Dementia and Incontinence: A Carer's Guide to Cues, Routines and the Right Products
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The first sign is rarely a wet chair. It can be a person pulling at their waistband mid-conversation, pacing the hallway after lunch, or standing in a doorway looking for something they can't name. Those are toileting cues, and dementia is what stopped them arriving as words. Dementia and incontinence together ask something different of a carer than incontinence on its own.
How do you manage incontinence in someone with dementia?
Rule out treatable causes first, then build a predictable toileting routine around the person's own patterns and the cues they show. Make the toilet easy to find and reach. Match the continence product to what the person can still do for themselves, and treat every change as a chance to protect their dignity.
Dementia and incontinence get talked about as one problem. They're really two things happening at once, and separating them is what makes the situation manageable. The bladder and bowel may be working. What has changed is the chain of steps between the signal and the toilet.
Continence Health Australia sets out how that chain breaks down for people living with dementia. Awareness of the urge can be reduced, because the brain no longer recognises and responds to signals from the bladder or bowel in the usual way. Memory and planning changes mean a person may forget where the toilet is, how to use it, what the urge means, or when they last went. Mobility or coordination changes make the trip harder, communication difficulties make the need hard to say out loud, and constipation adds leakage on top.
The Better Health Channel puts the same mechanism plainly: staying in control depends on noticing a bodily sensation and remembering how, when and where to respond. Dementia can interfere with recognising the need to go, waiting until it's appropriate, finding the toilet, recognising the toilet, and using it properly. That's five separate points of failure, and knowing which one you're dealing with changes what you do about it.
Worth holding onto, because it takes the sting out of a hard day: Continence Health Australia is explicit that these changes reflect the effects of dementia, not a lack of effort or care. Nobody in this situation is being difficult on purpose. For the clinical detail behind why continence changes happen, Continence Health Australia is the place to go, and this article stays with the carer's side of it.
Dementia and incontinence: rule out the reversible causes first
A new or sudden change in continence deserves a GP visit before it becomes the new normal. Dementia Australia lists infection, constipation, menopause and prostate enlargement among the causes of incontinence, and notes it's possible to treat those conditions. A dementia diagnosis doesn't make a person immune to any of them.
Urinary tract infections deserve a special mention here, because in someone with dementia they can show up as increased confusion or a change in behaviour rather than the usual symptoms. That's why the questions a doctor asks include whether there's been a rise in confusion or any behaviour change, and whether there's been a fever. We've written separately about the link between urinary tract infections and incontinence, which is worth a read if things have shifted suddenly.
Constipation is the other one that hides in plain sight. Continence Health Australia names it as a cause in its own right, because reduced movement, diet changes and some medicines slow the bowel and increase leakage. Our piece on how constipation affects bladder and bowel control covers the mechanism properly.
Medicines are the third thing to raise. A doctor will ask what the person is taking, and Continence Health Australia lists checking current medicines alongside treating infections, managing an overactive bladder and supporting prostate health as options a health professional can explain. None of that is a conversation to have alone. A nurse continence specialist can help you work through it, and our guide to finding and working with a continence nurse explains how to reach one in Australia.
Read the cues, then build the routine around them
Once treatable causes are ruled out, the work shifts to prompting and environment. Dementia and toileting problems show up in behaviour long before anyone reaches for a product. Dementia Australia's advice to carers is to suggest toilet breaks at times that follow the person's own bowel or bladder patterns, rather than at times that suit the household. That means watching for a few days and writing down what you see before you set a schedule.
The cues themselves are physical. Dementia Australia describes watching for reactions that indicate a person needs to go: they may pull on their clothes, become agitated, or their face may become flushed. And the instruction that follows matters as much as the observation. If they need to go, don't rush.
Continence Health Australia frames the routine side as making toileting predictable. Encourage regular toilet visits rather than waiting for an urgent need. Keep routines consistent, especially after meals and drinks, and it notes that using the toilet 30 minutes after a meal can help support bladder and bowel control. Prompt gently and help as needed.
The environment does real work here, and it costs very little. Continence Health Australia and Dementia Australia both recommend a toilet seat that contrasts with the floor, colouring the toilet water with a cleaning tablet or safe food dye, and choosing toilet paper a different colour from the wall, so the fixtures are easier to pick out. Clear signs or a picture of a toilet on the door help, as does leaving the door open.
The path matters too. Keep it clear of trip hazards such as loose mats or cords, use night lights so the toilet is findable in the dark, and keep mobility aids within reach. Dementia Australia adds two more: remove any objects the person might mistake for a toilet, and make the toilet area more private if privacy is a concern for them.
Clothing is the last piece, and it's the one that gets changed last and is worth changing first. Both organisations point to adaptive clothing that's easy to adjust, with elastic waistbands or Velcro rather than small buttons and stiff zips. Machine washable, easy off, easy on. Seconds saved at the door are the difference between making it and not.
Match the product to the dementia, not just to the leak
Here's the part the clinical guidance tends to stop short of. The authorities will tell you to use continence products such as pads, pull-ups or bed protectors. What they don't do is help you work out which one, for this person, today. That decision turns on what the person can still do for themselves and who does the changing, and it changes as the dementia progresses.
Dementia incontinence products are the same products everyone else uses. What changes is the basis on which you choose between them.
This is the table we'd talk a carer through on the phone.
| Dementia-specific factor | What it means for product choice | Comfort First format to consider |
|---|---|---|
| Still self-toilets with prompting, good hand dexterity | Keep the person doing it themselves for as long as they can. The product should work like underwear, not like a task someone else performs | Pull-up pants, pulled up and down without help |
| Reduced dexterity, needs full changing assistance, or spends most of the day in bed or a chair | The carer applies and removes the product, which may mean doing it with the person lying down. A pull-on style means lifting and manoeuvring someone who can't help | Slips, tab-fastened so they can be changed without standing |
| Pulls at, fiddles with, or removes the product | Read it as a fit and comfort signal before anything else. Re-measure the waist and correct the size. A product that fits properly and feels right gives a person less reason to pull at it | Correct waist size in whichever format already suits, checked against the size chart rather than guessed |
| Night wandering, or heavy overnight loss | Protect the bed as well as the person, so a night-time change doesn't turn into stripping and remaking a bed at 3am | Higher overnight absorbency plus bed protection: Underpads Small, Underpads Regular or the Maxi Bed Mat |
| Skin at risk from frequent changes | Every change is an opportunity to clean gently and leave intact skin dry, rather than a rushed wipe with whatever is nearest | Unscented body wipes and a barrier product used on intact skin |
A few notes on using that table. A search for incontinence products for elderly dementia care returns long lists with no way to choose between them, which is the gap this table is meant to close.
Sizing is by waist measurement only. Measure around the waist at the point where the product will sit, keep the tape snug and flat, and match the number to the chart. Comfort First pull-up pants run from 60cm at the smallest through to 180cm in the largest size, and the slips from 60cm to 180cm across their four sizes, so there's real overlap between formats and the choice between them isn't a size decision. It's a "who does the changing" decision.
A pull-up that gaps at the leg is a fit problem, and the product gets blamed when the size is the actual culprit. Sizing up because a person seems to be leaking more can make it worse, since a looser leg opening leaks sooner. If someone sits between two sizes, try the smaller one first.
Slips get overlooked, and that's worth saying out loud. The assumption is that they're harder to put on. They do take slightly more handling, but for a person who can't stand for a change, they're kinder to both people in the room. If a size turns out to be wrong, give us a call.
Dementia night incontinence is where bed protection earns its place, and it deserves its own thought rather than being an afterthought. The Underpads Small, Underpads Regular and Maxi Bed Mat are three separate products at three sizes, from a small 30cm x 40cm pad through to the 60cm x 90cm Maxi Bed Mat, and the right one depends on whether you're protecting a chair, a section of the bed, or the whole sleeping area. Our guide to managing incontinence at night goes into the full night routine, which is a longer conversation than this article can hold.
Where dignity draws the line
Continence products support dignity. They are not a substitute for toileting support, and they must never be used to restrict a person, restrain them, or override someone who resists care. If a product is being used so that nobody has to take a person to the toilet, something has gone wrong with the care, not with the person.
That line matters more with dementia than almost anywhere else, because a person may not be able to object in words. Continence Health Australia's stated approach is one that respects the person's needs and preferences, includes them in decision making, supports independence where possible, and maintains comfort, safety and dignity. Every one of those is a check you can run on your own routine.
Practically, it means a person who can still get to the toilet with prompting keeps being prompted, even on the days that's slower than a product change. It means the product is chosen to support what they can still do, not to remove the need for anyone to help. And it means asking, when a product choice starts to look convenient, who it is convenient for.
When personal care is refused
Dementia Australia puts it plainly: caring for someone with dementia and incontinence can be challenging. A refusal of personal care is one of the moments where that shows. Resistance to personal care is communication. A person who pushes your hands away, refuses to sit down, or becomes distressed during a change is telling you something they can no longer say: this is uncomfortable, this doesn't fit, I'm frightened, I don't understand what's happening to me, or this is my body and nobody asked.
The response that works is slower than the one that feels urgent. Explain each step before you do it. Use short, simple words and give step-by-step instructions, as Dementia Australia advises. Offer a choice where there is one, even a small one, and pick your moment rather than pushing through the wrong one.
Dementia Australia's specific advice for restlessness is useful and counterintuitive. If the person is restless and doesn't want to sit on the toilet, let them get up and down a few times. Music may calm them, and giving them something to hold can distract them. The instinct is to hold someone in place, and it's the wrong instinct.
Skin care in this context stays simple: clean and dry the skin to prevent rashes, and speak to a doctor or pharmacist about suitable soaps and creams. Dementia Australia adds one practical detail worth knowing, which is to wear a layer of fabric under protective plastic, because plastic can irritate skin. If skin is already broken or inflamed, that's a GP or nurse conversation, not a product one.
The broader mechanics of hands-on care sit in our general guide to caring for someone with incontinence, and if the person you're caring for is your mum or dad, the relationship side of it is covered in caring for an elderly parent with incontinence. One more thing, said once: if this is wearing you down, that's worth taking seriously, and carer burnout and continence care is written for exactly that.
Paying for continence products
Continence products may be funded through more than one pathway, and which one applies depends on the person's age, diagnosis and existing supports. The Continence Aids Payment Scheme is administered by Services Australia and has its own eligibility criteria. NDIS participants may have continence consumables funded through their plan, under Core Supports. People receiving aged care support have their own pathways through My Aged Care.
You can't receive CAPS and NDIS continence funding at the same time, and eligibility criteria apply to both. For amounts and current rules, go to the source rather than to us: Services Australia for CAPS, ndis.gov.au or the person's plan manager for NDIS, and myagedcare.gov.au for aged care. Our NDIS continence funding guide walks through the NDIS side in plain language.
Two phone numbers are worth writing on the fridge. The National Continence Helpline on 1800 33 00 66 is free and confidential, and puts you through to a nurse continence specialist who can talk about assessment, strategies and products for your situation. The National Dementia Helpline on 1800 100 500 is free and confidential, staffed 24 hours a day, every day of the year, for information, advice and support about dementia itself.
Where to go from here
Nothing in this article makes dementia easier. What it can do is take a few decisions off your plate, so the energy goes into the person rather than into guessing about products. How to manage incontinence with dementia comes down to a short list: start with the GP visit, watch for the cues for a few days, fix the two or three things in the bathroom that make the toilet easier to find, and then choose the product format around what the person can still do.
If you want to talk it through, ring the National Continence Helpline on 1800 33 00 66 for continence advice, or the National Dementia Helpline on 1800 100 500 for dementia support. Both are free, both are staffed by people who do this all day, and neither will make you feel like you should have known already.
When you're ready to look at products, the full Comfort First range is there, and you can order a free sample pack to test the fit before committing to a carton. If you'd rather just ask someone, call us on 03 5443 2239 or email sales@comfortfirst.au. Comfort First is Australian owned and run, and the person who answers is in our East Bendigo warehouse.