Published research, clinical guidance, and evidence related to toileting, incontinence, mobility, falls, skin integrity, caregiver workload, and conditions that can make toileting more difficult.
Selected recent additions from the complete research library.
Across neurological conditions, aging, home care, and institutional settings, published research repeatedly connects toileting with mobility, falls, incontinence, skin exposure, caregiver workload, sleep disruption, and dignity. Carebidet is designed around that broader care process.
Research: Weakness, impaired balance, urgency and nighttime bathroom activity can make toileting transfers difficult and contribute to falls.
Carebidet relevance: Toileting can occur while the person remains lying in bed, removing the bathroom transfer from that toileting episode.
Research: Repeated exposure to urine and feces is associated with moisture-related skin damage and incontinence-associated dermatitis.
Carebidet relevance: Carebidet detects waste, removes it through a sealed system, washes, and dries—designed to reduce prolonged contact with waste and moisture.
Research: Nocturia, urgency, confusion and impaired mobility can make nighttime toileting disruptive and increase exposure to fall risk.
Carebidet relevance: In-bed toileting can eliminate the need to stand, pivot, walk to the bathroom, and return to bed for that toileting event.
Research: Toileting assistance can involve repeated transfers, repositioning, hygiene, clothing or bedding changes and cleanup, adding physical strain and time demands.
Carebidet relevance: Automation can reduce several manual steps while keeping the caregiver in control of the care process.
Research: Stroke, dementia and other neurological conditions can make it harder to recognize, communicate or respond to toileting needs in time.
Carebidet relevance: Automated waste detection can initiate the toileting-care cycle without relying solely on the person being able to call for help.
Research: Incontinence and dependence for intimate care can affect privacy, embarrassment, confidence, relationships and quality of life.
Carebidet relevance: A more contained and automated process may reduce manual handling, exposure, and some of the most intrusive parts of toileting care.
Independent studies cited in this library establish the clinical and caregiving problems described above. They do not, unless specifically identified as Carebidet research, establish that Carebidet prevents or treats a particular clinical outcome.
Toileting difficulty is rarely one problem. It can involve bladder or bowel control, mobility, transfers, communication, cognition, nighttime care, skin exposure, dignity, and caregiver workload. This library brings those subjects together so visitors can find the evidence most relevant to the person or care setting.
Classic study of 135 stroke patients reporting urinary and fecal incontinence during the first year after stroke; immobility and dependency were important correlates.
Family caregivers described continence care through themes including chaos, hypervigilance, exhaustion and creating a new life.
Urinary incontinence, long caregiving hours and disrupted nighttime sleep were associated with caregiver burden.
Examines caregiver task difficulty and the added impact of aphasia and communication problems after stroke.
A 2024 meta-analysis of 21 studies and 7,327 patients estimated post-stroke urinary incontinence prevalence and evaluated associated risk factors.
American Stroke Association guidance on aphasia and post-stroke communication changes that can complicate asking for toileting help.
Alzheimer’s Association guidance describing how toileting commonly becomes more difficult in late-stage disease and may require step-by-step assistance.
Alzheimer’s Association guidance on continence routines, scheduled toileting and practical dementia care.
Alzheimer’s Society guidance on accidents, continence problems and difficulty using the toilet in dementia.
Community-based research found frequent nocturia was associated with increased incident fall risk over follow-up.
Systematic review examining the association between nocturia and risk of falls and fractures.
Study of toileting-related falls in older adults; cognitive impairment was more common among toileting-related fall cases.
Review of factors associated with sleep disturbance among family caregivers of people with dementia.
Research linking greater sleep difficulty among dementia caregivers with adverse caregiver health indicators.
NIHR Evidence collection on personalized continence care, dignity and quality of life in dementia.
Review and recommendations concerning urinary symptoms in Parkinson’s disease and their impact on quality of life.
Systematic review and meta-analysis examining urinary urgency, incontinence, retention and overactive bladder in Parkinson’s disease.
Clinical review of autonomic bladder and bowel dysfunction associated with Parkinson’s disease.
Review of balance impairment and postural instability, important contributors to fall risk in Parkinson’s disease.
Critical review of IAD risk factors, prevention and management, including the effects of repeated urine and fecal exposure.
Systematic review of IAD prevention and care strategies.
Randomized clinical trial evaluating behavioral therapy for urinary symptoms in Parkinson’s disease.
Home-safety guidance addressing fall risk and bathroom safety for people living with Parkinson’s disease.
Practical guidance on bathing, toileting, personal hygiene and grooming challenges in Parkinson’s disease.
Systematic review and meta-analysis examining quality-of-life effects across multiple domains in Parkinson’s disease.
Study reporting bladder and intestinal symptoms among people living with ALS, including urinary symptoms and constipation.
Research documenting bowel, bladder and sudomotor symptoms in an ALS population.
Study examining urinary symptoms and retention in people living with ALS.
2024 research on family caregivers providing toileting assistance, including burdens associated with urinary and fecal leakage.
In a 7-day, nonrandomized ICU study of 55 patients, the Carebidet group showed less progression of incontinence-associated dermatitis and more favorable Braden pressure-injury risk scores than the standard wet-wipe cleansing group. The small quasi-experimental study does not establish definitive effectiveness.
In a one-month field trial, 30 caregivers evaluated Carebidet. Durability, effectiveness, convenience and safety exceeded minimum acceptable levels, while cost rated slightly below the acceptable level. The study measured caregiver perceptions, not clinical outcomes.
In a discrete-choice study of 23 professional caregivers, automatic waste management was the most influential excretion-care robot attribute (30.4%), followed by combined urine/feces detection and post-defecation washing and drying. The study measured stated preferences, not care outcomes.
In a 21-day single-person home-care pilot, 115 automated cycles were recorded. By Week 3, weekly toileting time fell from 880 to 140 minutes and wet-wipe use from 196 to 5. This observational result cannot predict outcomes in other people or settings.
An 8-week residential aged-care report summarized six staff feedback forms. All six were favorable across the reviewed domains, including skin integrity, comfort, workflow and manual handling. The small uncontrolled report reflects staff observations, not established clinical effectiveness.
COHealth repository for Carebidet research on caregiver burden, efficiency, IAD and pressure-injury risk.
Stanford-led study using Japanese nursing-home data found robot adoption reduced staffing-retention difficulties and increased employment of care workers and nurses under flexible contracts.
Research on Japanese nursing homes found robot adoption associated with increased employment and retention, task reallocation, productivity and measures of care quality.
Stanford project page describing the research program that examined robot adoption, staffing, productivity and care-quality measures in Japanese nursing homes. The project is no longer active.
2024 review describing urinary incontinence, urgency, frequency and difficulty voiding as common post-stroke bladder problems and reviewing diagnosis and management.
Large cohort of 1,683 post-stroke rehabilitation patients; 11.6% experienced a UTI, and UTI was associated with poorer functional and ambulation outcomes and longer rehabilitation stays.
Prospective stroke-rehabilitation study identifying repeated elevated postvoid residual urine as an independent risk factor for urinary tract infection.
Prospective rehabilitation study finding urinary retention in 29% of participants and an association with cognitive impairment, aphasia, lower functional status and urinary tract infection.
In a cohort of 720 hospitalized stroke patients, urinary incontinence was associated with increased risk of a first fall.
Cochrane review evaluating interventions for post-stroke urinary incontinence and describing the substantial frequency and persistence of incontinence after stroke.
Mixed-methods systematic review highlighting urinary, fecal and functional incontinence in dementia and the importance of communication, dignity and individualized continence care.
Study finding lower urinary tract symptoms and toilet problems significantly correlated with caregiver burden in people with mild cognitive impairment and Alzheimer’s disease.
Review describing nocturia as a common Parkinson’s nonmotor symptom with effects on sleep, falls, quality of life, institutionalization and caregivers.
2026 meta-analysis of 66 studies involving more than 30,000 people with Parkinson’s and caregivers; greater disability and longer daily caregiving time were among factors associated with higher burden.
Study reporting that 34% of falls were toileting-related and at least 44% of those occurred at night; many nighttime toileting falls occurred while patients mobilized without the recommended assistance.
Systematic review and meta-analysis finding a significant association between urinary incontinence and falls, including among adults age 65 and older.
Systematic review concluding that nocturia is probably associated with increased fall risk and may also be associated with increased fracture risk.
Meta-analysis of 58 studies finding significant associations between incontinence-related moisture factors and pressure-ulcer development, with particularly high risk associated with double incontinence.
Large analysis of incontinent patients finding both IAD and immobility independently associated with increased likelihood of sacral pressure injury.
Meta-analysis of 10 studies comprising 286,544 participants estimated a pooled urinary-incontinence prevalence of about 40% among people with dementia, with substantial variation by setting and assessment method.
Qualitative research with people with dementia, unpaid carers and healthcare professionals found toileting problems arise from cognitive, physical, psychosocial and care-system factors and increase caregiver workload and harms to health and social participation.
Systematic review of 48 papers found prompted voiding and timed toileting among the better-documented approaches, while also highlighting ethical, autonomy and evidence limitations in dementia continence care.
Systematic review found limited high-quality evidence for community continence interventions and highlighted the need for practical, individualized support for people with dementia and their family caregivers.
Study of 120 six-month stroke survivors found greater caregiving needs among patients with functional disability, cognitive impairment, speech impairment and urinary incontinence; 18% required attention every night.
Cross-sectional study compared caregivers of stroke survivors with and without aphasia, examining how post-stroke communication impairment affects caregiver burden, quality of life and daily occupational performance.
Prospective cohort study found urinary urgency associated with falls in Parkinson’s disease; 13.8% of recorded falls occurred on the way to or from the toilet.
Study of 350 ambulatory patients found urinary incontinence was the factor most strongly associated with fall status after adjustment, alongside disease duration and mobility measures.
Clinical review reports urinary dysfunction is common in Parkinson’s disease, negatively affects quality of life, and requires behavioral, medical and procedural management.
Review describes urgency, nocturia, incontinence and poor emptying as common lower urinary tract symptoms that can increase dependence, infection risk and caregiver burden in neurodegenerative disease.
Study of 70 people with ALS found caregiver time increased as disability worsened; housekeeping, feeding and toileting were the most time-consuming duties, underscoring toileting as a major component of ALS caregiving burden.
In a mixed-methods study of 59 South Korean hospital nurses, elimination care averaged 29.3% to 43.8% of nursing work per shift across the three unit types studied. Nurses also reported physical strain, frequent care needs, delays in other duties and complications.
Analysis of 175,632 skilled-nursing-facility residents found those with urinary incontinence or overactive bladder had more mobility and cognitive impairment, falls, UTIs and moisture-associated skin damage than controls.
Systematic review of five randomized trials examined pharmacologic and nonpharmacologic approaches to preventing and managing urinary incontinence-associated dermatitis and found benefit across included interventions.
Meta-analysis of 27 studies identified fecal incontinence, stool characteristics and frequent bowel movements among important factors associated with incontinence-associated dermatitis.
Systematic review found that controlling skin overhydration from urine and feces through absorbent-product selection and pad-changing frequency may influence IAD prevention and improvement, though evidence quality was low.
Systematic review found moderate-quality evidence that increased stool frequency, limited mobility and friction/shear are risk factors for developing IAD.
Network meta-analysis of 14 randomized trials found several fecal collection approaches reduced moderate-to-severe IAD compared with usual care in critically ill patients, reinforcing the importance of limiting prolonged fecal exposure to skin.
This clinical-practice guideline describes individualized bowel programs for adults with SCI, including rectal medications, enemas, stimulation and manual evacuation. It supports structured bowel management but does not evaluate Carebidet.
In a cross-sectional Korean study of 87 SCI patient-caregiver dyads, bowel-toileting assistance was rated the most difficult and time-consuming care activity, while transfers created the greatest concern for caregiver physical injury. Findings are from one rehabilitation center.
In a cross-sectional study of 59 non-ambulatory people with SCI, 63% reported at least one fall in the prior six months. Transfers were the most commonly reported activity during a fall, accounting for 43.2% of reported circumstances.
This review included 24 unique studies. Pooled 12-month fall prevalence was 78% among ambulators and 69% among wheelchair users; sampling bias was high, and nearly all included studies involved community-dwelling populations.
In this matched case-control study of 98 SCI rehabilitation inpatients, most falls occurred during transfers or bathroom use. The single-center retrospective study did not evaluate Carebidet or an in-bed toileting intervention.
Multidisciplinary consensus recommendations describe how urgency, frequency, nocturia, incontinence and voiding dysfunction can affect quality of life and caregivers, with mobility limitations and nighttime symptoms contributing to fall risk.
A cross-sectional study of 382 older adults with incontinence-associated dermatitis across 39 tertiary hospitals identified differing dignity-support needs; 35.6% were classified in a high-dependency, severe-psychological-distress profile. The study cannot establish causation or product effects.
A 2024 literature review of 73 articles reported substantial urological involvement in EDS/JHS, including urinary incontinence, pelvic organ prolapse, bladder diverticula and related lower urinary tract problems.
Large international survey reported stress urinary incontinence in 60%, urgency urinary incontinence in 54%, fecal incontinence in 24%, and pelvic organ prolapse symptoms in 21% of respondents with EDS.
Case-control research found rectal hyposensitivity was significantly more common in women with functional constipation and hEDS/HSD, supporting a physiological basis for impaired awareness of rectal filling and difficult evacuation in a subset of patients.
Study of 144 patients found altered anal relaxation and pressure patterns during simulated defecation in the hEDS/HSD group, adding objective evidence of pelvic-floor-related defecatory dysfunction.
Critical review found constipation and other gastrointestinal symptoms substantially more common in HSD/hEDS than comparison populations and discusses pelvic floor dysfunction, autonomic factors and multidisciplinary management.
National cohort study found high rates of incomplete evacuation, incomplete urinary voiding, urinary incontinence and fecal incontinence among respondents with EDS, demonstrating that bowel and bladder difficulties can occur together.
2025 expert review recommends considering anorectal testing for hEDS/HSD patients with incomplete evacuation and other lower-GI symptoms because pelvic floor dysfunction, including rectal hyposensitivity, is common.
Study of 65 adults documented varying levels of independence and mobility. Dependence for washing/bathroom activities was a major functional deficit, and one respondent described dependence for toileting as the worst handicap.
Cross-sectional study of 22 adults with amyoplasia found wide variation in function. Seven participants were independent in all measured daily activities; compensatory techniques, environmental adaptations, and often custom assistive devices supported independence.
In a selected series of 26 AMC patients already diagnosed with neurogenic bladder, 81% had urinary incontinence and 50% had a history of urinary tract infection. These figures describe that selected clinical group and do not apply to everyone with AMC.
Published occupational-therapy report describes toileting as an activity that may require one or two assistants in severe arthrogryposis and documents a toileting adaptation that increased independence and reduced assistance needs.
Adult outcome study found lower physical-function scores and substantial mobility limitations despite high rates of independent living, supporting the importance of adaptive strategies for daily activities.
Peer-reviewed rehabilitation review emphasizes maximizing range of motion, strength and participation in activities of daily living throughout life, with individualized strategies and assistive technology.
Review found chronic musculoskeletal pain is a significant issue in adults with AMC and can restrict activities of daily living, mobility and participation—factors that can further complicate transfers and self-care.
Case-control research documented impaired balance and gait in women with hypermobile-type EDS; 95% of the 22 EDS participants reported at least one fall during the preceding year. The small sample should be considered when interpreting the finding.
International expert recommendations emphasize mobility training, transfers, assistive equipment and maximizing autonomy in self-care activities including toileting and bathing. The authors also note that high-quality AMC rehabilitation evidence remains limited.
Cross-sectional research found falls were common in participants with AMC: 70% of adults and 89.3% of adolescents reported falling in the prior year. Multiple falls were associated with several mobility-related factors; the study was exploratory and does not establish causation.
Systematic review of 12 studies found falls were common across acute care, rehabilitation and community settings after lower-limb amputation, with cohort fall rates ranging from 20.8% to 58%. Risk factors varied by setting and amputation characteristics.
Study of 52 adults who initially required self-care assistance found significant improvement after a pre-prosthetic ADL intervention in toileting, bed-chair transfers, dressing and bathing. Unmet needs for bathroom adaptation also decreased.
Prospective cross-sectional survey of 91 adults found high levels of urinary urgency and leakage, with substantial interference in daily life among participants with symptoms.
Clinical review identifies urinary incontinence, frequency and urgency as common concerns and reports that functional toileting strategies, medication and incontinence aids are successful for many adults. Retention and unsafe bladder pressures require clinical assessment and treatment.
Questionnaire study of 57 people with Duchenne muscular dystrophy and 56 controls found bowel symptoms and combined bladder-and-bowel symptoms more often in the Duchenne group; 42% of patients reported a negative impact on daily functioning.
Survey study of 27 adult men found weekly or daily urinary incontinence in 37%; most affected participants reported an impact on travel, social activity, or emotional well-being. The small volunteer sample limits generalization.
National Spina Bifida Patient Registry analysis included 1,370 adults and describes bowel-management practices and continence outcomes in a population where neuropathic bowel dysfunction can cause constipation, incontinence and diminished quality of life.
Study of 66 adults examined urinary quality of life across bladder-management methods and ambulatory status, finding urinary continence-related quality of life closely associated with general health quality-of-life measures.
Rehabilitation case series of 84 people with first-ever TBI found urinary incontinence in 62% on admission and 36.9% at discharge; incontinence was associated with poorer functional status and bilateral brain lesions.
Traumatic Brain Injury Model Systems study followed 1,013 rehabilitation inpatients after TBI. Fecal incontinence declined from 68% at rehabilitation admission to 12.4% at discharge and 5.2% at one year, and was associated with injury severity and functional outcomes.
Validated questionnaire study of 272 polio survivors found bladder symptoms were common and bothersome, with incontinence reported by 73.3% of women and 40.9% of men. The study concerns polio survivors broadly, not only people formally diagnosed with post-polio syndrome.
Stanford research on Japanese nursing homes provides broader context for how care technology can complement the workforce, help ease retention challenges and support more flexible care delivery.
View Stanford ResearchAbout this library: Sources are provided for education and research. Independent studies, Carebidet-specific research, pilot findings, and professional guidance are labeled separately and should be interpreted in their original study or care-setting context. This library is not a substitute for individual medical, nursing, or occupational therapy advice.
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