Dementia can indeed cause people to forget how to use the bathroom properly, leading to difficulties such as incontinence or accidents. This happens because dementia affects brain functions that control awareness, communication, and physical coordination related to toileting.
The brain normally signals when the bladder or bowel is full, prompting a person to find and use the toilet. In dementia, these signals may not be recognized or understood. People may not feel or interpret the urge to urinate or defecate correctly. They might also forget where the bathroom is or how to use it, including removing clothing or sitting down properly. This is not simply a memory problem but involves a loss of cognitive control over bodily functions, including the inability to override physical reflexes like the need to have a bowel movement[1][4][5].
Communication difficulties caused by dementia worsen the problem. As the disease progresses, individuals may struggle to express their need to go to the bathroom or understand instructions from caregivers. Physical mobility issues common in dementia can also prevent timely access to the toilet[1][2][4]. Additionally, dementia can cause a loss of social inhibitions, leading to inappropriate urination or defecation in places other than the toilet[1].
Urinary and bowel incontinence in dementia is often described as “functional incontinence.” This means the incontinence is not primarily due to physical problems with the bladder or bowel but rather due to cognitive and functional impairments that interfere with toileting. For example, a person may not recognize the sensation of needing to go, cannot communicate the need, or cannot physically get to or use the toilet properly[1][6].
Other medical issues can contribute to toileting problems in people with dementia. Urinary tract infections, constipation, prostate problems in men, medication side effects, dehydration, and poor nutrition can all worsen incontinence or toileting difficulties. These conditions should be ruled out or treated because they may be reversible causes of toileting problems[1][5][9].
In some cases, neurological conditions related to dementia, such as Normal Pressure Hydrocephalus, can cause a combination of gait disturbance, memory loss, and urinary incontinence[3]. Neurogenic bladder, a condition where nerve damage affects bladder control, can also cause symptoms like inability to sense a full bladder or control urine leakage, which may overlap with dementia symptoms[8].
Age-related changes also play a role. As people age, pelvic floor muscles weaken, and neurological pathways that control bladder function deteriorate. Dementia exacerbates these issues by impairing brain-bladder communication and cognitive functions needed for continence[2][7].
In summary, dementia can make people forget how to use the bathroom by disrupting the brain’s ability to recognize bodily signals, communicate needs, remember the location and process of toileting, and physically access the toilet. This leads to functional urinary and bowel incontinence, which is common in dementia and worsens as the disease progresses. Medical conditions like infections or constipation can worsen these symptoms and should be addressed by healthcare providers.
Sources:
[1] YouTube – Toileting, Incontinence and Dementia
[2] Pantai.com.my – Urinary Incontinence: Stress vs Age
[3] DrOracle.ai – Normal Pressure Hydrocephalus
[4] Dementia Australia – Continence
[5] myALZteam.com – Alzheimer’s Bowel Incontinence
[6] NIH – Functional Urinary Incontinence in Older Adults
[7] Wikipedia – Urinary Incontinence
[8] UIHC.org – Neurogenic Bladder Treatment
[9] DementiaCareCentral.com – Incontinence Challenges with Dementia
