Bladder and bowel problems in dementia

Many people living with dementia start to have trouble with bladder or bowel control. It is most common in the middle and later stages.¹ Doctors call this incontinence (losing control of urine or stool).

Accidents are upsetting, but they are not on purpose. Many causes can be treated or eased. A calm plan, the right products and good skin care make daily life easier and protect the person's dignity.

Why bladder and bowel problems happen

In dementia, the brain may no longer notice the signal that the bladder or bowel is full. The person may also forget where the bathroom is, or not recognize the toilet.¹ Later, they may not be able to tell you they need to go.

Other common causes include:¹

• Infections, such as a urinary tract infection (UTI, an infection in the bladder or kidneys).
• Constipation. A hard mass of stool can press on the bladder. Watery stool can also leak around it, which looks like diarrhea but is not.⁵
• Prostate problems in men.
• Other health problems, such as diabetes, stroke or Parkinson's disease.¹
• Medicines. Some sleeping pills and anxiety medicines relax the bladder. Water pills (diuretics) make more urine.¹
• Drinks like coffee, tea and cola, which make the body pass more urine.¹
• Trouble getting there. Slow walking, a long or dark hallway, or clothes with hard buttons and zippers can turn a near miss into an accident.¹

Dementia also affects the nerves and signals that help hold in stool. Lack of movement, such as sitting or lying down most of the day, can make stool build up, especially in frail older adults.⁵

First step: a check-up

If accidents are new, or suddenly worse, make a doctor's appointment. Do not assume it is "just the dementia."¹ Bring notes on:

• When accidents happen (time of day, after meals, at night).
• Bladder, bowel or both.
• How often the person has a bowel movement, and what it looks like.
• What and how much they drink.
• All medicines, including over-the-counter ones. Ask the doctor or pharmacist whether any could play a part.¹

A simple diary for a week or two helps. You can use our behavior diary and add a column for bathroom trips.

About urinary tract infections

In older adults, new confusion can sometimes be the main sign of a UTI.³ But many older people have bacteria in their urine without being sick. Antibiotics do not help in that case, and they can cause harm, such as severe diarrhea.⁴

An expert guideline says that when an older person with memory problems becomes more confused, or falls, but has no fever or bladder symptoms, the doctor should look for other causes and watch closely. Antibiotics for bacteria alone are not advised.⁴ So ask the doctor what else might explain the change.

About bladder medicines

Some medicines for an overactive bladder (a strong, sudden urge to go) block a brain chemical called acetylcholine. These are called antimuscarinic or anticholinergic medicines. The American Urological Association says doctors should talk with patients about a possible risk of dementia and thinking problems with these drugs.⁶ Other bladder medicines work in a different way.⁶

If the person already takes a bladder medicine, do not stop it on your own. Talk with the doctor or pharmacist before changing anything. You can ask: "Is this medicine still needed? Is there one that is easier on the brain?" See managing medicines at home.

A toileting routine

A routine is often the most useful tool. It means helping the person to the bathroom at set times, before the urge becomes urgent.

1. Watch for a pattern. For a few days, note when accidents happen and when the person usually goes.¹
2. Set regular times. Many caregivers use: first thing in the morning, after each meal, about every two hours during the day, and right before bed.¹ If accidents tend to happen about three hours apart, plan trips a bit sooner.
3. Prompt, don't ask. "Do you need to go?" often gets a "no." Try "Let's stop by the bathroom before lunch." Gentle prompts and praise are the heart of a method called prompted voiding.⁷
4. Give enough time. Rushing makes it harder to empty fully.¹
5. Help things start. If the person has trouble starting to urinate, run water in the sink or offer a sip of a drink.¹
6. Check after. Glance in the toilet to see if they went, so you know how well the plan works.¹

Studies are small and mostly from nursing homes. A review of prompted voiding found it reduced wet episodes in the short term, but the evidence was limited.⁷ Limited research A review of help for people with dementia living at home found only three small studies, too few to prove what works.⁸ Even so, a routine is low-risk and many families find it helps.

Learn the person's signals

Many people show they need the toilet without saying it. Watch for restlessness, pacing, tugging at clothes, odd sounds or faces, suddenly going quiet, or hiding in a corner.¹ Some people use other words for it, such as "I can't find the light." Learn what the person's own words and actions mean.¹

Make the bathroom easy to find and use

Drinks and food

Some caregivers cut back on drinks to stop accidents. This usually backfires. Too little fluid can cause dehydration, which can lead to UTIs and more incontinence.¹

• Offer drinks often during the day.
• Offer fewer drinks in the evening, and have the person use the toilet just before sleep.¹
• Swap some coffee, tea and cola for water or decaf.¹
• To prevent constipation, offer fiber-rich foods and fluids, and help the person move around during the day. Long stretches of sitting can make stool build up.⁵

For more ideas, see meals and nutrition and eating, drinking and swallowing.

Choosing products

Products do not replace a routine, but they add comfort and confidence, especially when going out or at night.¹

Tips for choosing:

• Some people pull at or refuse briefs. Call them "underwear," not "diapers." Calm wording helps. See refusing help.
• Change wet or soiled products soon, rather than waiting until they are full. This helps protect the skin.

Paying for supplies

Medicare pays for durable medical equipment, meaning items that can be used again and are expected to last at least 3 years.¹⁰ Throwaway pads and briefs do not fit that rule, so families usually pay for them. If you have a Medicare Advantage plan, call and ask whether it offers any help with these supplies.

In Virginia, Medicaid lists adult briefs, pull-on underwear and bed pads as covered supplies, with monthly limits.¹² A practitioner must order them on a Medicaid form.¹³ Medicaid will not usually pay for bed pads on top of briefs unless there is a specific medical need.¹³ See Medicaid and long-term care. Veterans can ask their VA care team about supplies; see VA benefits for dementia.

Caring for the skin

Urine and stool can irritate skin quickly. Doctors call this incontinence-associated dermatitis (IAD): red, sore, itchy skin, sometimes with open areas.⁹

1. Clean soon after each accident. Use warm water and a gentle skin cleanser or soft wipes. Wipe gently; do not scrub.
2. Pat dry. Pay attention to skin folds.
3. Ask about protection. Ask a nurse or pharmacist whether a barrier cream or ointment would help, and which one.
4. Look at the skin every day, at least during changes. Watch for redness that does not fade, rash, or broken skin.

A 2025 Cochrane review (a careful summary of the studies) looked at 15 trials of skin cleansers and leave-on creams. One trial suggested a foam cleanser may work better than soap and water. Another suggested adding a leave-on product may help prevent IAD. Other trials found little difference. The evidence was low quality, so no single product is clearly best.⁹ Limited research

Call the doctor or nurse if skin is broken, bleeding, very painful, or not improving. A person who sits or lies a lot is also at risk for pressure sores, so ask about changes in position and cushions.

Keeping dignity

How you respond matters as much as what you do.

• Stay matter-of-fact. Do not scold or show disgust. Say "Anyone can have an accident" or "Let's get you into something fresh."¹
• Use adult words. Talk about "the restroom" and "underwear."¹
• Protect privacy. Close the door, cover the person, and send others out of the room.¹
• Let them do what they can. Hand over a washcloth, guide their hand, and give one step at a time.
• Plan outings. Bring spare clothes, wipes and a bag. A family restroom lets you help a person of another gender.
• Look after yourself. Toileting care is tiring and very personal. It is normal to feel upset. Join a support group, or call the Alzheimer's Association 24/7 Helpline at 800-272-3900.¹ See caregiver stress and burnout.

If toileting care is becoming too much, a home care aide, adult day care or respite care can share the load.

Is incontinence a sign that dementia has reached the final stage?

Not always. It is common in the middle and later stages.¹ But sudden changes often have another cause, like an infection or constipation, which can be treated. Always check with the doctor.

The person hides wet clothes or says nothing happened. What should I do?

This often comes from embarrassment, not lying. Do not argue. Quietly replace the clothes, keep a clean set where they can find it, and focus on the routine.

Should I wake the person at night to use the toilet?

It depends. Waking can cause confusion and poor sleep. Many families use a good overnight product, a bed pad and a bedside commode instead. Talk with the doctor or nurse about what fits. See sleep problems in dementia.

When to get help

Call the doctor soon (the same day or next day) if:

• Accidents start suddenly or get much worse.¹
• There is burning, pain, fever, or new back or side pain.³
• There are no bowel movements for several days, or watery stool keeps leaking.⁵
• Skin is broken, bleeding or not healing.
• A new medicine was started around the time the problem began.¹

If you, as the caregiver, feel hopeless or have thoughts of harming yourself, call or text 988 any time.

Read more in dementia symptoms and behaviors, middle-stage dementia and late-stage dementia.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.