Incontinence - tips for carers

Incontinence is any involuntary or accidental leakage of urine or faeces. It can affect men or women of any age, although people who are elderly or who have a chronic health problem are at greater risk. It is not an inevitable part of ageing. Caring for someone with incontinence can be challenging, but help is available from many sources, so you do not have to manage alone.

A good starting point is your doctor, who can refer you to a continence service for assessment, advice and management. Caring for an unwell person is demanding, and incontinence adds considerably to the strain. Many carers feel overwhelmed, frustrated, angry or upset about coping with someone’s incontinence. These feelings are normal.

Effective treatments are available to help improve, manage or cure incontinence, so it is worth seeking help.

Continence assessment#

There are different types and causes of incontinence. An assessment at a continence service, usually carried out by a continence nurse, can help you build a plan suited to the needs of the person you care for. Information collected during an assessment may include:

• the person’s medical history and current health concerns
• how often the person passes urine and faeces, and a rough estimate of the amount of urine passed
• a description of the faeces, and whether the leakage is urine or faeces
• whether the person recognises the need to use the toilet, or remembers where the toilet is
• details of diet and fluid intake
• a list of medications, including prescription, over-the-counter and herbal preparations
• self-care abilities — for example, whether the person can feed, dress and bathe on their own

Tests during an assessment can include a urine test and an ultrasound of the bladder (performed on the skin surface below the navel).

Management and treatment#

Treatment depends on the type and cause of the incontinence. Options may include:

• increased fluid intake of up to about two litres a day
• a high-fibre diet
• pelvic floor exercises
• bladder training and training in good toilet habits
• medications, such as a short-term course of laxatives to treat constipation
• aids such as incontinence pads

Treatment may take a while to work, and it may manage the incontinence rather than cure it. Be guided by your health professional.

General tips for carers#

• The person you care for may be deeply distressed or ashamed about their incontinence.
• Aim to be calm and patient, and talk openly together about the situation.
• Try to accept your own discomfort and embarrassment. Humour can help.
• Despite effective treatment, accidents may still happen from time to time. Try to keep a relaxed attitude as much as possible.
• Look after yourself too. Plan regular breaks from caring so you can recharge.

Practical suggestions#

Pads for urinary or bowel incontinence are available, and a continence service or helpline can give advice about pads and any funding that may be available.

• Change pads as required.
• Clothing with velcro fasteners or elasticised waistbands may be easier to manage than zips or buttons. Choose machine-washable garments that do not need ironing.
• Check the fit of protective garments and adjust if necessary. Note that some plastic or rubber garments may cause rashes where they touch the skin.

Toileting suggestions#

• Consider aids such as a raised toilet seat or a wall-mounted grab bar if the person is unsteady on their feet. Remove floor mats and make sure the seat is securely fastened to the toilet.
• Don’t rush the person while they are on the toilet. Music can help create a calm, unhurried atmosphere.
• Run a tap or offer the person water to sip if they have trouble passing urine.
• Note the person’s toileting patterns and suggest they visit the toilet at times that suit their pattern. Keeping a record of how often they pass urine and faeces can help you and your doctor or continence professional recognise problems such as constipation.
• Keep a portable commode by the bed if the toilet is too far for the person to reach reliably in time.
• Use accessible toilets when you are out if they are available; these are usually unisex and have room for two people.
• Try to accommodate the person’s need for privacy. If privacy isn’t possible, a relaxed manner can help set the mood, and humour may dispel embarrassment or upset.

Hygiene suggestions#

• Wear disposable gloves (available from most supermarkets and pharmacies) when helping the person clean up.
• Wash the person’s skin afterwards with warm water, pat dry, and apply a barrier cream sparingly to prevent irritation.
• Wash your hands thoroughly with soap and water afterwards, even if you wore gloves.
• Dispose of used pads and gloves appropriately. Do not flush pads or gloves down the toilet.

When to see the doctor#

Some problems need prompt medical attention, including:

• inability to pass urine
• sudden bedwetting or loss of urinary control
• chronic constipation
• diarrhoea that lasts longer than 24 hours
• a persistent skin rash that does not respond to careful hygiene and barrier creams
• strong negative emotions, such as anger, stress or depression, experienced by the person or the carer

Key points#

• Effective treatments are available to help improve, manage or cure incontinence.
• There are different types and causes of incontinence.
• Treatment depends on the type and cause of the person’s incontinence.
• Treatment may take a while to work, or it may manage the incontinence but not cure it.
• Despite effective treatment, accidents may happen from time to time.

Where to get help#