why do dementia patients play with poop?

Written by Nguyenjessica

Published on June 20 2025

Caring for someone with dementia is never easy. But when a loved one suddenly starts smearing or playing with feces, many caregivers feel lost. Is this a sign that the disease is getting worse? Could it be a way of expressing discomfort, stress, or sensory changes? In truth, this behavior often results from a mix of cognitive decline, emotional distress, sensory shifts, and physical issues.

Understanding why it happens is the first step to managing it. In this article, we’ll explain in simple terms why some dementia patients show this troubling behavior, and share practical ways caregivers can handle or even prevent it. Read on to find answers that can truly help.

why do dementia patients play with poop?

Key Points

Why do dementia patients smear feces?
As dementia progresses, patients feel confused and lose social awareness. Sensory changes make them curious about textures and smells. When they can’t express discomfort or emotions, they may smear feces as a way to cope.

Is this behavior a sign of disease progression?
Yes. Feces-smearing usually happens in moderate to severe dementia. It reflects worsening brain function and is often linked with insomnia, agitation, incontinence, and poor impulse control.

How can caregivers manage this behavior?
Encourage regular toileting, change diapers promptly, create a calm environment, and reduce anxiety. Stay patient, avoid scolding, and work with healthcare providers to develop a care plan.

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Table of content

Why do some dementia patients start smearing or playing with feces?

Is this behavior a sign of disease progression?

Are sensory issues involved in why they touch feces?

Can feelings of confusion or frustration lead to this behavior?

What role do environmental factors play?

How can caregivers manage or prevent feces-smearing behavior?

Why do some dementia patients start smearing or playing with feces?

Some dementia patients may start smearing or playing with feces. This behavior is often caused by a mix of cognitive decline, sensory changes, emotional distress, and physical discomfort. In medical terms, it is known as scatolia (fecal smearing) or coprophagia (playing with or eating feces).

As their cognitive abilities fade, patients often feel confused and disoriented. They may no longer understand social norms or the consequences of their actions, which can lead to inappropriate behaviors like smearing feces.

Dementia also affects how they process sensory information. Some may find the smell, texture, or appearance of feces interesting or stimulating, which prompts them to touch or smear it.

As communication skills weaken, many patients can no longer express their needs or emotions through words. Feelings of anxiety, frustration, pain, or discomfort often come out through unusual behaviors like fecal smearing.

Physical discomfort is another key factor. Constipation, rectal discomfort (such as fissures or hemorrhoids), and incontinence are common in dementia, and these issues may trigger smearing as a coping mechanism.

The environment also plays a role. A chaotic setting, dirty clothes, or sudden changes in routine can increase distress and lead to such behaviors. Emotional agitation or anxiety can make things worse.

Brain scans have shown that these behaviors are connected to neurodegeneration, especially in the medial temporal lobe and amygdala.

Sleep problems and severe cognitive decline are often present in patients with this behavior. Insomnia can further intensify symptoms.

Why do some dementia patients start smearing or playing with feces?

Is this behavior a sign of disease progression?

Fecal smearing or playing with feces in dementia patients is generally seen as a sign of disease progression and more advanced cognitive decline. This behavior is closely linked to ongoing brain deterioration, particularly in the medial temporal lobe and amygdala, which are key areas for cognition and behavior control.

Studies show that patients who display scatolia often have lower cognitive scores and more negative emotional states. This indicates that the behavior is not random, but rather a reflection of worsening dementia.

Fecal smearing usually occurs alongside other signs of disease progression, such as increased agitation, loss of inhibition, confusion, and incontinence. These behaviors are also linked to physical discomfort, constipation, pain, anxiety, and communication challenges.

In many cases, fecal smearing is observed in patients with moderate to severe dementia. It is often associated with insomnia and other behavioral issues, which further highlights its connection to advanced stages of the disease. Brain imaging studies confirm that patients with coprophagia and scatolia show significant brain atrophy, consistent with progressive neurodegenerative conditions like frontotemporal lobar degeneration and Alzheimer’s disease.

Are sensory issues involved in why they touch feces?

Yes, sensory issues do play a role in why some dementia patients touch or play with feces. Dementia can change how the brain processes sensory information like smell, touch, and texture. Patients may find the feel or smell of feces interesting or stimulating, which leads to smearing or manipulation.

This abnormal sensory experience, combined with cognitive decline and lowered inhibition, contributes to these behaviors.

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Can feelings of confusion or frustration lead to this behavior?

Yes, feelings of confusion and frustration can definitely lead some dementia patients to smear or play with feces. As cognitive abilities decline, patients become more disoriented and lose their understanding of social norms. Their ability to control impulses also weakens.

At the same time, their verbal and nonverbal communication skills deteriorate. Many patients can no longer express their needs or discomfort clearly. As frustration, anxiety, or depression build up, they may turn to fecal smearing as a way to cope or release emotions.

This behavior is often tied to emotional distress such as anxiety, agitation, or depression. When patients feel overwhelmed or unable to communicate, they may use such behaviors to express unmet needs or emotional tension.

Environmental stress or changes can make these feelings worse and trigger the behavior.

In short, confusion and frustration are major emotional factors behind fecal smearing in dementia patients. When communication is impaired, these behaviors become a way for patients to show distress and unmet needs.

What role do environmental factors play?

Environmental factors play a big role in triggering or worsening fecal smearing behaviors in dementia patients. Changes or stress in the surroundings can make patients feel disoriented, anxious, or frustrated, which can lead to these behaviors.

For example:

Soiled clothing or bedding can directly trigger fecal smearing as patients react to discomfort or feeling unclean.
Stressful, confusing, or unfamiliar environments can increase agitation and emotional distress, leading to behaviors like scatolia (fecal smearing).
Lack of clear environmental cues or inadequate toileting support may cause accidents or confusion about using the bathroom, indirectly contributing to smearing.
Uncomfortable clothing or irregular toileting routines can further increase frustration and the likelihood of fecal manipulation.
Making environmental changes can really help. Providing comfortable clothing, encouraging regular toileting routines, and reducing environmental stressors are all effective ways to manage and reduce fecal smearing.
In short, environmental factors greatly influence the patient’s emotional state and comfort. Managing these factors is essential when addressing fecal smearing behaviors in dementia.

How can caregivers manage or prevent feces-smearing behavior?

Caregivers can manage or prevent feces-smearing behavior in dementia patients through a mix of physical care, environment adjustments, emotional support, and long-term planning.

Physical care:

Treat underlying issues: Address constipation, rectal discomfort, pain, infections, and other causes of distress.
Regular toileting routines: Encourage bathroom use every couple of hours, especially before bed or naps.
Frequent diaper changes: Check and change to avoid itching or discomfort.
Use comfortable protective garments to maintain hygiene and dignity.
Regular medical checkups to monitor cognitive, emotional, and physical health, including sleep and pain.

Environmental and behavioral tips:

Keep the bathroom clean and accessible, with grab bars and non-slip mats for independence.
Offer safe hand activities like folding towels or playing with soft clay to redirect focus.
Modify the environment to reduce confusion and remove items mistaken for toilets.
Stay calm and redirect during incidents—avoid punishment or anger.

Emotional and caregiver support:

Be patient and empathetic, use simple words, and help the patient clean up without shame.
Educate caregivers to understand behaviors, manage triggers, and care for their own well-being.
Cognitive and psychosocial support: Gentle brain activities and emotional care can ease distress.

Long-term strategies: