Why Might Someone with Dementia Urinate in the ‘Wrong’ Place? Understanding Behaviour and Support Strategies

Let’s talk about something that many people find difficult to discuss—unexpected toileting behaviours in dementia care support. It’s a topic that carers, families, and care home staff frequently deal with but often struggle to bring up. Why does someone with dementia urinate in what we consider the ‘wrong’ place? Is it deliberate? Is it a sign of worsening dementia? Or is there something else going on?

First, Rule Out Medical Causes

Before we look at what might changes in behaviour indicate, the first step should always be to rule out medical issues. Urinary tract infections (UTIs), constipation, prostate problems, and certain medications can all contribute to changes in toileting habits. If someone suddenly starts urinating in unusual places, a medical check-up is essential. But when physical health isn’t the cause, we need to dig deeper into what’s happening cognitively and behaviourally.

The Brain’s Changing Relationship with the Environment

For someone with dementia, the world doesn’t look the same as it does to you and me. Their ability to recognise and respond to environmental cues—the small details that tell us where we are and what we should do—can break down over time. This is called a loss of stimulus control in behavioural science, but put simply, it means that the usual signs that tell a person where and when to use the toilet no longer stand out to them.

Imagine walking into a bathroom. Without even thinking, you recognise the toilet, understand its purpose, and use it accordingly. But for someone with dementia, the usual visual and contextual cues might no longer trigger that automatic response. If they see a cupboard that is shaped like a toilet or a dark corner that offers privacy, they might think they’ve found the right place.

When the Behaviour Makes Sense (to Them)

To us, urinating in a bin, a plant pot, or a hallway seems obviously incorrect. But for the person with dementia, it might not feel that way because:

•  Toilets Are Hard to Recognise – A white toilet against a white wall, or a modern design that looks different from the toilets they’ve known for most of their life, may not stand out to them.
•  The Urge to Go Is Immediate – Dementia can reduce the ability to ‘hold on’ or plan ahead. If they feel the need to go, they act on it.
•  The Bathroom Isn’t Obvious – If they don’t remember where the toilet is, or if the signage isn’t clear, they may not find it in time.
•  A Breakdown in Routine – The sequence of steps involved in toileting (recognising the urge, finding the bathroom, using the toilet) may no longer be automatic.
•  Past Associations – Someone who spent decades working outdoors might associate trees or garden areas as appropriate places to relieve themselves.

How to Help

Understanding dementia, and that this behaviour isn’t intentional or ‘difficult’ is the first step. Here are some practical ways to reduce these incidents when caring for a person with dementia:

•  Make Toilets Easier to Recognise – Use contrast (e.g., a brightly coloured toilet seat against a white toilet) to make it more visually obvious.
•  Improve Signage – Clearly label bathrooms with easy-to-read signs and symbols, placing them at eye level where they are most visible. How many times have you walked into public toilets and stood in front of the abstract signage to try and figure out which one to go in?!
•  Increase Bathroom Accessibility – Keep doors open where possible and ensure the path to the toilet is clear and well-lit.
•  Prompt Regularly – Offer reminders or take them to the bathroom at regular intervals, rather than waiting for them to ask.
•  Consider Clothing Adaptations – Sometimes, difficulty with buttons and zippers can contribute to accidents. Adaptive clothing can help.

A Different Perspective on Behaviour

What looks like ‘challenging’ behaviour is often just an attempt to meet a need in the only way that makes sense to the person in that moment. When we understand why these behaviours happen, we can move from frustration to compassion—and from reaction to prevention.

This is why training and behavioural support in dementia care are so essential. By recognising the breakdown in environmental cues and routine behaviours, we can adjust the environment to better support the person, rather than expecting them to adapt to a world they no longer perceive the same way. The more we understand, the better we can support those living with dementia and their care needs.