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Acknowledging and coming to terms with continence problems

Part 2: Continence care at home

Emotional reaction to continence problems

People are often embarrassed to admit that they have continence problems. They may have concerns about their dignity and worry about what people would think if they knew. Some people face continence problems with resignation, perhaps thinking that it is normal for older people or for people with dementia to have continence problems or believe that nothing can be done. This is not the case.

Nevertheless, such concerns may make some people reluctant to seek help. Although continence problems are medical issues for which care, treatment and support are available, due to stigma and misunderstandings, many people do not seek help and experience a lower quality of life as a result. We hope that the following information will encourage you to take action to prevent continence problems from affecting your quality of life.


Part of the difficulty in acknowledging and coming to terms with continence problems is that for many people, incontinence is a stigma. Stigma is a socially constructed phenomenon involving stereotyping, loss of social status and discrimination. There is usually an element of fear involved and a tendency to consider people with the stigmatising attribute as being in a separate group, namely the “out group”.

Action box 1: Challenging the stigma of continence problems and dementia

Stigma is a societal issue which depends on the way certain issues (such as incontinence) are perceived. You can challenge such perceptions and any devaluation or discrimination of people with dementia and continence problems. The following statements may be helpful to consider:

  • A person may have dementia and/or continence problems but he or she is a whole and unique person with a history, relationships and place in society. Dementia and continence problems may have a considerable impact on a person’s life but that person should not be reduced to those problems,
  • Anyone can develop dementia or continence problems and people with such problems and those without are all part of the same society,
  • Having dementia and/or continence problems is not something to be ashamed of and does not make a person any less valuable,
  • Much can be done to help people with dementia retain continence and independence for as long as possible.

Considering signs of continence problems

People sometimes lack awareness that they have a problem with continence due to misunderstandings and cognitive difficulties linked to dementia. The list below provides details of some of the issues which might indicate a problem with continence, especially if a few occur together.

Action box 2: Becoming aware of continence problems

It is possible that you have continence problems if you notice any, but especially a combination, of the following (or if someone draws your attention to these):

  • You spend a long time in the toilet,
  • You have lower urinary tract symptoms (e.g. frequent urination, rushing to the toilet to urinate, itching and pain),
  • You get up to pass urine more frequently at night,
  • You use sanitary towels (for fear of “accidents”),
  • You hesitate to go out, particularly to unfamiliar places,
  • You are reluctant to eat or drink,
  • You sometimes vomit or have pain (this can happen with severe constipation),
  • You are using natural remedies (e.g. against diarrhoea or constipation),
  • You have soiled laundry/stained underwear and poor hygiene,
  • You are restless, agitated or anxious,
  • There are often wet patches or stains on furniture,
  • Soiled laundry and toilet paper are sometimes found  in strange places (perhaps hidden or forgotten),
  • There are unpleasant smells and a mess in the bathroom/toilet,
  • You are going to the toilet more or less than what is usual for you.

Taking action in case of suspected continence problems

There may be other explanations for some of the behaviours described above so it is important not to self-diagnose.  Moreover, as continence problems are not inevitable and as much can be done to help people with dementia retain continence and independence as long as possible, it is important to take action.

Action box 3: Taking action in case of suspected continence problems

  • Speak out and seek help when needed,
  • Insist on an assessment when experiencing continence problems. Talk to your GP about this,
  • Try to break the vicious circle of stigma by addressing continence problems in a pragmatic and direct manner. This may help others to do likewise.



Last Updated: Friday 20 February 2015