Incontinence Management Solutions - OT Advice

Having difficulty controlling your bladder or bowel can cause social isolation, anxiety, embarrassment and difficulty in completing daily activities.

Neurological conditions like Parkinson's and multiple sclerosis can interfere with bowel and bladder health. Diabetes, cancer, pregnancy and even smoking can contribute to incontinence issues. Back surgeries, limb surgeries, any conditions that impair your immobility can also slow down or restrict your ability to access toileting facilities, then triggering additional pressures for your routines.

Add to this medications like diuretics and specific conditions like IBS and you’ll soon realise that anybody at any age can have continence issues.

If unaddressed, incontinence can cause skin irritations and infections that can really affect your quality of life.

Signs of continence issues

If you have leakage at day or night, or feel urgency to get to the toilet, you may have continence issues. If you wake more than twice a night to use the toilet you may have continence troubles. If it is a new or sudden onset issue do always seek medical advice. Some causes, like infections, are reversible.

Continence might not be something you freely talk about, but there are often ways to improve your symptoms, and there are always ways to help maintain your privacy and dignity.

The stress associated with incontinence can make bowel and bladder issues worse so talking about it and getting early help can really assist in maintaining your independence for longer, and it is often independence that people tell me is the key to keeping their dignity.

As an Occupational Therapist, I examine everything from daily routines, your mood, and pain in relation to incontinence, trying to determine whether there are rehabilitative practises or compensatory measures that can help maintain your independence and preserve your dignity.

From whether you can use your hands to manage zips and buttons on trousers, to reaching your body to maintain your hygiene, and remembering which bowel medications to take, an OT will consider the environment and your functional levels to give the best advice.

Continence Rehabilitation is Real

In many situations there is scope to improve your physical abilities in relation to toileting:

Bladder Retraining is one method. This looks at the frequency of your toileting habits and often results in a toileting schedule being developed.

Pelvic Floors Exercises. Whether you’re male or female, these muscles can be strengthened at any age and can be essential in improving leakage issues.

Nutrition matters. When are you drinking, what are you drinking and how much? If you have continence worries you may consciously limit your intake of all fluids which can make other conditions far worse. If you have IBS you may alter your food choices. But there may be some things you are unaware of that could be exacerbating your symptoms.

Sometimes, avoiding acidic foods such as oranges and tomato products can help. Caffeine products can be an irritant so a quick switch to decaffeinated drinks may help - caffeine isn’t just in coffee but also in tea, energy drinks and some carbonated drinks too. Some simple diet changes can have enormous effects!

Reaching body parts. Although body dimensions and upper limb functions are different for everyone, being able to attend to your own toileting hygiene brings much dignity. Although the options of bides and specialist toilets with wash and dry functions are available, cheaper and more versatile options can be long-handled sponges or paper grabbers like the Fanwer bottom buddy. A carefully placed mirror can also really help with hygiene checks.

Getting caught short

The anxiety you feel being in an unfamiliar place with a continence issue is totally understandable. Regardless of your rehabilitative exercise regime and preventative diet changes, it’s now that you may find compensatory support useful to help restore your confidence and dignity in public.

There are a host of products you can add to your underwear to absorb and contain both fluid and bowel motions should you not be able to access a toilet in good time. Gone are the days of bulky, obvious inserts. Shaped pads are now the norm, fitting more naturally to body contours, meaning more comfort and less visibility.

Pointers to making the right choices for you

To choose the right product firstly check if they are unisex or specific to male or female use as the fit and absorbency pattern will change for each.

Then decide if you will be using them at day or night – the night products are often longer to account for absorption whilst lying down.

Thirdly consider the volume of protection you will need – the more droplets the box shows the larger the absorbency.

Then think about your mobility. If you are less mobile or even bed bound there is a Proskin range that specifically caters for your needs, being designed for easy fitting and removing from seated or lying with a nappy style fitting process.

If you’re mobile, you can choose pads or pants, allowing you to either use your own underwear with inserts or just wear the absorbent pants. In this situation I would think about your dexterity and how often you’ll be changing the chosen product to help make your selection.

If you struggle to fit or remove a pad, having an all in one absorbent underwear may be useful in staying independent. Being washable, you can wear them just like you would your usual underwear. There are even belted pants now available (like the Proskin flex) that fasten around the abdomen to allow for whatever waist fit you feel comfortable with, which could help if you have a stoma, line or wound that needs to be accommodated.

Some products even link to your mobile devices to alert when they need replacing which is amazing news if you have sensory deficits, reducing your risk of complications like moisture lesions.

Whichever style product you finally choose, do check their sizing against your own as not all companies will use the same guidance for small, medium and large. For added dignity, ensure the product has an odour control property.

Finally, if choosing reusable products do consider if you are able to launder them yourself at 90 degrees as you will want to refresh them in a timely fashion to maintain the odour control properties.

Looking for added night-time confidence?

Remaining hydrated is a top priority, and managing the way you address nocturnal toileting rather than limiting your fluid intake is a far better way of staying healthy. Think about having a urine bottle (specific for males and females) to hand or a bed-side commode to reduce your need to walk whilst half asleep out to a toilet.

Protective bed sheets are also a great idea if you experience leakage or are worried about spillage when using a urinal in bed. A full-size waterproof sheet can help if you move around the bed a lot, with a smaller absorbent pad a great alternative if you share the bed and only need protection to your side.

With a little bit of forward planning to set up your home, some exercises to optimise your control and regular medical reviews to ensure your health needs are well managed you can begin to feel confident that you are still able to live your best life regardless of your continence needs.

Specialist help and advice is available from NHS Continence Services. They can even provide some products free of charge and have a wealth of knowledge and contacts for community support groups and networks. Or contact your local OT and Physio services who are also there to help keep you independent and confident in practical ways.