CONTINENCE CARE FOR OLDER PEOPLE

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1 FACTSHEET 23 CONTINENCE CARE FOR OLDER PEOPLE The aim of this factsheet is to provide information for people suffering from incontinence and to those caring for them. Going to the toilet is, like eating and sleeping, something we all have to do regularly. However, it is something which many of us avoid talking about. If someone has problems controlling their bowel or bladder it is not surprising that they may wish to keep it to themselves. Incontinence suggests loss of control and independence, yet many people suffer from it. Because it is a taboo subject they may not be getting all the help that is available. It is estimated that 1 in 12 people in Great Britain experience some form of incontinence. Many health professionals feel this figure is just the tip of the iceberg. Because incontinence is a very sensitive subject, causing a great deal of unnecessary embarrassment, there may be many people suffering in silence. 1

2 This factsheet has the following sections: 1. What is incontinence? 2. Types of incontinence 3. What help is available and where can I get it? 4. Help in residential care and nursing homes 5. Further advice and information 1 What is incontinence? Incontinence is not an inevitable result of getting older. However, certain age changes do occur in the nervous system, kidneys, bladder and urethra which can make older people more vulnerable to developing incontinence. To understand incontinence we need to understand being incontinent actually means. To be continent This is knowing when you need to go to the toilet and being able to 'hold' until you get to a toilet at the right time. Incontinence This is when you pass urine or faeces when you do not want to or when it is socially unacceptable to. Many things can cause incontinence. For example, a disease or trauma that has affected your central nervous system, weak bladder muscles a disease or disorder that has affected your bladder or other related organs, drugs with certain side effects, hormonal changes in your body. It is important to understand the difference between wetting or soiling that is 2

3 caused because you do not know when you need to go to the toilet or you can not control your bladder or bowels because of a disease, disability or illness, and wetting or soiling because you can not get to a toilet in time. It is very important that those who have problems with continence and those looking after them, understand the difference between the two. Some types of incontinence can be cured, others can not. With good advice and a change in your routine you may be able to manage your continence or take positive steps to reduce the effects of incontinence. How to identify incontinence It is worth keeping a chart to assess the type of incontinence you have. Many care homes do this for their residents and with a simple checklist it is possible for a carer or yourself to get some idea of your body's pattern for dispelling waste. A chart is a good starting way to get to know how this part of your body works and so get an idea about the type of help you need and the changes that may be made in your daily routine that might make your condition better. 2 Types of incontinence Stress incontinence This is when you leak urine when you laugh, cough or sneeze. More women than men suffer from this type of incontinence. It is caused by muscles surrounding the base of the bladder being weak. It is possible to strengthen these muscles (pelvic floor muscles) by doing exercises. A doctor or continence advisor can give advice about these or other possible sources of help. Your GP may refer you to a gynaecologist as a simple operation can sometimes help. Frequency incontinence You may find that you need to go to the toilet more often than normal. This can be caused by a number conditions and therefore, if the condition persists, you should discuss the matter with your GP. Urge incontinence This is a strong desire to go to the toilet, which you cannot ignore. It may be caused by an infection and you should talk to your GP about it. If your incontinence is not caused by an infection you may be advised to do 'bladder training'. Bladder training is simply where you attempt to increase the length of time between each time you go to the toilet. 3

4 Dribbling or leaking This may not happen a lot but if it does it can be worrying and annoying. In men this problem may be due to changes in the prostate gland. In men and women it may be because of constipation causing pressure on the bladder and leading to leaking. Talk to your GP if you have this problem. If you suddenly develop frequency or urge incontinence or dribbling, accompanied by a burning sensation, it may only be a slight infection. Your GP may give you medication to cure it. Environmental incontinence This happens when your urinary system is working well but you just cannot get to the toilet in time perhaps because you need help to get there. There are a number of ways that you can improve your environment so that going to the toilet is easier for you. All health authorities employ continence advisors who can talk to you about aids which might be able to help, such as a commode for your bedroom or comfortable clothes you can undo quickly and easily. Painful joints can mean getting to the toilet is time consuming and exhausting. Talk to your GP about the possibility of physiotherapy to strengthen your muscles or medication to relieve your pain. Bowel incontinence This can be caused by a number of things, for example, eating different foods, or not getting to the toilet in time. If the problem carries on it is important to get advice from your GP. Unawareness People who have suffered physiological damage, for example, caused by a stroke, may no longer be aware when they need to empty their bladder or bowels. Mental confusion can also lead to people being unaware that they need to go to the toilet. As soon as you realise that you or someone you are caring for may be having problems you should get professional advice to find out if the symptoms are temporary or likely to be permanent. Getting help at an early stage increases the chances of the problem being sorted out or at least improved. You may find that by changing your diet, your daily routine, carrying out special exercises and drinking at different times of the day helps you to cope with your incontinence. 4

5 3 What help is available and how and where can I get it? Incontinence is a symptom not a disease. If you find out the cause of your incontinence then you will find out if it can be treated. The first step is visiting your GP for a check up to see if there is something specific causing the incontinence. If the problem cannot be cleared up with medication then you should ask your GP for an appointment with a continence advisor, a health visitor or a district nurse. They can discuss your problem with you and together you can work out a plan of action. A full investigation will mean that your condition might be improved either by treatment, training, suitable aids and adaptations, prevention or intervention. It may be that all that is needed to solve the problem is regular exercise to strengthen your weakened muscles. Some things that may help might be changing your diet to reduce the amount of coffee and tea you drink and increase your intake of food with higher water content such as fruit and vegetables. Drinking plenty of water can also help. Our bodies need plenty of water to work properly and if you do not drink enough liquid you might get constipation which in itself can cause incontinence. If it looks as though your incontinence cannot be cured you should get all the support and information you can so that you can make decisions on how to maintain a good quality of life. If you need a special aid because of your incontinence you should make sure that it helps you * are happy and confident with the product * can carry on with your normal life as much as possible * can wear it discreetly * can get it easily * can wash it and dispose of it easily Which aid? There is a wide choice of aids available to help people live as normal a life as possible. But before you rush out to buy something, talk to an advisor about the type of aid that suits your needs. Unfortunately it is not possible to list every type on the market but here are some ideas about the types that are available. i) There are different of types of underwear for men and women which are designed to look and feel like normal underwear. These pants are designed to hold an absorbent pad and you can get ones for different levels of 5

6 ii) incontinence (including faecal and urinary). You should ask the continence advisor, district nurse or health advisor about the type that is most suitable for you. You can get appliances which you wear on your body which drain urine into a collecting bag. There are two types, internal and external. External appliances tend to be used by men. An example of an external appliance is a sheath worn over the penis which drains the urine into a collecting bag. The collecting bag could be attached to the leg and hidden under clothing. An internal appliance may be in the form of a catheter which drains the urine directly from the bladder into a leg bag or a bag supported by a waist belt. Men and women can use this type of device. These devices tend to be used when there is no other way of managing incontinence. iii) You can get waterproof covers for your bed which protects it. There are also absorbent pads to soak up any spillages. If you think that you need this sort of protection it is important to get advice about the types that are available. Odour It is important to pay attention to hygiene to avoid any odour. Rinse clothes and bed linen in cold water as soon as possible after an accident, then soak and wash them. You can get deodorants to add to the water before cleaning or washing carpets, mattresses or chairs. NB A pronounced change in the odour of urine maight mean you are suffering from an infection. Clothing You can buy or adapt your clothing so it is easy to undo, for example you could replace zips or buttons with Velcro. Finances It is possible to buy a wide range of continence aids but it can work out quite expensive. You should find out what is available free in your area. The more help you can get the easier it may be to manage your incontinence. For example: i) Health authorities provide incontinence pads and other incontinence equipment free. As what health authorities offer differs from area to area you should check with your GP, continence advisor or clinic. 6

7 ii) iii) Your local social services department may also be able to help you. Check what type of help is available in your area. You might be able to get help with the following: laundry commodes, and adaptations to help you get to the toilet in time. If the social services are not able to supply the equipment you need there are another organisations that might be able to help such as the Red Cross, Women's Royal Voluntary Service, or St John s Ambulance. If you are incontinent, the right advice can help you lead a normal life. The most important thing is to get help as soon as you notice changes in your toiletting routine. 4 Help in residential and nursing homes If you go into a residential or nursing home you should be confident that the staff at the home have a positive attitude towards managing incontinence. When you are looking for a home you should ask about how much help you will get if you have problems going to the toilet: * Are there plenty of toilets on each floor? Could you get to them easily? Are they warm, well lit and comfortable? Do the toilets have raised seats and grab rails? * Will the staff help you to go to the toilet regularly? * Are there enough staff to do this? * Is the home in touch with a continence advisor? Would you be given the opportunity to meet the continence advisor? * Does each resident have an individual plan to help them and the staff manage their incontinence? * Does the manager know about the advice and equipment that is available to help people with incontinence? 7

8 * Will you have to pay extra for incontinence aids such as pads? People who live in care homes should have individual plans to help them manage their continence and avoid having to use a catheter or incontinence pads. If you can smell urine when you visit a care home you should ask the manager about this. A strong smell of urine in a care home is usually a sign that the home is not coping very well with residents with incontinence. It cannot be stressed enough that people in care homes are entitled to the same advice and professional help as those who live in their own homes. If you are worried that you or someone you know is not getting the type of help that they should talk to the manager or matron of the home. If you are still not happy you should ask to see a continent advisor for an individual assessment. You could also ask for advice from your GP. If you are not satisfied with the response from the home then you can complain to the registration and inspection unit. If the complaint is about a residential care home the inspection unit is based at the social services department of the local authority. If your complaint is about a nursing home the inspection unit is based at the health authority. 5 Further advice and information Sometimes it is easier to discuss personal problems with someone other than your GP. There are organisations you can talk to for advice and support. They can also give you the confidence to insist on a more positive approach to managing your incontinence problem from your GP or care home. Continence Foundation 307 Hatton Square 16 Baldwins Gardens London EC1N 7RJ Public helpline open from Monday to Friday, 9.30 am to 4.30 pm. Phone: The helpline provides a confidential service to people who have any bladder or bowel problems. They can also put you in touch with a professional adviser. They produce leaflets about incontinence. 8

9 Continence Foundation Helpline The Dene Centre Castle Farm Road Newcastle NE3 2PH Phone: (9am to 6pm) Helpline for people with bladder or bowel problems. Incontact United House North Road London N7 9DP Phone: Incontact is an organisation for people who suffer from incontinence. They produce quarterly newsletters and give information and support. Association for Continence Advice Winchester House Kennington Park Cranmer Road London SW9 6EJ Phone: Can put you in touch with a professional advisor. Continence Resource Centre Southern General Hospital Glasgow G51 4TF Phone: Helpline for people affected by incontinence in Scotland. 9

10 Counsel and Care Twyman House 16 Bonny Street London NW1 9PG Tel: (local rate number) 10am to 12.30pm and 2pm to 4pm Website: We are a member of the Federation of Information and Advice Centres (FIAC) Registered Charity No Counsel and Care for the Elderly As a charity we rely on donations April

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