Essentials of incontinence care for the elderly

Discussing practical and emotional support for incontinence in older adults

Incontinence is a common problem for older adults, and requires a specific type of care that combines practical assistance and emotional support. Here, we are looking at why many older people experience incontinence, the causes and risk factors, signs that carers must watch out for, how incontinence can be diagnosed, treated and managed long-term, the emotional support that may be required, and information for family caregivers looking after a loved one. At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about incontinence care for older adults, we can help. 

What causes incontinence in older adults, and what types are there? 

There are several different types of urinary incontinence to be aware of:

1. Stress Incontinence – This is when urine leaks occur when the bladder is under pressure, such as when the person coughs or sneezes.
2. Urge Incontinence – This is when the person simply has a sudden urge to urinate that they cannot hold.
3. Overflow Incontinence – Otherwise known as chronic urinary retention, this is when leaks happen due to being unable to fully empty the bladder when urinating.
4. Total Incontinence – This is when the person is unable to hold urine at all, which means there is a constant leak.
5. Nocturia – This is when the person feels the need to get up multiple times at night to urinate.

There are also two types of bowel incontinence, and these are:

1. Urge Bowel Incontinence – This is a sudden urge to have a bowel movement, but being unable to reach a toilet in time.
2. Passive Incontinence/Passive Soiling – This type of bowel incontinence means the person will experience no sensation before soiling themselves, or they may release faecal matter when passing wind.

Some of the most common causes of incontinence in older adults include: 

• Weakened pelvic floor muscles or overactive bladder muscles
• Urinary tract infections (UTI)
• Vaginal infections (studies suggest women with bacterial vaginosis report more stress incontinence) 
• Constipation (you can read more about this in our guide to safely managing constipation in older adults)
• Pelvic organ prolapse
• Neurological disorders such as Parkinson’s
• Taking certain medications that cause incontinence as a side effect, such as some diuretics, antidepressants, hormone replacement therapy (HRT), and more
• Health conditions such as diabetes or prostate issues
• Mobility issues that make reaching the bathroom difficult

Cognitive decline (such as dementia) causing physical problems or a reduced ability to recognise the need to urinate or have a bowel movement

What are the treatment options for incontinence? 

If incontinence is the result of an underlying medical condition, a doctor will provide treatment options to address this. However, if incontinence is thought to be due to stress, weakened muscles or another cause, there are a few treatment options that could help to minimise this: 

• Bladder Training – This can be done with the help of a specialised doctor, and involves gradually increasing the time between bathroom visits in order to improve bladder control.
• Pelvic Floor Exercises – Strengthening the muscles of the pelvic floor can make a difference to the amount of control a person has when urinating, and this can be done through Kegel exercises. Kegel exercises are repeated flexing of the pelvic floor muscles to strengthen them, which supports the uterus, bladder, small intestine and rectum. 
• Medications – A doctor can sometimes prescribe certain medications to help relax the bladder or tighten sphincter muscles to provide more control over leaks. Some medications for an overactive bladder have beenlinked to an increased risk of cognitive impairment in older adults, so speak to your doctor about the risks of this as they may wish to do periodic checks for any side effects. 
• Device insertion – In severe cases of incontinence, intermittent or permanent catheters, urethra inserts orpessaries can be inserted to support the bladder and help manage incontinence.
• Surgery – If incontinence is a particularly bad issue for someone, surgery is also an option. This might be a sling procedure or a colposuspension to lift the neck of your bladder and reduce incontinence issues.
• Botox Injections – Sometimes botox injections can be offered to reduce muscle spasms that lead to incontinence, and to alleviate an overactive bladder. Studies have found 75% of women who receive this treatment find it helps with incontinence, as well as night time incontinence symptoms. 
• Nerve Stimulation Therapy – In some cases, a small device can be implanted to stimulate the nerves that control the bladder, providing increased control.

What are the signs of incontinence in older people, and how do you spot it?

If you are caring for an older adult, it is important to recognise the signs of incontinence so you can assist them where needed and encourage them to seek medical advice. Some of the obvious signs of incontinence in older adults include:

• Frequent trips to the bathroom
• Damp clothing or bedding
• An unusual odour of urine or faeces
• Skin irritation, rashes or sores near the genitals 
• Avoidance of social activities or becoming more withdrawn
• Expressing anxiety about leaving the house

To spot incontinence early, caregivers must pay close attention to the above physical and behavioural signs, and monitor their bathroom habits to determine how often they need to go. Remember, gentle and open communication is important when discussing this, as older adults may feel embarrassed or reluctant to talk about their needs, and try to hide it. 

What are the best ways to manage incontinence issues? 

Managing incontinence on a long-term basis may require a combination of lifestyle adjustments and supportive measures to avoid any embarrassment or complications. Here are some of the best ways that older adults and their caregivers can manage this: 

• Lifestyle Changes – Some lifestyle changes can make a difference to the intensity or frequency of incontinence issues, such as maintaining routines and planning out toilet stops, avoiding caffeinated drinks that can increase the need to urinate, avoiding acidic foods or alcohol, avoiding lifting heavy objects, and maintaining a healthy weight in order to reduce bladder pressure. 
• Managing Water Intake – Often people who suffer from incontinence will limit their fluid intake in order to avoid leaks. While you can manage the timing of your water intake to fit around important events in your day (such as being out somewhere with limited bathroom access), you should not stop drinking fluids entirely as this can cause dehydration, and could decrease bladder capacity and worsen the issue. It is recommended to drink 6-8 glasses of fluid a day unless a doctor tells you otherwise.
• Using Absorbent or Protective Garments – It can help to wear absorbent pants or pads that can soak up any urine quickly and avoid leaks onto furniture or clothing. Depending on how bad your incontinence is, there are different types of pads available in a variety of thicknesses, so you can choose what is right for you. You can also use bed protectors, chair protectors and other absorbent options to avoid leaks and give you extra time to make it to a bathroom. These products are available online or in some shops, or you may be able to access them through the NHS – speak to your doctor about what you may be entitled to. 
• Eating a Healthy Diet – If you suffer from bowel incontinence, it can help to eat a high-fibre diet. This can prevent constipation, which can exacerbate incontinence. You can read more about this in our guides to safely managing elderly constipation and the best supplements and vitamins for older adults.
• Choosing the Appropriate Clothing – Certain types of clothing can help to make any leaks more discreet, such as loose fitting garments, darker colours and layers that can cover any wet patches if accidents occur outside of the home. 
• Managing Skincare – With incontinence issues, skincare is an important factor to consider as leaving urine or faeces on skin for a long time can lead to rashes, irritation and infections. Prompt and proper cleaning of the area, using appropriate products to ensure hygiene, and changing clothes are all vital to avoid this. 
• Apply for a ‘Just Can’t Wait’ Card – If you suffer from incontinence and feel worried about leaving the house, you can apply for a ‘Just Can’t Wait’ card in the UK. This is a physical card you can show when out and about to access a toilet if you need it quickly. If there are public toilets, this gives you something to show in order to move to the front of the queue. Or, if there are no public toilets, the card is widely recognised in venues, so you may be able to show it to cafes, shops or restaurants who should allow you to use their toilet, or staff-only toilet if needed. You can learn more and request your card through Bladder and Bowel UK. 

How can I support a loved one who is struggling with incontinence? 

Incontinence can be emotionally difficult for an older adult who relies on a caregiver for help getting to and from a bathroom, or for changing after a leak. A level of empathy and reassurance is needed to put them at ease. Try to make sure they know that incontinence is a common problem for their age group, and nothing to be ashamed of. Avoid showing judgement or frustration, as this will undoubtedly increase their anxiety and discourage them from telling you when they have had an accident in future. Encourage them to be open about how they feel and seek a doctor’s appointment to determine whether or not there is an underlying medical condition. As well as offering practical help such as assisting with medical appointments or finding solutions like incontinence products, providing the necessary emotional support can ensure they feel empowered to discuss their needs in a positive and supportive environment. Although you may not be able to stop them from experiencing incontinence issues, you can significantly improve their quality of life by doing what you can to reduce their anxiety, embarrassment, frustration and low mood. Encouraging them to drink a good amount of the right fluids is beneficial, avoiding fizzy drinks and caffeine as much as possible.

How can a home carer help with incontinence issues? 

A home carer can be incredibly helpful for older adults with incontinence issues, as many of them may prefer to have a professional carer handle leaks rather than their loved ones. By providing emotional and practical assistance to manage incontinence, seeking further medical help, and cleaning up any leaks, home carers can be a vital support to older adults going through this. A home carer might be able to help by:

• Maintaining a regular bathroom schedule to prevent accidents and ensure hygiene
• Changing and cleaning if accidents occur
• Ensuring skin is clean to avoid irritation
• Supplying and managing incontinence products like pads or protective underwear, and providing education so they can be used independently if able 
• Providing encouragement and reminders to do pelvic floor exercises or bladder training if required 
• Supporting a healthy diet and fluid intake, which may help them to manage symptoms
• Providing emotional support during times when they feel embarrassed or anxious 
• Promoting dignity while managing incontinence issues, by ensuring the person’s comfort and confidence at all times 

Home care can be offered in the form of occasional visits from a home carer, regular visits, or a live-in carer if the person needs more frequent assistance with incontinence issues. If you feel you or a loved one could benefit from support from a home care professional to help with personal care, you can get in touch with your local Home Instead office to learn more, or read our guide for everything you need to know about how to choose and arrange home care services.Our Care Professionals are the best of the best, and highly trained to deliver the services you need. No matter what type of home care you are looking for, we can provide a tailored service that suits you or your loved one.We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.