Lauren Mahakian

Lauren Mahakian

From 1996 to 2005, Everybody Loves Raymond became one of America’s favorite television comedies. During one memorable episode, Raymond’s older brother Robert discloses that his wife, Amy, “Pees a little” when she laughs.

Naturally, Robert later regrets sharing this personal detail about his spouse as the story unfolds. In the end, it’s just part of one humorous storyline woven into the episode.

In the real world, urinary incontinence is common, probably more so than many of us realize. It’s also embarrassing to people who suffer from it, along with their caregivers who deal with it.

But, it’s certainly no laughing matter. 

Like many conditions we associate with aging, incontinence disproportionately affects older adults and complicates caring for our loved ones with Alzheimer’s disease and other dementias.

The Mayo Clinic explains the severity of urinary (or bladder) incontinence can vary greatly. Occasional leaking with a cough, sneeze or even a good laugh like the fictional Amy on television, can be an embarrassing inconvenience. At the other end of the range is more severe incontinence. Most people describe it as a loss of bladder control, but the situation is far more complex. 

Medical professionals describe several urinary incontinence types: stress, urge, overflow, functional, and mixed, which refers to having more than one kind, often stress and urge.

The stress variety describes Amy’s situation. It’s when urine leaks from pressure on the bladder, such as by laughing, coughing, sneezing, lifting heavy objects or even exercising.

Urge incontinence is different, referring to a sudden intense urge to urinate and no ability to stop it. Overflow incontinence is the term used to describe dribbling that comes from not fully emptying the bladder. 

Functional incontinence can result from other issues that prevent someone from reaching the toilet in time.

Arthritis can be such a cause if someone simply cannot remove their clothing in time. Struggling with a wheelchair in a confined space might be another.

In the case of people living with dementia, it can be caused by losing the ability to recognize the need to use the bathroom or even forgetting where it is until it’s too late.

Professionals acknowledge people may experience occasional urine leaks as they age. As embarrassing as the situation may be, people should consult their medical professionals when it affects their quality of life. In my experience, many people keep the condition a secret, even from their doctors, until it’s severe.

Last-minute rushing to the toilet is a warning sign since haste can lead to accidents and falls. If your loved one avoids even one social gathering or family activity over concerns about incontinence, tell your doctor immediately. There may be an underlying medical condition or another factor they can address.

Several medical conditions can trigger temporary or persistent incontinence, such as menopause, enlarged prostate, urinary tract infections, obstructions, constipation or neurological disorders. Your doctor can address many of these.

Alcohol, caffeine, chocolate, and even carbonated drinks can contribute to the problem. Highly spiced, sugary, and acidic foods are high on the list of everyday causes. Nutritional experts may help with dietary aspects, and medical professionals can assess the effects of any prescription medications, including hearty or blood pressure medications, muscle relaxers, sleeping pills or sedatives.

Most of us have trouble kicking bad habits and behaviors, but we should listen to medical experts’ advice.

While urinary incontinence is not always preventable, the usual risk factors contribute. Doctors suggest that maintaining a healthy weight, exercising regularly, not smoking, and avoiding irritating foods such as coffee, tea, and alcohol can reduce the risk of incontinence.

There are a few simple things we can do when caring for a loved one with dementia and incontinence.

Forgetting bathroom locations is a real issue. Making them easier to identify with colors, lighting or unique markings can help. For example, the brightly colored bathroom doors in my memory care homes distinguish them from other rooms.

While making them easier to find, pathways to bathrooms should also be well lit and kept clear of obstacles. To address clothing issues, wear clothing that is easy to put on and remove when it’s time to use the toilet.

Understanding is the first step in most caregiving situations, followed by good interactive communication. As the Alzheimer’s Association summarizes, follow this with planning ahead, following-up, monitoring fluids and adjusting as you go. 


Lauren Mahakian is a certified care manager and offers a free podcast, Unlocking the Doors of Dementia™ with Lauren. Visit for more information.

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