hard for someone to say that they need to go to the toilet.
• Constipation: Reduced movement, changes in diet and some medicines can slow bowel movement and increase leakage.

Tips to help manage incontinence with dementia

Supportive, person-centred strategies can significantly improve wellbeing and reduce distress associated with bladder and bowel changes.

1. Make toileting predictable

• encourage regular toilet visits rather than waiting for the urgent need to go
• use consistent routines, especially after meals and drinks – using the toilet 30 minutes after a meal can help support bladder and bowel control
• gently prompt or help as needed.

2. Make the toilet easier to find and use

• use a toilet seat that contrasts with the floor, such as a blue seat on white base
• colour the toilet water using a cleaning tablet or safe food dye to make it easier to see
• choose toilet paper that is a different colour from the wall so it’s more visible
• keep the path to the toilet clear of trip hazards such as loose mats or cords
• use night lights to make it easier to find the toilet when it’s dark
• use clear signs or visual cues, such as an image of a toilet on the toilet door
• keep the toilet door open so it’s easy to see
• choose ‘adaptive’ or ‘assistive’ clothes that are easy to adjust eg with elastic waistbands or Velcro
• allow extra time and maintain privacy.

3. Support bladder and bowel health

• encourage regular fluid intake through the day
• support a balanced, high-fibre diet
• encourage movement within the person’s abilities
• see your doctor to treat constipation.

4. Use supportive products if helpful

An occupational therapist can help you choose equipment that suits your needs. Use our service directory to find an occupational therapist near you.

• use continence products such as pads, pull-ups or bed protectors
• keep mobility aids, such as frames, close by
• use a raised toilet seat or handrails
• keep a commode or urinal near the bed or chair if mobility (movement) is hard.

These supports can help maintain independence and reduce stress – alongside care and toileting routines.

Use Find a product provider for continence and mobility aids near you.

Medicines to help with bladder and bowel control

Medicines can sometimes help support bladder and bowel control and may help improve dignity and quality of life.

A doctor or health professional can explain options that are suitable, such as:

• treating infections
• managing an overactive bladder
• supporting prostate health
• checking current medicines

Always follow the instructions on the pack and from your doctor. Ensure medicines are regularly reviewed by your doctor, pharmacist or health professional.

If you notice any new symptoms or side effects, it’s important to speak with your doctor.

Resources

10 Guiding Principles

A resource, the ‘10 Guiding Principles’, supports shared decision-making about medication for urinary incontinence for people living with dementia.

There are versions for consumers and for healthcare professionals. Download them from the Monash University website:

• Guiding principles for consumers (pdf)
• Guiding principles for health professionals (pdf)
• Summary comparing the efficacy of medicines (pdf) – a table to use with the 10 guiding principles

This resource aims to:

• help people with dementia and their carers feel informed and empowered to make decisions together
• support healthcare professionals in delivering person-centred care.

These are the first co-designed resources of their kind, developed through a collaboration between:

• National Ageing Research Institute.
• Monash University, with researchers supported by a grant from Dementia Australia Research Foundation
• Continence Health Australia

Where to find help and support

• For help with assessment, strategies and support for your situation, contact a nurse continence specialist or GP. The National Continence Helpline (1800 33 00 66) is a free and confidential helpline where you can speak to a nurse continence specialist.
• Search for service providers near you, such as occupational therapists and medical and nursing specialists.
• Find product providers so you can choose the right continence products.
• Explore options for financial support to help pay for continence products.
• The National Public Toilet Map shows you nearby toilets, including facilities such as bins for male incontinence pads (BINS4Blokes).
• The national toilet access card from Invisible Disabilities Australia helps you ask for urgent access to facilities.
• Dementia Australia has information for families, friends and carers, as well as a National Dementia Helpline, 1800 100 500.
• Dementia Support Australia provides behaviour support for people living with dementia and their family, friends and health professionals. They also have a 24/7 helpline, 1800 699 799 and videos to help with understanding behaviour change.

This content has been reviewed by sub­ject mat­ter experts in line with Continence Health Australia’s established process. Read about our clinical content review protocol.