Incontinence Care: A Guide to Understanding Your Needs

To understand what it involves, and to work out whether or not you may need to consider incontinence care, we’ve put together this guide to answer any questions you may have. This guide will cover the following:

• What is Incontinence?
• What is Incontinence Care?
• What causes incontinence in the elderly?
• Is Incontinence a sign of dementia?
• Is incontinence a normal part of ageing?
• Living at home with incontinence
• What is nocturia?
• How to manage incontinence care at home
• How a carer can help you

Incontinence is the loss of bladder and bowel control that results in unwanted leakage of urine or faeces. Incontinence can be diagnosed by a medical professional with simple investigation and aims to be treated. In some cases, a cure may not be achievable but optimum management can alleviate embarrassment in social situations. There are two types of incontinence:

• Urinary incontinence
• Bowel incontinence

Urinary incontinence is a common condition that results from problems with the muscles or nerves that help the bladder control or release urine. Bowel incontinence is more common in elderly people and is a result of the loss of control of bowel movements. What is Incontinence Care? One of the roles of a carer may be to provide incontinence care to someone with urinary and/or bowel incontinence. Incontinence care can help provide some alleviation of responsibility, less anxiety and better management of incontinence for those people living with the condition. A carer can help to plan, prepare, manage and reassure someone with incontinence, leading to the individual having a better quality of life and a greater feeling of dignity.

What causes incontinence in the elderly?

Although urinary and bowel incontinence can be experienced by all ages, incontinence is usually more common in the elderly, with causes being related to factors such as:

• Overactive bladder muscles
• Weak pelvic floor muscles
• Damage to nerves that control the bladder
• Blockage from an enlarged prostate in men

Most urinary incontinence that occurs in men is related to the prostate gland. More women than men experience urinary incontinence due to pregnancy, childbirth and menopause increasing the risk of developing urinary incontinence. As we age, our bodies work less effectively, leaving us more prone to factors that can contribute to incontinence.

Is Incontinence a sign of dementia?

Incontinence is quite common in people living with dementia, as they lose the ability to react and remember things. This may result in the person not being able to recognise when they need to urinate, forgetting to go to the bathroom or not being able to find the toilet. However, incontinence is not a defining trait of dementia, so not all people who have dementia will develop incontinence. Caring for someone who does have dementia and incontinence can be challenging at times but an experienced carer will be able to recognise non-verbal cues such as tugging on clothing, restlessness, facial expressions, pacing and sudden silence that may indicate the need to use the toilet. A carer who has a good relationship with the cared-for individual will also learn individual patterns of behaviour and be able to support the person effectively.  Some helpful advice for incontinence carers:

1. Learn about the typical patterns of incontinence so that you can better plan for them. For instance, if an accident generally happens every 2 hours, help the person to go to the toilet before this time.
2. Avoid giving drinks that are caffeinated, such as coffee, tea and fizzy drinks, which can increase urination, but do not limit water.
3. Ensure the bathroom is clutter-free and a good quality working light is easily turned on.
4. Keep regular bathroom breaks.
5. Have a clean supply of underwear on hand for when accidents do happen.
6. Use absorbent underclothes for trips away from home.
7. Choose clothing that is easy to remove and clean.
8. Allow the person plenty of time in the bathroom, do not rush them.
9. It can be helpful to run water in the sink or bath to stimulate urination.

For those individuals with dementia, it may also be important to support the person with their communication around incontinence. They may use certain words that refer to their need to use the toilet or they may use non-verbal cues indicating that they want to use the bathroom. In addition, people with dementia can suffer from disorientation so they may need extra help with locating a toilet. It is important for a carer to be supportive in helping them find the toilet and to prevent any falls that can occur during the process (i.e. remove any rugs or mats and keeping the bathroom door open). Is incontinence a normal part of ageing? Ageing itself does not cause incontinence, however, there is an increase in the likelihood of incontinence over the age of 65. As we age our muscles can become weaker, which can cause us to have less control over our bladder and bowel movements. This means that about 1 in 10 people aged 65 years or older will have incontinence. There are some risk factors for people developing incontinence including:

• Having a urinary tract infection
• Being overweight
• Being pregnant
• Going through childbirth
• Menopause
• An enlarged prostate
• Certain medications
• Experiencing trauma that affects the nerves

Living at home with incontinence

Living with incontinence within your own home can sometimes be reassuring, as you are in a familiar environment where you likely have a routine to help you plan around incontinence. On the other hand, it can be difficult to manage by yourself, and you may find your life being negatively impacted by incontinence. Increasing concerns that others will find out or that an accident will occur can raise stress levels and affect overall wellbeing. Social isolation may occur if you do not feel capable of managing your incontinence outside of the home and exercise levels reduce, as incontinence can be more frequent during periods of activity. This may lead to a vicious cycle where less exercise means more weight is carried, which can worsen incontinence, leading to less exercise being carried out and increasing other health risks.

What is nocturia?

Nocturia is a lack of sleep due to an increased frequency for the need to urinate at night. It may lead to mental and physical fatigue and a greater risk of psychological morbidity. People who suffer from severe nocturia may get up five or six times during the night to go to the toilet. Trying to manage incontinence by yourself can be draining and challenging. Home care for incontinence can be a way of providing you with assistance in managing your incontinence, thereby reducing the stress and fatigue you may experience as a result of living with incontinence. A carer that comes into your home can help you cope better with incontinence. Carers are trained in managing incontinence and they can provide the time and empathy to help you. They can take away some of the stress around managing incontinence by yourself and they can help you to continue to enjoy your daily activities with less concern for incontinence. Incontinence services are often provided by NHS community teams that offer support, assessments, treatment and advice to individuals over 18 years of age who have bladder and or bowel problems. An incontinence service can also provide support to carers and families who may be helping an individual manage their incontinence.

When are urinary catheters used?

Urinary catheters are used in different situations when someone may have difficulty emptying their bladder. For instance, during surgery whilst under anaesthesia, you are unable to control the emptying of your bladder and therefore a catheter may be put in place. If you have a medical condition whereby you are unable to empty your bladder, then a catheter may also be used. In some cases, urinary catheters are only used temporarily, such as in surgery or when someone is in intensive care. In other cases, longer-term use may be necessary, such as when someone is too weak to make it to the bathroom frequently and in time or when there is an obstruction to the urinary tract, such as a bladder stone or swollen prostate gland.

This article goes into more detail about guide to catheter care so that you can learn more about them.

What medical conditions require a catheter?

Medical conditions that require a catheter can vary greatly and the type of catheter needed will also vary depending on the medical condition. For instance, medical conditions where the nerves controlling the bladder may be affected, such as spina bifida, multiple sclerosis or stroke may require long-term use of a urinary catheter. Other conditions where the person becomes less mobile or loses awareness may lead them to have a long-term catheter to support emptying of their bladder. Shorter-term catheter use may be implemented following surgery or to help people retrain their bladder control.

Types of urinary catheter

The two main types of urinary catheter are:

1. Indwelling catheter – this catheter is inserted through the urethra, into the bladder, but it can also be inserted through the stomach wall. It usually remains in place for some time, but is replaced regularly for hygiene purposes. Indwelling catheters can be drained into either a drainage bag or drained intermittently via a valve. A catheter valve can help keep the bladder in good shape and lessen the risk of infection or trauma to the bladder.

2. Intermittent catheter – this catheter is inserted through the urethra into the bladder to empty it each time that you need to drain urine. This is therefore done at similar intervals to those at which you would use the toilet to pass urine. Intermittent catheters do not interfere with a normal sexual relationship and they help reduce the risk of infection and damage that may occur if the bladder is not emptied adequately. There can be a risk of developing recurrent urine infections so it is a good idea to speak to a healthcare professional if this is occurring.

Can carers change catheters?

Catheter care at home can be managed by carers and usually, carers will have experience with doing this. A live-in carer for elderly people can be particularly used to managing catheters as it is more likely that elderly people have physical health problems that may lead them to use a catheter, such as incontinence. Elderly live-in carers are optimally placed so that they can manage a catheter when required.

If you have a carer that comes into the home at specified hours then they may not be available during the times when a catheter needs to be drained. Additionally, a live-in carer can get used to the routine of changing an individual’s catheter and build up a relationship with your loved one so that they feel reassured that they are in safe hands. Elderly live-in care is therefore a good option for those people who have either the indwelling or the intermittent catheter since each will either need to be changed regularly or drained regularly. A live-in carer can support your loved one with going out of the house whilst requiring a catheter so that they do not miss out on social occasions or events. A carer can also manage any concerns your loved one may have and they can help your loved one to adjust to living with a catheter.

How does incontinence care work?

Incontinence care involves supporting the person with incontinence to still live a fulfilling life where they can carry on doing activities that they enjoy. Caring for the elderly can naturally involve elements of incontinence care as the likelihood of experiencing incontinence can increase with age. Live-in home care can support someone with their incontinence by helping in several different ways. A carer can help your loved one to be prepared for situations that might arise when out and about. They can carry some spare underwear and pads or they may be able to help your loved one to locate a toilet in time. A carer can also help with keeping your loved one smelling fresh by helping them to clean and regularly changing pads. Hydration is key when looking after the body, including with incontinence care and so a carer can support your loved one to drink plenty of liquid each day and to avoid drinks that may irritate the bladder, such as coffee, alcohol, and too many sweeteners.

Care in the home may also include looking at what home adaptations might be helpful for someone with incontinence such as easy access to a bathroom and supportive handrails in the bathroom. If these adaptations are not possible, then the carer can be on hand to support when needed.

You can read more about our incontinence care services here.

How often do you need to give catheter care?

Home catheter care will vary depending on the type of catheter being used. An indwelling catheter should be changed around every 3 months and this can be performed by a doctor or nurse, although a carer can also be trained to do this. If the catheter has a drainage bag attached then this should be emptied when it is roughly ¾ full. The bag should be changed once or twice a week and an overnight bag, that is larger, should be used.

Our relative’s guide to live-in care is a guide for relatives wanting to get support from a live-in carer to help with things like catheter care.

How a carer can help you

An in-home carer can help you with various aspects of managing your incontinence. They can:

• Support you during the night
• Help you with getting on to the toilet
• Aid with locating the bathroom
• Help prepare for accidents when out and about
• Introduce and help with the use of disposable pads
• Help clean up after any accidents
• Help remind you of any beneficial lifestyle changes, such as reducing caffeinated drinks, exercising, doing pelvic floor muscle exercises, eating a healthy diet.
• They can remind you to take your medication
• They can help organise medical appointments if something arises
• Support you outside the house with incontinence
• Help you to plan ahead
• Help with catheter use, if needed
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How we can help

At The Live in Care Company we want to make the process of finding and choosing a carer straightforward – and that includes carers who is experienced and trained in supporting their client with incontinence care.

Our expert back office will be happy to speak to you and will take the time to understand your situation and your needs and will match you with a wonderful full-time live-in carer. You can speak to us by calling 0118 449 2373, filling in our contact form or emailing hello@theliveincarecompany.co.uk