For many families, the first accident is a turning point. It can be upsetting for your loved one, awkward for you, and a sign that care needs are changing. It’s also one of the most common challenges in dementia care, and with the right routines and supplies it can become a manageable part of the day rather than a daily crisis.
This guide explains what causes incontinence in dementia, what stage it usually appears, signs that your loved one needs the bathroom, and practical tips for days and nights. It also covers how Alzheimer’s and dementia care at home can help with toileting and personal care while protecting your loved one’s dignity.
What does it mean when a dementia patient becomes incontinent?
Incontinence means losing control of the bladder, the bowels or both. In dementia, it often happens because the brain has trouble with the steps involved, not because the body can’t hold urine. The Alzheimer’s Association lists several common reasons (Alzheimer’s Association):
- Not recognizing the urge to go
- Forgetting where the bathroom is, or not finding it in time
- Clothing that is hard to remove quickly
- Physical problems that make it hard to get to the toilet
Incontinence can also have medical causes that have nothing to do with dementia getting worse. That’s why it’s important not to assume, especially if it starts suddenly.
Common medical causes to rule out first
If your loved one has recently started having accidents, the Alzheimer’s Association recommends first looking for causes a doctor can treat (Alzheimer’s Association). These include:
- Urinary tract infections, which may also cause sudden confusion or behavior changes
- Constipation, which can put pressure on the bladder
- Prostate problems in men
- Diabetes, stroke or muscle conditions such as Parkinson’s
- Medications, such as some sleep aids and anti-anxiety drugs, which can relax the bladder muscles
- Caffeinated drinks like coffee, tea and cola, which increase urination
Mention any new accidents to your loved one’s doctor, along with a list of their medications. A short record of when accidents happen is helpful at the appointment.
What stage of dementia is incontinence?
Bladder and bowel incontinence becomes common as the disease progresses, especially in the middle and late stages (Alzheimer’s Association). In the middle stage, accidents often come from confusion: not finding the bathroom, not getting clothes off in time, or not recognizing the urge. In the late stage, when a person needs help with almost all personal care, full incontinence is more common.
What stage of dementia is soiling yourself?
Loss of bowel control is part of the same pattern, and it’s most common in the late stage, when a person needs help with nearly all personal care. Every person is different, though, and a sudden change at any stage should be checked by a doctor. Families sometimes wonder whether incontinence means the end is near. It’s one of many changes that reflect how the disease is progressing, so ask your loved one’s doctor what it means in their situation.
Signs your loved one needs to use the bathroom
Many people with dementia can’t say they need the toilet, but their body language often does. The Alzheimer’s Association suggests watching for (Alzheimer’s Association):
- Restlessness or pacing
- Unusual sounds or facial expressions
- Pulling at clothes
- Sudden silence, or hiding in a corner
Learn your loved one’s own words for needing the bathroom, which may not sound like they’re about toileting at all. And always use adult language, not baby talk, when you talk about it.
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How do caregivers deal with incontinence?
Use a bathroom schedule
Regular, prompted bathroom trips are one of the most effective tools. Many people do well going after waking, about every two hours during the day, after meals and before bed (Alzheimer’s Association). If accidents tend to happen at certain times, offer a bathroom trip just before then.
Make the bathroom easy to find and use
- Keep the bathroom door open so the toilet is visible.
- Put a picture of a toilet on the door, and use a door color that stands out from the wall.
- Add a raised toilet seat and grab bars.
- Use night lights in the bedroom, hallway and bathroom.
- Keep the path clear of clutter and well lit.
- Remove things that could be mistaken for a toilet, such as a wastebasket or a large plant pot.
Choose easy clothing
Pants with elastic waists and clothing that’s easy to pull down, take off and wash make a big difference. Avoid tricky buttons, zippers and belts.
Give extra time
Allow plenty of time in the bathroom, and don’t rush. If urinating is difficult, running water in the sink or offering a drink can help.
Should you limit fluids to prevent accidents?
No. It’s a common instinct, but the Alzheimer’s Association warns that restricting fluids can lead to dehydration, which can make incontinence worse and raise the risk of infection (Alzheimer’s Association). Instead:
- Encourage plenty of fluids earlier in the day.
- Limit drinks in the hour or two before bedtime.
- Cut back on coffee, tea and cola, which act as diuretics.
Managing incontinence at night
Nighttime accidents are common and exhausting for family caregivers who get up again and again. Small changes help:
- Limit fluids in the evening and offer a bathroom trip right before bed.
- Light the path from the bed to the bathroom.
- Keep a portable commode or urinal near the bed.
- Use waterproof mattress covers and washable bed pads.
- Choose overnight-strength protective underwear.
If you’re up several times every night, an overnight caregiver can help with toileting and changes so you can sleep.
Choosing incontinence products
Padded underwear, adult briefs and bed pads can make life easier, especially when you’re away from home or when getting to the toilet in time is hard (Alzheimer’s Association). Some tips:
- Call them “underwear” rather than “diapers.” Words matter for dignity.
- Try a few styles. Pull-ups work well for people who still use the toilet; tab-style briefs are easier when someone needs more help.
- Buy the right size. Too big leaks, too small irritates the skin.
- Keep a small kit with a change of clothes, wipes and a bag for outings.
Handling accidents with dignity
How you react matters as much as what you do. The Alzheimer’s Association recommends being matter-of-fact, using gentle wording, never scolding, and respecting privacy as much as possible (Alzheimer’s Association).
- Stay calm and reassuring: “No problem, let’s get you comfortable.”
- Help your loved one clean up and change in private.
- Wash and dry sensitive skin gently after each accident.
- Check the skin for redness, rashes or sores, and tell the doctor if you see any.
Regular, gentle washing is important for skin health. If washing up has become a struggle, our guide on what to do when someone with dementia refuses to bathe covers calm, practical techniques, including no-rinse products and sponge baths (Alzheimer’s Association).
Protecting your loved one’s skin
Moisture from urine or stool can irritate the skin quickly, especially for someone who sits or lies down for much of the day. Healthy skin is easier to protect than broken skin is to heal, so build skin care into every change:
- Change wet or soiled products promptly rather than waiting.
- Clean gently with warm water or a no-rinse cleanser, and pat dry instead of rubbing.
- Pay attention to skin folds, the groin and the buttocks.
- Ask the doctor or pharmacist about a barrier cream to protect the skin.
- Encourage position changes during the day if your loved one sits for long periods.
- Look for redness that doesn’t fade, rashes, blisters or open areas, and tell the doctor right away.
Good hydration and a balanced diet help the skin too, and they also lower the risk of constipation and urinary tract infections, two common causes of accidents.
Taking care of yourself
Toileting care is physically tiring and emotionally hard, especially for adult children caring for a parent or spouses caring for each other. Many family caregivers say this is the point where they first ask for help. That isn’t failing. It’s protecting your relationship with your loved one, so you can spend your time together as a daughter, son or spouse instead of only as a caregiver.
How Premier Comfort Care helps
Premier Comfort Care provides non-medical Alzheimer’s and dementia care, including toileting, incontinence care, bathing and dressing, in Sacramento, Folsom, Roseville, Granite Bay, El Dorado Hills, Elk Grove, Rocklin, Citrus Heights and nearby communities. Our caregivers are Teepa Snow-trained in respectful, dignified personal care, and we focus on keeping the same caregivers in the home so your loved one feels comfortable with the person helping them. Our caregiver retention is 65%, five times higher than the industry average.
Care is available from 1–2 hour microvisits to around-the-clock and overnight care, including weekends and holidays. Families stay up to date through our family portal, and when you call, you’ll talk directly with our owner, Mariam.
Let’s talk about personal care support for your loved one.
Sources: Alzheimer’s Association, Incontinence; Alzheimer’s Association, Bathing.
