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Real Talk with Dr. Barbara Frank, OBGYN: The Connection Between Incontinence & Dementia and Related Conditions

Real Talk with Dr. Barbara Frank, OBGYN: The Connection Between Incontinence & Dementia and Related Conditions

June is Alzheimer’s & Brain Awareness Month—the perfect time to raise our collective awareness of the different forms of dementia that affect nearly 7 million Americans and 55 million people globally today (an estimated ⅔ of whom are women). By 2050, there will be a projected 13 million people living with dementia in the United States alone. 

Urinary incontinence is remarkably common among people with different forms of dementia, especially as their condition progresses over time, and we are fierce believers that everyone deserves respectful, quality care for their incontinence. We wanted to learn more about why this overlap exists, whether a formal diagnosis of incontinence can be helpful when it overlaps with dementia or if it’s just something to accept, and how treating incontinence might be different when a person has dementia.

Whenever we have lots of big questions, we like to call in the big guns. So today we’ve asked Attn: Grace medical advisor Dr. Barbara Frank, OB-GYN, to share some perspective on this important topic. 

Attn: Grace: Dr. Frank, thanks for your point of view on this important topic that affects so many Americans. Tell us a little bit about this connection between Alzheimer’s/dementia and urinary incontinence. What’s going on? How do these diagnoses relate? 

Dr. Frank: The urge to urinate from the muscle of the bladder is both conscious and subconscious. So, knowing that you have to urinate seems like something that just happens, but really the urge comes from a muscle talking to our brain. The ability to hold it in actually takes brain power. When you have dementia, your brain power is not always directed appropriately and you may not notice the urge to pee. Or if you do notice, you may not be able to coordinate urination the way you used to. If you had any level of urinary incontinence before diagnosis, the symptoms could worsen. Also, plaques in the brain that come with some forms of dementia can affect the “pee center” (AKA the micturition center). That can result in improper signaling from the bladder to the brain. 

AG: Why is it important to get a diagnosis rather than accept UI as a ‘part of life’ for a person with Alzheimer’s or dementia? 

DF: Getting the proper diagnosis can help tremendously because there are still different types of incontinence that a person with dementia could be experiencing. If the cause of the incontinence is anatomical, the symptoms could be improved with a pessary or a sling. If the cause stems from an overactive bladder, there are medications that may be helpful. If it is simply memory-based, there are techniques and strategies that your doctor can tell you about to help you better manage leaks. For instance, establishing a daily routine and setting reminders to void on a schedule. 

AG: A 2024 study showed that conversations about incontinence are often considered a caregiver issue by healthcare providers, or take lower priority than other discussions for these patients. Actually, half of primary care providers reported that they do not feel adequately prepared to address incontinence issues in individuals with Alzheimer's and other dementias. How might a caregiver advocate for their loved one in a conversation about incontinence during an appointment?

DF: Incontinence always needs to be proactively discussed, along with plans for handling it. Caregivers should ask to talk about what could be causing the UI – is it stress incontinence? Is it an overactive bladder? Is it purely cognitive?  This may help determine if the problem is due to dementia or if there are other factors involved. It’s not an easy topic to talk about, but healthcare providers must be a part of these conversations with patients and their caregivers. 

AG: What are the urinary or overall health risks associated with dementia-related incontinence?  

DF: There is an increased risk of urinary tract infection with incontinence, which is a struggle for those with dementia. Either not fully emptying or leaking can cause UTIs and skin irritation. Similarly, wearing a pad that doesn’t keep you fully dry or with ingredients that irritate your skin can cause irritation and contribute to UTIs and other infections.  

AG: Dr. Frank, do you have any other suggestions, strategies, or favorite products for caregivers of people with Alzheimer’s and dementia to consider?

DF:  Reminders to urinate on a schedule is very helpful. Limit fluids before bed. It is also important to remember that this can change as dementia increases and usually gets worse over time. As far as products go, I like Attn: Grace for its clean and less irritating incontinence products, as well as the fact that they make it easy for those caring for people with dementia-related incontinence (including many men!) to get the products they need. Their briefs are the antithesis of everything we loathe about “adult diapers” but offer incredible absorbency and coverage. I’m a fan of pairing an absorbent product with the Attn: Grace barrier cream to heal and protect compromised skin. This is a combination that works well for many people with dementia. It can go a long way in improving overall comfort and quality of life just to have products you can trust and a routine for managing the symptoms of UI. 

I also suggest making sure you have someone to check in with regularly. Incontinence is something that causes a lot of stress for caregivers and just being aware that it exists as part of this diagnosis is helpful. Knowledge is power. Feeling supported is power. 

AG: Thank you so much for your insight on this topic that affects so many of us. What an important reminder that incontinence is a topic that we can and should discuss with a healthcare provider and not something that we need to secretly suffer through.

Caregiver hack: If you take care of someone with dementia, our auto-renew subscriptions ensure one less thing to remember. Set one up today and we’ll deliver predictable quantities of the products your loved one needs when they need them—plus, you get 10% off your order every time. If you’re not sure what product would work best, our customer service team is compassionate, knowledgeable, and happy to help. Send us an email at or call us at 833.713.9212 and we will be happy to assist. 

Everyone deserves better incontinence care. That’s why we’re here.