The short answer
- It is common, and rarely anyone's faultIncontinence affects millions of adults in the UK and becomes more common with age. It is not something your parent has let happen, and treating it as ordinary rather than shameful makes it easier to manage.
- The type matters more than the symptomStress, urge, overflow, functional and bowel incontinence each have a different main cause and a different first step, so knowing which one you are dealing with saves time.
- Small daily habits do most of the workPelvic floor exercises, the right products and looking after the skin manage most cases well, often before anything more is needed.
- A GP referral opens up free helpA GP or continence service can supply products once your parent is assessed, and equipment such as a commode is usually free regardless of savings.
This guide is about how to help yourself and your parent. If washing, products or routines have become more than you can manage alone, a carer can take on some or all of these visits.
Why this matters
Incontinence is common, often treatable, and worth raising early
Involuntary loss of bladder or bowel control becomes more common with age, but it is not an inevitable part of growing old, and leaving it unmanaged tends to make the underlying problem worse rather than better.
An estimated 14 million people in the UK live with some degree of urinary incontinence, and more than half a million adults have bowel incontinence that affects their daily life. Among people aged 85 and living at home, around 15% have some degree of bowel incontinence, and it is more common again in care homes. Despite how common it is, most people are reluctant to mention it to a doctor, let alone to a son or daughter, which means the underlying cause often goes untreated for far longer than it needs to.
Skin and infection
Getting out and about
The cost of products
Confidence and the relationship
Caring for a parent covers the wider decisions around arranging support, and privacy and dignity goes further into keeping your parent's dignity intact as the help they need grows.
What is happening
The five types of incontinence, and what tends to help each one
Most people fit one of five patterns, and the type points fairly directly at what will help, so it is worth working out which one sounds like your parent before trying products or exercises at random.
Stress incontinence
- Sign
- Leaks when coughing, laughing, sneezing, lifting or exercising
- Common cause
- Weakened pelvic floor muscles, most often after childbirth or as the muscles lose strength with age
- What tends to help first
- Daily pelvic floor exercises. Most people notice an improvement within a few months
Urge incontinence
- Sign
- A sudden, intense need to go, sometimes with little warning before leaking
- Common cause
- The bladder muscle contracting too often, more common with an enlarged prostate or after nerve damage
- What tends to help first
- Bladder training and cutting back on caffeine and alcohol. A GP can also prescribe medication
Overflow incontinence
- Sign
- Frequent small leaks and a bladder that never feels fully empty
- Common cause
- A blockage or weakness that stops the bladder emptying properly, often linked to an enlarged prostate
- What tends to help first
- A GP assessment to find and treat the blockage, which usually resolves the leaking
Functional incontinence
- Sign
- Accidents happen because they cannot get to the toilet in time, not because the bladder has failed
- Common cause
- Reduced mobility, or memory and thinking problems such as dementia
- What tends to help first
- A commode close by, a clear sign on the toilet door, and a regular prompted routine rather than waiting to be asked
Bowel (faecal) incontinence
- Sign
- Leaking stool, ranging from a small amount when passing wind to a full loss of control
- Common cause
- Weak pelvic or sphincter muscles, long-term constipation, or a digestive condition
- What tends to help first
- A GP can treat the underlying cause. Specialist bowel retraining works for most people who try it
A few things make any of these more likely, whatever the type: drinks that irritate the bladder such as caffeine, alcohol and fizzy drinks, some blood pressure and diuretic medications, a urinary tract infection, the menopause, and neurological conditions such as Parkinson's disease or MS. A GP can usually tell which type is involved from a short conversation and a few questions, and getting that right first matters, because the exercises that help stress incontinence do very little for overflow incontinence caused by a blockage.
Functional incontinence is common in dementia, where the problem is finding or recognising the toilet in time rather than the bladder itself. Dementia care goes further into the changes that help with toilet routines and signage specifically.
Day to day
Managing it day to day: pelvic floor exercises, products and skin care
Most people manage well with a handful of simple habits, alongside whatever a GP has prescribed for the underlying cause.
- 1
Learn the pelvic floor exercise
A few minutes, most daysSit comfortably, squeeze the muscles used to stop the flow of urine, and hold for a count of five before releasing, breathing normally throughout. This is recommended for both men and women, and most people notice an improvement within a few months of doing it daily. - 2
Get the right products, not just any products
Ask before you buyA GP or continence nurse can recommend the right pad or product for the type and amount of leakage, rather than guessing and overpaying for something too heavy or too light. Products for beds and chairs, such as waterproof sheets and mattress protectors, are worth having alongside personal ones. - 3
Look after the skin
Every changeChange pads promptly rather than waiting, and use a barrier cream if the skin is exposed to moisture for long. Skin that stays damp breaks down quickly and can lead to sores that take weeks to heal. - 4
Keep drinking, do not cut back
Through the dayIt is tempting to drink less to avoid accidents, but this concentrates urine, irritates the bladder further and increases the risk of a urinary tract infection. Less caffeine and alcohol usually helps more than drinking less overall. - 5
Write down what works
Once you have a routineNote the products, the times and the exercises that help in a care plan, so anyone else helping, a relative, a district nurse or a carer, follows the same approach.
A care plan helps if more than one person is involved in your parent's day, and writing a continence care plan shows the fuller version a paid carer would keep.
Talking about it
How to raise the subject without it becoming a stand-off
Your parent is almost certainly already aware of the problem and may feel deeply uncomfortable about it, so how and when you raise it matters as much as what you say.
What helps
- Choosing a private, calm moment rather than raising it in passing or in front of others
- Expecting them to already know, and to feel embarrassed rather than surprised
- Leaving written information for them to read alone if the first conversation goes badly
- Trying again on a different day rather than treating one refusal as final
- Involving the GP early, since a referral opens up practical help and equipment
What tends to fail
- Raising it in front of other family members or visitors
- Pushing for a decision or an answer in the same conversation
- Reacting with frustration to an accident, which makes the next one harder to admit to
- Assuming a defensive or angry reaction means they do not want help at all
Getting help
Getting the GP, the continence service and the council involved
Much of what makes this easier does not have to come out of your own pocket or be worked out alone. The GP, the council and a paid carer each cover a different part of it.
| Who to contact | What they help with | |
|---|---|---|
| GP or NHS continence service | Ask your GP for a referral, or self-refer in areas that allow it | Diagnosing the type and cause, and supplying continence products at no cost once your parent is assessed as eligible. |
| Council occupational therapist | Ask your local council for a care needs or equipment assessment | Grab rails, a raised toilet seat, a commode and similar equipment. Items under £1,000 are usually provided free, whatever your parent's savings. |
| Bladder & Bowel Community | Contact their helpline or website directly | Independent advice on products, and the Just Can't Wait card for easier access to shop and venue toilets. |
| A paid carer | Search carers near your parent | Hands-on help with routines, products and skin care at the times of day it is hardest, from £18 to £25 an hour with our fee included. |
GP or NHS continence service
- Who to contact
- Ask your GP for a referral, or self-refer in areas that allow it
- What they help with
- Diagnosing the type and cause, and supplying continence products at no cost once your parent is assessed as eligible.
Council occupational therapist
- Who to contact
- Ask your local council for a care needs or equipment assessment
- What they help with
- Grab rails, a raised toilet seat, a commode and similar equipment. Items under £1,000 are usually provided free, whatever your parent's savings.
Bladder & Bowel Community
- Who to contact
- Contact their helpline or website directly
- What they help with
- Independent advice on products, and the Just Can't Wait card for easier access to shop and venue toilets.
A paid carer
- Who to contact
- Search carers near your parent
- What they help with
- Hands-on help with routines, products and skin care at the times of day it is hardest, from £18 to £25 an hour with our fee included.
Equipment assessments are free regardless of income or savings. Ongoing paid care may be means-tested if you ask the council to fund it; the upper capital limit in England is currently £23,250.
To ask for an equipment assessment, contact your council through GOV.UK. For continence products, ask your GP to refer your parent to the local NHS continence service, since many areas also accept self-referral. Age UK's guide to urinary incontinence and Bladder & Bowel Community both give further advice on causes and products. If your parent's savings are below the council funding threshold, the council may also help pay towards ongoing care.
If washing, changing products or managing routines have become more than you can manage alone, whether because of your own back, your own time, or because your parent would rather be helped by someone other than family, a carer can take on some or all of these visits. Bathing and toileting an elderly parent covers the wider personal care routine, and how many visits a week does my parent need helps work out what that would cost. A carer's own training for this is set out in managing a client's incontinence, worth reading if you want the fuller approach a paid carer would take.
Questions
Questions families ask about incontinence
It becomes more common with age, but it is not something to simply accept. Many cases have a specific, treatable cause, such as a urinary tract infection, an enlarged prostate or weakened pelvic floor muscles, and a GP can usually identify which type is involved and suggest a first step.
Stress incontinence is a leak caused by pressure on the bladder, such as coughing or lifting, and usually responds well to pelvic floor exercises. Urge incontinence is a sudden, hard-to-delay need to go, often linked to an overactive bladder or an enlarged prostate, and responds better to bladder training or medication. Many people have a mix of both.
Ask your GP to refer your parent to the local NHS continence service, or contact the service directly, since many areas accept self-referral. A nurse assesses what is needed, and eligible products are supplied at no cost. Bladder & Bowel Community can advise on products in the meantime.
Ask your local council for a care needs or equipment assessment. An occupational therapist visits, looks at what your parent struggles with, and recommends equipment. Items costing under £1,000 are provided free, whatever your parent's income or savings. Apply for an assessment on GOV.UK.
It depends on the cause. Stress incontinence often improves significantly with pelvic floor exercises, and overflow incontinence caused by a blockage can resolve once the blockage is treated. Some causes, particularly nerve-related or age-related ones, are managed rather than cured, but products, routines and medication still make a large difference to daily life.
Leave it for now rather than pushing, and try again on a different day. Leaving written information for them to read alone, and involving the GP rather than only family, often makes the second conversation easier than the first.
When washing, changing products or managing routines has become more than you can manage physically or in the time you have, or when your parent would rather be helped by someone other than family. Search vetted carers near your parent to see who is available.