Charmaine Champ is a Queen’s Award-winning Registered Nurse in Learning Disability (RNLD) and Continence, Sleep and Understanding Behaviour/Emotions Consultant with over 30 years’ experience working with people facing continence issues.
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How To Care For Someone Living With Incontinence
Whether you’re looking after a loved one at home or caring for patients at work, caring for someone living with incontinence can be challenging but so rewarding.
As a child, you never imagine that, one day, you may care for an incontinent parent. That responsibility may feel like a role reversal – redefining a relationship where you were previously the dependent.
Meanwhile, for those helping to manage continence care in residential or nursing homes, the practical considerations may feel overwhelming – particularly around hygiene, dignity, comfort and the fear of doing things “wrong” in a highly regulated environment.
Experiencing leaks may feel embarrassing, shameful or frightening, and can be physically unpleasant or triggering for others to see and manage.
As a nurse, I recommend that you firstly acknowledge uncomfortable feelings on all sides and accept there is no “right” or “wrong” way to feel about caring for the incontinent elderly. These thoughts and feelings are natural, and do not indicate a lack of love or professionalism.
The best way to care for someone living with incontinence is to lead with compassion – both for yourself and your parent, client or patient.
Understanding The Challenges Of Incontinence Care
Incontinence isn’t something we should assume goes hand in hand with older age.
In fact, incontinence can affect any of us at any time. NHS guidance published in 2018 cited research suggesting 14 million people in the UK experience some degree of leaks, with more than 500,000 adults having regular bowel leaks that impact their quality of life.
Our role as carers is to encourage open conversation and promote independence wherever possible. Crucially, we must recognise that our parent is still our parent, and our client/patient is still an individual requiring a holistic approach. Toileting needs are a practical consideration, not a label or an identifier. Everyone has the right to an identity beyond their continence capacity.
How To Support Someone Living With Incontinence
Continence challenges arise for many reasons, from medication side effects to urinary tract infections and even illness. Unfortunately, it’s not uncommon for all of these challenges to also bring shame for the person experiencing them.
When raising the topic of incontinence, an indirect approach focused around noticing changes can feel less confrontational. For example: “I’ve noticed you seemed worried about where the toilet was at the garden centre today. Was that because you were worried about getting there in time?”
If toileting challenges surface, avoid childlike or judgemental words and normalise the situation: “It might be worth mentioning it to the GP. They are used to this sort of thing and can help.”
Acknowledge potential discomfort in a gentle way (“I know it’s a bit personal”); then keep the conversation solutions-focused: “There are many products that can help. Would you like me to look into them for you?”
Creating A Comfortable Home Care Routine
Carrying out home care for incontinence is best done with a calm, consistent routine, selecting the right products to maintain comfort, hygiene and dignity.
Gentle Cleansing Matters
Wet wipes, dry wipes or gloves, designed specifically for intimate areas, are best for gentle cleansing. Fragrance-free, dermatologically tested products are recommended where allergies are a concern.
Before carrying out any cleaning, remember that consent is crucial. Explain what you plan to do, ask for permission and offer reassurance where necessary – being prepared to stop if the person experiences discomfort or pain.
To help guide you through helping to clean your loved ones, here are some tips from my experience:
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Lead with dignity by offering to cover exposed body parts so that only the area requiring cleansing remains visible
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Clean front to back to reduce the likelihood of infection caused by transference from the bowel
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A light touch is essential, as thinning skin can easily tear, and rough handling can feel dehumanising
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Your wellbeing also matters. Disposable gloves and aprons should be used, alongside facemasks where necessary
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Dispose all cleaning and incontinence products in line with the manufacturers’ recommendations
Protecting Delicate Skin
According to the National Institutes of Health, the top layer of skin decreases in thickness by 6.4% every decade. Incontinence accidents can accelerate this process, alongside greater risk of pressure sores or ulcers.
Incontinence products, such as barrier creams leave a protective layer on delicate skin can help prevent irritation caused by friction, dryness and moisture-related skin damage caused by leaks. A gentle rinse-free, vitamins-enriched cleansing foam can also help to nourish the skin.
Choosing The Right Protection
As carers, we may assume we “know best”, but however well-intentioned your suggestions are, it’s important to encourage the person who will be wearing the products to lead on decision-making. Read product descriptions together for a summary of key benefits and purchase single packs to test before committing to larger orders.
The right incontinence product is the one that balances comfort and fit, while meeting the wearer’s practical needs, such as absorbency.
From a discreet liner for light leaks through to a belted slip for heavier needs, there are options for every situation. These include fixation pants, designed to hold disposable incontinence pads in place, to washable incontinence pants with built-in protection. Products are generally categorised by male, female or unisex anatomy, size and absorbency level.
When looking at incontinence products for the first time, it can help to shop by category and to use filters to narrow the options – making it easier to find products that best suit your parent, client or patient’s needs.
My nurse’s recommendations include:
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Consider the type of underwear they usually prefer. Choosing a similar style can make the transition feel more natural and comfortable.
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Think about the style of outerwear they favour. Close-fitting garments may suit discreet, low-profile liners whereas looser clothing can help conceal larger products such as adult nappies.
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Belted fixation pants can be ideal for people who may move around frequently, as they help keep the product securely in place.
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Access to laundry facilities and disposal protocols are important considerations when deciding between washable products or disposable products.
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Choose an absorbency rating one degree higher than needed. This helps to build confidence in effectiveness, and it is often easier to scale down than up.
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Monitor the product for absorbency, comfort and bulkiness for a minimum of 48 hours – changing as is required – to make a more informed decision.
Managing Night-Time Care & Sleep Disruption
When we sleep, all the muscles in our body relax – including the bladder, since it is also a muscle. For people with incontinence or weakened pelvic floor muscles, bladder control may be reduced, which can sometimes lead to leaks.
To help reduce the risk of disruptive night-time leaks, my nurse’s recommendations include:
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Avoid drinks in the hour before bedtime
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Empty the whole bladder (wherever possible)
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Remove trip hazards between the bed and bathroom
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Install a commode or keep a portable urinal nearby
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Choose nightwear without waist fastenings
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Upgrade to a waterproof mattress/mattress protector; waterproof duvet/duvet protector; and a waterproof pillow/pillow protector
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Use disposable or washable bed pads – especially with a bed partner
Incontinence products specifically designed for night-time, with larger absorbency capabilities, are essential for a dryer, more restful night’s sleep.
When To Seek Additional Support
Managing incontinence or caring for someone who is experiencing leaks is best approached with professional support. Involving a GP or specialist can help identify whether leaks are an indicator of other underlying health conditions requiring investigation or treatment.
Persistent rashes and skin damage that do not improve with topical treatment or gentle cleansing routines should always be investigated further by a healthcare professional.
Equally important is to make time for you – whether that’s 10 minutes with a warm drink or a longer shower to unwind. If you feel low-mooded or overwhelmed, speak to a healthcare professional or support service about available help.
Charmaine’s Closing Thoughts: The Small Things Make The Biggest Difference
The calmer and more patient you are, the better it is for the person you are caring for. There are days when someone will have an accident immediately after being cleaned and changed – and as a tired, stressed human being, it’s only natural to feel frustrated.
Reacting unkindly, however, only reinforces embarrassment and shame – making the person more likely to try to ‘hold on’ or avoid asking for help in the future. No-one wants to feel like a burden, so please reinforce that it’s OK.
Lastly, try to have a relationship outside continence care.
With some planning, it’s still possible to go out, make memories and experience moments of joy and normality.
Incontinence does not limit love, connection or dignity. It reminds us that we are having deeply human experiences, and of the difference we can make by caring for each other through every stage of life.
