4 Effective Methods in Reducing Fecal Smearing in Adults with Dementia

This article is evidence-based, verified by Dr. Ahmed Zayed

Fecal smearing, also referred to as scatolia, has a massive psychological impact on caregivers and family members who are in charge of taking care of adults with dementia. While it may not be as frequent as other disruptive behaviors, it does happen, and it is probably one of the most challenging problems to manage. Here, you will learn how to help adults with dementia overcome this problem efficiently. 

4 Methods to Manage Fecal Smearing in Patients with Dementia 

Smearing will not dissipate over time, which is why it’s essential to take the right measures to manage it. Some of the most effective methods are sensory integration therapy, wearing restrictive outfits, and analyzing the patient’s functional behavior. In other cases, however, this problem could be the result of a health issue, so you might have to take the patient to the doctor for evaluation. 

This disruptive behavior is much more complicated than most people believe. It could have deeper roots as a result of psychological problems, for example, in individuals with post-traumatic stress, anxiety, depression, etc., or could be caused by a medical problem, such as hemorrhoids, protozoal infections, rectal prolapse, and more.  

It’s an unpleasant problem to overcome, but luckily, there are multiple methods you can try to manage the issue and prevent it from happening in the future. Here, we will focus on how to take the proper approach to manage fecal smearing in adults with dementia. We will talk about: 

  • Sensory integration therapy 
  • Restrictive outfits 
  • Analyzing functional behavior 
  • Visiting the doctor 

Sensory Integration Therapy 

Some cases of scatolia could be caused by under-stimulation. There are specific periods where our senses are understimulated, for example, when sitting alone in a dark room and being unable to fall asleep from insomnia.  

In such particular moments, an individual can be deprived of adequate sensory input, like smell and touch, and will look for other ways to satisfy that need. As a result, some can choose to smear their feces and fulfill that sensory need. 

To reduce the chance of fecal smearing in adults with dementia, you should try to inspire a supervised play with sticky or soft substances. For example, playing with bread dough, shaving cream, or clay can help individuals alleviate that need for handling their feces and give them a different thing to focus on with a similar consistency.  

To handle the odor craving, patients can try out various essential oils, cheese, spices, scented lotions, or anything that has an overpowering smell. The more potent the scent is, the easier it will be for it to overpower the senses and satisfy that craving. 

Try Restrictive Outfits 

Some patients with dementia result in fecal smearing out of a need to gain control over their environment and body since they lack power in other areas in their life. To reduce the problem, those responsible for these patients should take that control away in a non-aggressive way.  

There is a preventive, but temporary solution to the problem, and that is restrictive clothing. Wearing clothes such as onesie pajamas, overalls, or one-piece underwear can buy caregivers and family members those extra few minutes to respond appropriately.  

Analyze Their Functional Behavior 

Adults with dementia often don’t express their issues. Instead, they show them. Fecal smearing sends out a powerful message, and to manage it, you first have to understand it. Ask yourself what could lead up to such behavior, has the patient experienced any traumatic stress in their life. Are they expressing their helplessness, frustration, anger, or powerlessness? 

There could be many reasons for this behavior, but one thing is guaranteed if you want to manage it, then you have to act in a neutral emotional manner. When fecal smearing happens, it’s crucial to avoid working in a dominating, aggressive way. 

Records show that individuals who’ve reacted aggressively or negatively towards an individual while smearing their feces have increased the messiness and frequency of scatolia.  

Consult With a Doctor 

It’s complicated to pinpoint the cause of fecal smearing unless you talk with a doctor. But you should know that you are not alone. Other caregivers or family members are going through the same thing you are and are trying to overcome the same issues.  

Fifty million people around the world have dementia, but fecal smearing is only present in very few of them. One particular study, explicitly focused on this disruptive behavior, was issued to analyze the rate of this problem and how prevalent it is in patients with dementia.  

Out of the 246 patients tested, fecal smearing (or scatolia) was frequently present in 23% of cases, and it was rarely noticed in 14% and never appeared in 51% of all the tested. Patients with fecal smearing showed a negative outlook concerning their quality of life and low scores with cognitive functions. 

But, all those tested had insomnia, some more frequently than others. This study suggests that the reason for such behavior could be insomnia and cognitive dysfunction.  

If an adult with dementia has insomnia or any cognitive dysfunction, they will try to soothe their problem or deal with the discomfort and pain by going through their rectal area. To reduce that behavior, the doctor can prescribe certain medications to help these individuals treat their health issues.  


Fecal smearing is one of the most unpleasant destructive behavior to overcome, but it’s doable. The first step to overcoming the issue is to learn about it; then, you will be more prepared to manage and prevent it. If you, as a caregiver or someone responsible for an adult with dementia, take the right approach, it will be much easier to avoid an incident in the future. 

Dr. Ahmed Zayed

Dr. Ahmed Zayed, MD holds a baccalaureate of Medicine and Surgery. An avid contributor to the Huffington Post and Chicago Tribune, Dr. Zayed believes in providing accurate and accessible information to general readers. With years of writing and editing content in the medical niche, Dr. Zayed likes to think of himself as a man with a mission, keeping the internet free of false medical information.


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