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Incontinence: How Family Caregivers Can Help Manage This Common Health Issue

Treatment, advice and products to help reduce accidents and preserve a loved one's dignity

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Incontinence. It may not be the single most difficult condition to live with but if you’re caring for a loved one — mother, father, husband, wife — who has urinary incontinence (UI) or bowel incontinence (BI) it may be one of the most challenging due to the social stigma that surrounds it. 

Research from the National Health and Nutrition Examination Survey suggests that 62 percent of women in the U.S. live with UI and yet less than half seek treatment; those who do hold off for up to a year from the onset of symptoms. Men hold off even longer, according to a report in the journal Urology. Why? Quite simply, they’re too embarrassed to talk about it. The same is likely true of the seven to 15 percent of adults in the U.S. with BI, but no one can say for sure because many never discuss it.

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​“Incontinence involves private and intimate acts of how we live, so for many people there’s a lot of shame about the loss of control,” explains Rotimi Nettey, M.D., assistant professor of urology at Baylor College of Medicine. How can you help someone with a condition they’re too embarrassed to admit they have? A good starting place: Let them know they are far from alone.

Hygiene 101

“One key challenge with UI and BI is proper hygiene,” says AARP family caregiving expert Amy Goyer.  “Keeping skin clean and preventing sores and infection is critical.”  Things to keep in mind when assisting a loved one with toileting:

  • Fit pads and absorbent wear close to body to avoid leaks,
  • Always wipe from front to back,
  • If using a bidet, ensure water flows appropriately (again, front to back),
  • Change pads frequently for UI and immediately after BI,
  • Use cleansers and wipes that are gentle and moisturizing and made for incontinence like Aloe Vesta Perineal/Skin Cleanser, Peri-Fresh and No-Rinse Peri-Wash; avoid products with perfume,
  • Apply barrier cream like Lantiseptic, Thera Calazinc Body Shield or Calmoseptine to protect skin from irritation and breakdown. If sores develop, consult a healthcare professional to prevent infection.

“Incontinence is not only exceptionally common, but there are good treatment options available depending on the specific reason for the incontinence,” says Gregory Amend, M.D., assistant professor of urology at Icahn School of Medicine at Mount Sinai. “It is mistaken for being an accepted part of the aging process because it can be associated with many factors commonly seen in both men and women as we age. As a result, we confuse the fact that though commonplace, it is not considered to be expected or normal,” he says. What’s more, there are plenty of over-the-counter products to help your loved one live with the condition, not just in spite of it.

When to seek the help of a physician

Simply put, incontinence is the loss of bladder control or bowel control. Once you realize your loved has the condition and see that their symptoms have begun to interfere with their quality of life — particularly on a social or sexual level — it’s time for them to see their health care provider. Incontinence may be the sign of a more serious medical condition. “It’s time to see a specialist when the psychosocial impacts of incontinence become bothersome, or if the incontinence is associated with blood in the urine, urinary tract infections, passing of urinary stones, issues with urination or changes in routine blood work that assesses kidney function,” says Amend.

Ways to manage incontinence

Once you’ve ruled out a medical condition, there are plenty of behavioral and lifestyle tweaks that go a long way in helping manage the condition. Those include:

Avoiding dietary irritants. It’s important to know what’s triggering your loved one’s sudden trips to the bathroom. Some are obvious (coffee, tea, soda) and some not so obvious (chocolate, wine, artificial sweeteners). Encourage them to keep a diary for several days to determine any patterns. Do they rush to the bathroom every time they have a diet soft drink? Do they have an accident after their morning orange juice? Once you identify the culprits, try eliminating them and see if it makes a difference. You can download this log from the National Association for Continence (NAFC).

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​Another way to measure the amount of liquids consumed by your loved one to see which dietary items may be causing excessive urination: Use a toilet hat, suggests Harvey Winkler, M.D., system chief for urogynecology at Northwell Health. “It’s a cheap, easy way to measure urine,” he says. You simply hang the device on the inside of the toilet so that it can catch urine. “Those are very helpful to understand what’s going on,” he says. “Otherwise, the caretaker doesn’t know how much the person is drinking and what’s going out.”

Drink plenty of water. A study published in SAGE Open Nursing found that up to 40 percent of people over age 65 may be chronically underhydrated. Part of that is because appetite and thirst tend to diminish with age and part of it is due to certain medications that increase dehydration risk. In any case, staying hydrated is not only essential for overall health, it’s especially important to bladder health. When you drink too little, what urine you do produce becomes concentrated, and that can irritate your bladder and make you go more frequently, according to the NAFC. In any case, it’s a good idea to stop drinking two to three hours before bedtime to reduce the number of nighttime trips to the bathroom, says Winkler.

Schedule trips to the bathroom. “Timed voiding” — a fixed schedule for going to the bathroom — “is a good way to keep the patient dry and reduce incontinence episodes,” says Winkler. “If they go to the bathroom every two hours, it keeps the bladder empty.”

Useful products and supplies

Depending on how well lifestyle and behavioral tweaks work, your loved one may need to wear an absorbent product. They won’t be alone. A 2021 survey of people with incontinence by the NAFC found that the majority of respondents — both men and women — reported wearing absorbent products all the time, day and night. “It takes some trial and error to find the one that best suits your needs,” says Amend, echoing the NAFC survey results, which found that many of the respondents tried seven or more products before finding one that works.

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Where to begin?

“Look for the level of absorbency, whether it offers daytime or nighttime protection, and whether it is disposable or reusable,” says Amend. “People tend to seek more absorbent products for the night to prevent disruptions in sleep. During the day, you may opt for light-coverage products for mobility and ease of use. There are also options that can be re-worn upon washing or disposed of after a single use.” Some caregivers find it helpful to layer personal absorbent products (a pad inside disposable briefs) and bed protection products (waterproof sheets, mattress covers and washable bed pads) for maximum protection against overnight leaks.

To navigate the seemingly endless options, consider function, form and fit. In other words, discuss with your loved one how and when they anticipate using the product, which style they’d liked to try (pad or panty liner for women, male guard for men, thicker pad, incontinence briefs) and what size they need. Then try lots of brands and styles until you find one that works best for the person in your care. According to the NAFC, many mail order services offer sample packs to make it easier (and less expensive) to test different products and most of them also have consultants on hand to walk you through selecting something that will be right for the wearer. Poise and Depends are popular options, says Winkler, but they’re not the only ones.

If your loved one is bedbound or finds they’re having multiple UI episodes during the night, they might consider using an external catheter while they sleep, suggests Nettey. Research published in 2022 in the Canadian Journal of Urology found that those who used the PureWick system, which uses a low-pressure suction to wick urine from an external catheter into a collection canister, were able to manage their condition more easily than with incontinence briefs. “It keeps the area dry and minimizes infections,” says Nettey. “It’s a game changer, especially for those who are bedbound.”

Make home safe and accessible

It’s also important to outfit the home to minimize accidents. For example, people who wake during the night because they have to pee (a condition called nocturia) or overactive bladder are especially susceptible to falling in an effort to get to the toilet fast. Be sure to clear a path to bathroom. Make sure the rugs in the house and bathroom are padded underneath to avoid slipping. Look at installing handrails or a raised toilet if you think your loved one could benefit from extra stability and easier access. Keep a nightlight in the bathroom. And encourage clothing that is easy to unfasten and remove.

For those who are bedbound or have mobility issues, consider a bedside commode (for women) or a urinal (for men). 

Where to find all of the above? Consider ordering online for a couple of reasons: Not only does there tend to be a better selection online, but you can shop with discretion, whether it’s on Amazon or one of the NAFC-vetted companies that can ship directly to you.  

How to Talk About Incontinence

​Your loved one is still living independently in practically all aspects. But lately you’ve noticed they’re rushing to the bathroom more often than they used to or maybe they’re waking multiple times throughout the night with a sudden urge to go — so sudden, in fact, they often don’t get to the bathroom in time.

What you also can’t help but notice: They aren’t talking about what is clearly a threat to their quality of life and quite possibly their overall health. Should you bring it up? In a word: Absolutely, say experts. But that’s not to suggest it’s an easy conversation to have.​​ “Many individuals with these issues are guarded and ashamed,” says Amend. “Asking questions that allow them to explain, in their own words, their life experience and concerns can help them to open up.”

Find some quiet time when it’s just you and your loved one. If it helps, imagine how you’d want to be approached if the roles were reversed. Try short, open-ended questions along the lines of: Do you ever have difficulty making it to the bathroom on time? How is that affecting your quality of life? What are your thoughts about seeking help from a specialist? Do you think maybe a pad or some other protection might help?

​Reassure them that they aren’t alone. And “emphasize that these are treatable conditions,” adds Nettey. “They’re not rare.”  

Video: Managing Incontinence

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