Practical strategies for caring for someone with continence issues

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Continence assessment 

Caring for someone with continence issues can be very challenging. It is a good idea to get some professional support and advice to make it easier to manage. A continence assessment is very useful to find the best way to improve bladder and bowel function where possible, and to suggest the best way to manage any incontinence.

If incontinence pads or pants are needed it may be possible to apply for a subsidy to cover some of the costs. Contact us for more information as there are eligibility conditions that apply. 

Diet and fluids 

A good fluid intakewill assist in maintaining normal blood pressure and will avoid issues associated with concentrated urine (such as urinary tract infections and urinary urgency) and constipation. 

When the person you are caring for is reluctant to drink water try making it more palatable by adding a splash of fruit juice or cordial, ice block, mint, slices of fruit or cucumber. Icy poles, ice-cream, custard, jelly, soup and high fluid content fruit such as watermelon can also help to boost fluid intake.

Try and avoid constipation where possible by ensuring that you provide a varied diet that is rich in fruit and vegetables and your loved one is well hydrated. Encouraging physical activity such as walking can also be helpful if the person is able to safely walk around.

Often these things can be challenging to achieve, and laxatives may be required to treat constipation. The advice of your healthcare professional is important on choosing the most effective laxative. Some laxatives may cause issues such as stomach cramps, or may only be suitable if the person has a good fluid intake of around 8 cups of fluid per day.

Personal care –washing, bathing and toileting 

When assisting your loved one with washing and bathing using a gentle, soap free cleanser is best. Avoid using perfumed soaps and body washes as these can irritate delicate skin. Always wash the genital area starting at the front and then washing the anal area. This will reduce the risk of bacteria from the bowel being transferred to the urethra (bladder tube). This can be a problem for women as they are more prone to getting urinary tract infections, particularly infections caused by the spread of bowel bacteria which travel up the urethra and into the bladder.

Ensure that the area is gently dried using a soft towel. Avoid the use of talcum powder as this can irritate delicate skin.

If your loved one has lost awareness of when to go to the toilet prompting them to go at regular intervals (say every 2-4 hours) may help. It is not a good idea to toilet someone every hour as this can lead to the bladder becoming smaller (and therefore holding less), and can cause the person you are caring for to react by becoming resistant to frequent toileting.

It is often more effective to direct the person to the toilet by saying, “let’s go to the toilet now”, rather than ask the question “do you need to go to the toilet? “

If the person is confused or has dementia it is easier for them to respond automatically by answering “no” despite having a full bladder or needing to empty their bowels.

Flushable toilet wipes can make cleaning up after toileting easier. Only use those wipes designed to be flushed and avoid using too many as they can cause problems in sewerage systems.

Incontinence pads and pants 

Incontinence pads and pants can help to provide comfort, safety, and dignity for those who are unable to get to the toilet on time. Where possible toileting programs should continue. It is not recommended to tell someone “it’s OK, you don’t need to go to the toilet – you are wearing a pad – just wee in that.”

A continence assessment can help to work out if an incontinence product is needed and if so, provide advice on the best pad, pant or other incontinence aid for the individual and its application and use.

Modern pads and pull-up pants are specially designed to draw any wetness away from the skin, keeping the skin dry. This means if there has only been a small amount of urine loss, the same pad can be reapplied, until it begins to feel wet. If there is any faecal loss the pad must be changed immediately as faecal matter can be very irritating on the skin, and odours can occur.

Incontinence pads and pants can be disposed of in the general rubbish bin. Solid faecal matter should be flushed down the toilet if possible, and then the soiled pant or pant should be rolled up and sealed inside a plastic p bag. This will help to reduce odours. Some people will use scented rubbish bags or nappy bags when disposing of soiled pads.

Other incontinence and toileting aids 

Some people may benefit from using a hand-held urinal (there are male and female styles) if they are unable to reach the toilet in time, perhaps at night – time or if they are travelling.

Other aids and equipment like bed side commodes, raised toilet seats, or grab rails in the bathroom may also make toileting easier. Your doctor can organise a home assessment from an Aged Care Assessment Team to assess if there are any home modifications or equipment that be helpful. For younger people, a referral to an Occupational Therapist can be made to assess this.

Incontinence Product subsidies 

Purchasing incontinence products can be expensive, especially if they are not used correctly or if the wrong ones have been chosen. Please contact us for advice on selecting incontinence pads, and other products and for advice on subsidies that may be available. 

Contact us to organise Education & Training

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Kylie – parent of a child that wets the bed 

Kylie rang our service as she was concerned about her five-year-old daughter, Mia, who was wetting the bed. Kylie had tried limiting Mia’s drinks in the late afternoon and evening and was also getting up at night to wake Mia and take her to the toilet.

Our advisor explained that it may take children until they around 5 ½ years old before they gain bladder control during sleep. Kylie was advised to encourage Mia to drink well throughout the day and was cautioned against cutting out drinks in the afternoon and early evening. Kylie was discouraged from waking Mia at night to take her to the toilet. Kylie was provided with information on obtaining a referral from Mia’s doctor to a bedwetting clinic if Mia continues to wet the bed past 5 ½ years of age.

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Anastasiya’s story

“As a mum of two young children, I have experienced the joys of two pregnancies and postpartum recoveries. I was shocked after the birth of my first child to discover that my pelvic floor muscles had become weak. I sought advice from Bladder and Bowel Health Australia and learnt the importance of exercising these muscles. This knowledge helped, and because I was better informed second time around, I have now fully restored the dignity of my body and truly enjoyed the changes - and my motherhood. Thank you, Bladder and Bowel Health Australia, for informing young families about bladder and bowel health issues.” 

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Doreen – carer of her husband who has dementia 

Doreen was becoming exhausted caring for her husband Tom, who has dementia. Tom was not always making it to the toilet on time and needed his trousers to be changed several times a day. Every day Doreen was also washing bedlinen and the four towels that Tom was laying on at night as he was soaking through his pull-up pants. 

Tom was receiving a high-level Home Care Package, and Doreen was able to arrange with their provider for some of Tom’s package to be allocated to funding continence assessment and management.  

Our advisor went to Tom’s home and conducted a thorough continence assessment. A continence management plan was developed with input from Doreen, and appropriate incontinence aids and linen protection were organised. Doreen is relieved that Tom’s incontinence has reduced, and her washing load has lessened. Doreen is now confident that she can continue caring for Tom in their home. 

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Gary – experiencing leakage after his recent prostate surgery 

Gary met with one of our Bladder and Bowel Health advisors, as he was concerned about his urine leakage that was persisting after his radical prostatectomy five weeks earlier.   

Gary discussed his concerns with the advisor and was reassured that he was making good progress towards regaining bladder control. This reinforced the information he had received from his urologist. Gary was encouraged to switch to a smaller incontinence pad rather than continuing to wear the pull- up incontinence pants he had worn since his surgery. The advisor arranged some smaller pads for him to trial and provided details on where he could buy them close to his home. 

Gary was encouraged to drink plenty of fluid (particularly water) and to increase his fruit and vegetable intake to avoid constipation. Gary was uncertain if his pelvic floor muscles were working properly and he was referred to a pelvic floor physiotherapist. Gary left the clinic in a brighter frame of mind, confident that he was improving and had clear strategies to further support his recovery.