Management of continence problems
Part 2: Continence care at home
General issues linked to continence problems and care
Once a type of incontinence or continence problem has been identified, your doctor may draw up or organise a coordinated care plan involving all health and social care professionals (including allied professionals), as well as you and your informal carers. Ideally, there should be one person with overall responsibility for coordinating the care you might need. In the next section, we will focus on lifestyle measures, environmental changes and behavioural measures. Medical treatment and surgery are equally important and depending on individual needs and wishes may be indicated. This should be discussed with a doctor who has experience in both dementia and continence problems.
Environmental changes and lifestyle measures
Promoting easy access to a toilet
An important aspect of managing continence problems is to adapt the living environment so as to maximise your possibility of reaching the toilet in time and being able to use the toilet.
Action box 5: Making it easier to reach and use the toilet at home
- Eliminate obstacles which make it difficult for you to reach the toilet in time,
- Reorganise your living area so that the bathroom is not too far away,
- Cover or remove mirrors in the bathroom if you find them disturbing,
- Make the toilet door recognisable by putting a sign on it,
- Put a sign on the inside of the door to remind you where you are,
- Get a coloured toilet seat to provide a clear contrast to the toilet pan,
- Dye the toilet water blue (this can help men aim when urinating).
Maintaining mobility outside the home
Continence problems sometimes make people reluctant to leave their home and this can limit social life, lead to increased dependency and have a negative impact on quality of life. Often, people are concerned that they will not be able to find a public toilet when needed.
Action box 6: Planning for trips outside the home
Find out about:
- a special key which unlocks all public toilets for disabled people (those which are kept locked). Disabled toilets usually have a wash basin and enough room to get washed, change clothes and for someone to accompany you if needed,
- a public toilet finding device(e.g. an APP on a mobile phone) or a “toilet map” (some town councils have these; they show where all the public toilets are),
- an incontinence card (available in some countries) which facilitates access to toilets which are not open to the general public (see below for example).
Prepare a small travel bag so that you can change a continence pad discretely whilst out or clean yourself after a possible accident. This might, for example, contain a change of clothes, pads, hand wash gel, wet wipes and plastic bags.
The above three services are available in the UK. For further information, see: http://www.disabilityrightsuk.org/news/2013/may/bbc-ouch-article-praises-radar-key. Check with your social services department, health care provider or disability organisation if something similar exists in your country.
The above card is reproduced with kind permission of the UK-based Bladder and Bowel Foundation. See http://www.bladderandbowelfoundation.org/resources/toilet-card.asp and also their webpage “travelling with confidence” at http://www.bladderandbowelfoundation.org/bladder/bladder-problems/travelling-with-confidence.asp.
Using containment products, assistive technology and products to enhance independence, safety and mobility
There are several ways to manage continence problems. One of these is through the use of continence products, especially those designed to prevent or contain incontinence. The aim of such products is to keep people independent from the care of others and to secure independence with maximum dignity for as long as possible.
Assistive technology (AT) and other products are also available which are designed to promote independence, safety and mobility and may contribute towards maintaining continence.
Action box 7: Consider how various products might be helpful in managing your continence problems
Ask your health and social care providers about containment products, assistive technology and products to promote independent toileting, safety and mobility.
Examples of containment products include the following:
- Handheld urinals,
- Commodes and bedpans,
- Absorbent products (such as insert pads, diapers, pull-ups and male pouches),
- Body-worn urinals (in particular sheaths for men),
- Urine drainage bags (worn on the leg or body, or hooked to a stand),
- Catheters (indwelling catheters should not be the first or long-term choice),
- Occlusive devices (to block/prevent leakage or to compress the penis),
- Plugs to prevent leakage of faeces,
- Devices to channel faeces into a container,
- Pads to contain faeces.
Examples of assistive technology and devices to promote mobility, safety and independence include:
- Devices for carers to detect moisture or movement,
- Devices to light up certain areas in the home automatically,
- Devices to signal for assistance,
- Hoists and equipment to facilitate lifting,
- Mobility aids,
- Raised toilet seats as well as seats for the bath or shower.
People with dementia may at some point have difficulty placing orders for containment products, ensuring that they always have a sufficient stock and deciding whether and if so which kinds of assistance might be beneficial. Assistance from health and social care professionals, as well as informal carers, may be needed.
It may also be difficult to determine which type and size of containment product is best suited to a person´s needs. Advice from a health or social care professional with knowledge about such products and also about dementia might be needed.
Monitoring food and drink intake
Adequate and appropriate food and drink play a role in the management of continence problems.
Action box 8: Paying attention to food and drink
- Make sure that you have enough fluids in your diet. Fluid intake is important in relation to both urinary and faecal incontinence,
- Do not restrict drinks as a means to prevent incontinence as this can be dangerous but limit drinks two hours before sleeping,
- Eat plenty of fibre (e.g. whole grains, bran, raw fruit and vegetables). This is particularly important to manage faecal incontinence.
When a person experiences continence problems, it is especially important to establish general routines for hygiene and skin protection. This may require the help of other people.
Action Box 9: Taking measures to maintain good hygiene
- Put on clean underwear every day,
- Try to use gentle cleansers (avoiding soap if possible) and avoid prolonged wetness and skin contact with urine or faeces,
- Consider using skin cleansers rather than soap, and wash mousse and wash gloves which are very skin friendly,
- Keep your skin moisturized and apply a skin protection or moisture barrier,
- If used, change continence pads and protective underwear regularly,
- Ensure the correct pad is used (the level of absorbency is important),
- Regularly check your skin for possible damage, irritations or chaffing,
- Avoid douching unless instructed to do so by a healthcare professional,
- When wiping around the anus, wipe from front to back to limit the risk of infection in other areas,
- At least once a day, and always after urinary or faecal incontinence, wash the perineal area (area between the anus and either the vulva or scrotum),
- To avoid damage to the skin in this delicate area, use warm water, a mild, unscented soap and pat dry. Do not rub or apply powder,
- Avoid scented toilet tissue,
- Report any foul smell, itching or bleeding to a doctor.
- Drink plenty of water to keep your urine less concentrated and your skin well hydrated.
Some people need to go to the toilet at roughly the same time of day or a certain time after eating or drinking. Others are less “predictable”. However, most people, regardless of whether they have dementia, need to go to the toilet 4-6 times over 24 hours, and once at night if they are over the age of 60.
Often, people with dementia do not recognize the signal that they need to go to the toilet, cannot react quickly enough or only realize when it is too late. Some measures have been developed to help address these problems and try to minimize the occurrence of accidents. There is conflicting evidence about their usefulness for people with dementia and some people with dementia need assistance to benefit fully from them. However, they can sometimes be helpful.
Action box 10: Ask your health or social care provider if any of the following might help in the management of your continence problem
- Timed voiding,
- Prompted voiding,
- Bladder retraining,
- Habit retraining,
- Pelvic floor muscle training,
- Keeping a bladder diary (recording liquid intake and urine output, including frequency, amount, urgency, accidents and circumstances surrounding any accidents).
Last Updated: Friday 20 February 2015