Incontinence, which means losing control over bladder or bowel functions, usually occurs in the **later stages of dementia**, particularly in the **severe and very severe stages**. Dementia progresses through several stages, and as the disease advances, the brain’s ability to control bodily functions diminishes.
In the **moderate to moderately severe stages** (often stages 4 and 5 in the seven-stage model), individuals begin to need more help with daily activities, but incontinence is not always present yet. It is in the **severe cognitive decline stage (stage 6)** and especially the **very severe cognitive decline stage (stage 7)** where incontinence becomes common. At this point, the brain loses much of its control over motor functions, including the muscles that regulate urination and bowel movements. People may lose the ability to recognize the need to use the bathroom or to physically get there in time. They may also have difficulty communicating their needs[1][6].
Bowel incontinence can also be complicated by other factors such as chronic constipation, which may cause overflow incontinence where liquid stool leaks around a blockage. Cognitive decline makes it harder for individuals to respond to bodily signals or remember where the bathroom is, increasing the risk of accidents[2].
Urinary incontinence in dementia is often linked to the overall decline in physical and cognitive function. It is associated with increased dependency and can be worsened by other health issues common in older adults, such as infections or mobility problems[3].
In rare cases, some types of rapidly progressing dementias, like Creutzfeldt-Jakob disease, may show incontinence earlier than usual, but this is not typical for most dementia types[5].
As dementia reaches its final stages, individuals often require full assistance with toileting and other personal care tasks. Caregivers need to anticipate these changes and provide support that maintains dignity and comfort[1][6][8].
Sources
https://www.care.com/c/stages-of-dementia/
https://www.myalzteam.com/resources/alzheimers-bowel-incontinence-late-stage-challenges
https://pmc.ncbi.nlm.nih.gov/articles/PMC12618406/
https://www.dementia.org.au/about-dementia/alzheimers-disease-everything-you-need-know
https://www.cureus.com/articles/432799-atypical-presentation-of-creutzfeldt-jacob-disease-cjd-early-incontinence-and-delayed-imaging-in-a-rapidly-progressive-dementia
https://www.aegisliving.com/the-stages-of-caregiving-the-changes-you-will-face-with-dementia-2/
https://empoweredendings.com/alzheimers-dementia-care/
