Tuesday 17th August 2021
This article aims to provide help to the friends, relatives or carers of people who need support with continence management.
Bladder and bowel problems affect millions of people; men and women, young and old alike yet, despite being so common, many people continue to needlessly suffer in silence, failing to get the help they need.
The choice and availability of treatments, products and medicines for the management of continence has never been greater and there is plenty of good advice and support available as well. Indeed, in some cases bladder and bowel problems can be completely cured and in others they can be effectively managed with the right products or treatments to improve or maintain quality of life.
In this section you can find about the different types of incontinence, what you can do to care for a loved one and discover where you can get some more help.
Managing Continence
Incontinence can be a very upsetting condition both for those suffering with it and the people around them. However, the first and most important point to remember is that everyone with continence management issues can be helped and many can be completely cured.
What is incontinence?
There are two types of incontinence:
- Urinary incontinence - when someone loses control of their bladder.
- Faecal (or Bowel) incontinence - when someone loses control of their bowels.
This may happen all or most of the time or may just be a case of the occasional unfortunate leakage. Urinary incontinence is far more common than faecal incontinence – although both conditions affect millions of people every day.
Urinary incontinence
If incontinence problems have already been diagnosed, then you can find out more about specific conditions in the Bladder Problems section. If a diagnosis has not yet been made by a healthcare professional, the following questions about the symptoms may give you a better idea of what your loved one’s problem could be and will help to inform any future discussions with a Healthcare professional.
Bladder Problems
Do they have a sudden urge to go to the toilet or are they unable to hold on and reach the toilet in time?
- They may have Urge Incontinence. This is a condition where the desire to pass urine can come on so quickly it does not allow sufficient time to get to the toilet. If they have urge incontinence they may leak on the way to the toilet or soon after you have experienced the initial urge to empty their bladder. Some people find hearing running water or putting the key in the front door may trigger episodes of urge incontinence'
Do they leak or dribble urine when they sneeze or when you exercise?
- They may have Stress incontinence. Leaking small amounts of urine when you cough, sneeze, laugh or exercise can occur if there is a weakness in the pelvic floor muscles. This type of leakage is called stress incontinence. It is more common in women as pelvic floor muscles can be weakened by pregnancy, childbirth and the menopause. Men may experience this type of leakage following surgery for prostate problems.
Do they find the need to go to the toilet very often and are only able to pass small amounts of urine at a time?
- They may have Overflow incontinence. If the bladder is unable to empty effectively this is known as overflow incontinence. Other medical conditions may cause obstructions which prevent the bladder from emptying completely which means there is very little space for new urine to be stored and frequent visits to the toilet to pass small amounts of urine often result. Some people with incomplete bladder emptying also experience a constant dribble of urine which they are unable to control and people with this type of problem may also feel that their bladder is never fully empty.
Do they have a mixture of the above symptoms?
- They may have Mixed Incontinence. This is where more than one type of incontinence is experienced e.g. leaking urine when coughing and sneezing but also needing to dash to the toilet, often leaking urine before they are able to get there.
Do they need to get up several times at night to go to the toilet?
- They may have Nocturia. Nocturia is the need to get up several times a night to urinate and can have many causes. Even when the symptoms are relatively mild, it can still be a challenging condition because it interferes with getting the right amount of sleep at night.
Faecal Incontinence
If bowel incontinence problems have already been diagnosed, then you can find out more about specific conditions in the Bowel Problems section. If a diagnosis has not yet been made by a healthcare professional, the following questions about the symptoms may give you a better idea of what the problem could be and may help any future discussions with a Healthcare professional.
Bowel Problems
Do they leak faeces without being aware of it?
- They may have Bowel or Faecal incontinence. This is an inability to control bowel movements, which means that faeces can leak out uncontrollably. Some people may just pass a small amount when passing wind, whilst others may have a complete loss of bowel control. This can severely affect a person’s quality of life, self-esteem and emotional wellbeing.
Again, the most important point to remember is that everyone with continence management issues, whether Urinary or Faecal, can be helped and many can be completely cured.
What can you do?
From a very young age we are strictly trained to control our urges to go to the toilet which is why being incontinent can make your loved one feel they are out of control and helpless. This can affect their sense of dignity and self-esteem and many people find it very hard accept that they might need help from someone else in such an intimate area of their life - whether from someone very close to them or a healthcare professional.
Caring for someone in this way can be both an intensely difficult and, at the same time, rewarding experience. You may learn things about yourself you may never have realised, such as your ability to be patient and your capacity for love and compassion.
Three Golden Rules
1. There’s nothing to be ashamed of
Carers can significantly reduce the emotional fears that come with incontinence by helping their loved ones feel less ashamed and being sensitive to their concerns. These concerns often arise because they think they are alone in their experiences; you can help them by providing reassurance that they are not alone and many people of all ages, male and female alike suffer from similar problems.
2. Build up their confidence
Continence management issues can significantly impact on a person’s quality of life, preventing them from exercising, playing with their children or grandchildren and even disrupting their daily routine. Everyday events suddenly become a lot more challenging and many sufferers become afraid to leave their own homes. You can help by accompanying your loved one on some initial short outings which will help build their confidence in managing their continence away from the home. After a few local trips to nearby destinations, they will feel more comfortable about travelling further and for longer periods.
3. Be patient
Caring for incontinent people requires huge amounts of understanding and patience and, given time, you can help them feel better about themselves and help them get back to doing the things they enjoy. The physical and emotional impact of continence management problems, which have often been present but not disclosed for a long time, mean it can be a slow journey, so don’t try to rush things, just take one small step at a time.
Practical Advice
Dealing with an accident
Approaching the problem with understanding, matter-of-factness and, if appropriate, a little humour can improve the situation for everyone concerned.
If someone has an accident, the three most important things that a carer can do are to:
- try to overcome any embarrassment they may feel.
- avoid being angry or appearing upset.
- remember that they are not to blame.
However, this may not always be as easy as it sounds. If a carer finds their feelings regarding continence are difficult to handle, it’s a good idea good idea talk things through with somebody else, for example a community nurse, a continence advisor or even another carer. It is vital not to let dealing with continence issues have a negative effect on the relationship you already have with the person being cared for.
Hiding the evidence
If someone feels very ashamed of their incontinence, they may try to hide the evidence in an effort to keep their problem a secret or to avoid any embarrassment. They may remove their wet or soiled clothing and try to hide it or even throw it away. They may also try to remove and hide evidence of faecal incontinence.
If you find the evidence, remember not to appear angry or upset and deal with the situation in a matter-of-fact way without apportioning blame.
Going in the Wrong Place
This can happen with elderly people if they become confused about their surroundings or indeed anybody who is badly ‘caught short’. They may use in an inappropriate place, such as a cupboard or a wastepaper basket and, when you discover this, it is important to react in a very understanding way.
When someone has problems with incontinence, one of the first things to check is whether they know (at all times) where the nearest toilet is and that are able to get to it without any problems.
Make it easy
The easier you can make the process of visiting the toilet the easier it will be to avoid accidents. Taking these simple precautions can really help.
- Make sure that there is nothing, such as awkwardly placed furniture or doors that are hard to open, obstructing the way to the toilet.
- Make sure the toilet is easy to use. Toileting aids such as handrails and raised seats are often helpful. If it becomes too difficult for the person to get to the toilet, an aid such as a commode may be useful. You should contact a healthcare professional for further advice on toileting aids.
- Ensure clothing can be quickly removed and unfastened. Some people find Velcro fastenings easier to use than zips or buttons.
- Always keep a bin with a lid in both the bathroom and the bedroom so they can dispose of continence management products in a safe and discrete manner.
Advance Planning
If the person you are caring for has regular accidents, carers will find it helps to do the following:
- Remind the person to go to the toilet, or take them there, at regular intervals. Taking the person to the toilet at a set time can help prevent faecal incontinence, if their habits are regular.
- Be aware of the signs that the person wants to go to the toilet. These may include fidgeting, getting up and down regularly or pulling at their clothes. Get to know the signs for the one you care for.
- If the person is incontinent at night, encourage them to avoid drinking for two or three hours before going to bed. However, always make sure that they drink plenty of fluids during the day.
Check what are they drinking?
It is important that the person you are caring for has enough to drink, even though they may be tempted to cut down on fluids to avoid accidents. If they don’t drink enough the bladder will become sensitive to small amounts of urine which means they will actually go to the toilet more frequently and they may also experience other health problems. They should drink as normal and try to avoid certain types of drinks such as tea, coffee and coca cola – all of which contain caffeine and may irritate the bladder.
Look after their skin
Skin can be easily damaged by urine if it’s not looked after correctly. Whilst protective products which draw moisture away from the skin can help, you should also follow some basic skincare principles.
- Avoid using harsh soaps as these can dry out the skin.
- Use a pH balanced soap.
- Don’t rub your skin, pat it dry instead.
Caring for the Elderly
This section provides advice for carers who look after elderly people coping with continence management, particularly those suffering from Dementia. The set of symptoms which are known as Dementia include loss of memory, mood changes, problems with communication and, commonly, incontinence.
Coping with incontinence
Incontinence can be humiliating for a person with dementia and upsetting for those around them. However, although it can be a distressing problem, it is common among the elderly and the good news is that it can be managed and often cured.
Why might someone with dementia become incontinent?
Incontinence is not an inevitable symptom of dementia, but it is very common and there are a variety of reasons why an elderly person could become incontinent. These include various medical conditions, a number of which are treatable:
- Urinary tract infections - these may respond to treatment with medication.
- Prostate gland trouble - this affects men and may be resolved with an operation.
- Side-effects of medication - please discuss with your loved one’s doctor.
- Severe constipation - constipation can put pressure on the bladder and can also lead to faecal incontinence. Eating foods that are high in fibre, drinking plenty of fluids and keeping physically active can help prevent this.
However, with in the case of an elderly person suffering with Dementia, additional causes of continence issues may include:
- Simply forgetting to go to the toilet.
- Not recognising the need to go to the toilet.
- Being unable to remember where the toilet is.
How may a person with dementia react to being incontinent?
Every individual will react differently to the experience of incontinence. Some people find it very upsetting, while others find it easier to accept. Common occurrences among elderly people with dementia include hiding the evidence and going to the toilet the wrong place.
Practical Advice for Carers
The advice previously given in the Practical Advice section applies equally to the elderly and people suffering with dementia.
It’s particularly important to remind the person to go to the toilet, or take them there, at regular intervals and to react calmly to any incidents.
Get some help
It is never too late to get some professional help for bladder or bowel problems, so you shouldn’t feel you have to cope on your own, remember the most important point is that everyone with continence management issues can be helped and many can be completely cured.
When seeking help for your loved one, your first point of contact will normally be a doctor, but it can often be possible to seek help from a local continence advisor without referral. You should check with your local Healthcare organisation to see if this is possible. You may also be able to talk about your problems with a continence care charity or local support organisation.
Talking to a doctor
As a carer your role in a meeting with a healthcare professional is to support the one you care for, to give them courage, to help remember what was said and done, and to act as a chaperone during any physical examination that the doctor has to make. If you have any specific questions or concerns to raise with the doctor or continence advisor, discuss them with your loved one in advance and try to write them down before the appointment and take them with you – this will help make sure nothing is forgotten and will also help you bring up any tricky subjects.
During the initial meeting, your loved one will probably be asked to explain their bladder or bowel functions in some detail; this will help to identify their problems. It would be very useful to keep a ‘bladder diary’ for a week or so before the appointment to accurately record things such as how many times they go to the toilet, when they have any problems or accidents and what they eat or drink.
When they visit the doctor, they should be prepared talk honestly about their symptoms; try to explain if they are feeling any pain and explain the sensations they feel when they go to the toilet. Do they have problems with urgency? Do they need to go to the toilet often? Do they always make it to the toilet in time?
It might also be helpful to tell the doctor about how their problems affect quality of life. Does their problem affect their relationships and social life? Have the problems affected their work or career? Have their problems affected their mental health and levels of self- esteem? Do they feel depressed because of their problems?
What to expect?
The doctor or Healthcare professional will want to know the history of the problems and will also want a detailed explanation of the symptoms. They may then want to perform a physical examination to help evaluate the problems.
If the problems have been present for a long time, and especially if they have been having treatments and investigations for various other medical problems, then it is worth making a list of the main events in their medical history to discuss with the doctor. Write down when and how they first suffered each symptom, what was diagnosed and what was done e.g. investigations carried out, medication prescribed.
What next?
Once a diagnosis has been made and you know what is causing the bladder or bowel problem, you will be able to discuss possible treatments with the doctor or healthcare professional. They will explain what is causing the problem and how the different products or treatments can help. They will also talk to you about any side effects that can be caused by the different treatments. Together, you can decide which treatment is the most suitable.
In the first instance they are most likely to be offered what are known as conservative treatments, which include ways in which they can help themselves such as lifestyle changes e.g. diet and exercise. These will often be suggested in conjunction with products that will help manage the symptoms, such as Incontinence Pads.
Medication may also be offered as a further option, possibly alongside some conservative treatments, depending on the symptoms and medical history. Surgery is a further option and will not normally be considered until other treatments have been tried for a length of time without success.
Products and Treatments
There are many products, devices and treatments available to help manage bladder and bowel problems.
For those people who cannot be completely cured or those who may just need some extra help whilst waiting for treatment, there are a range of special products and devices to help manage symptoms. The most common way of managing continence is by using Continence Pads and you’ll find a wide selection of these on this website in the Continence Care section.
