Incontinence is the thing families do not mention on the phone. It is usually the third or fourth item in the conversation, raised carefully, after mobility and meals. It is also, very often, the thing that finally tips a household from managing to not managing.
Two points before anything else. Incontinence is extremely common in later life, and it is never simply a consequence of being old. It is a symptom, it has causes, and a meaningful proportion of those causes are treatable or reversible. Anyone who has been told to buy pads and get on with it has been failed.
Why “it’s just her age” is the wrong answer
Ageing changes the bladder — capacity falls, the bladder empties less completely, the sensation of needing to go arrives later. None of that is the same as being incontinent. Plenty of people live into their nineties with no problem at all.
When continence changes, especially when it changes suddenly, something has happened. The list of things worth excluding is short and mostly cheap to check:
- Urinary tract infection. In older people a UTI often presents as new incontinence, confusion or a fall rather than stinging. A sudden change over days is a GP call the same week.
- Constipation. A loaded bowel presses on the bladder and causes urgency, frequency and leaking, and it also causes overflow diarrhoea, which is routinely mistaken for bowel incontinence and treated with exactly the wrong thing. Constipation is probably the single most common reversible cause, and it is easy to miss because nobody asks.
- Medication. Diuretics (water tablets), sedatives, some antidepressants, alpha-blockers and others all affect continence. A GP or pharmacist medication review can change the picture — sometimes just by moving the diuretic to the morning. See medication management at home.
- Undiagnosed or poorly controlled diabetes. High blood glucose causes thirst and large urine volumes. New night-time incontinence with weight loss and thirst needs a blood test. Read diabetes support at home.
- Prostate enlargement in men. Causes hesitancy, poor flow, dribbling and incomplete emptying that overflows. Treatable with medication or surgery.
- Not being able to get there in time. This is not bladder failure. It is arthritis, a walking frame, a distant toilet, fiddly buttons or a chair that is too low. Fix the route, not the bladder.
- Pelvic floor weakness after childbirth or with age, and vaginal atrophy after the menopause — both treatable, both under-treated in older women.
Cutting fluids is the instinct and it makes things worse: concentrated urine irritates the bladder, and dehydration causes confusion, constipation, UTIs and falls. Reduce caffeine and alcohol instead, and keep fluids up during the day while easing off in the two hours before bed.
Getting it properly assessed
Start with the GP. Ask for a continence assessment and, where the GP cannot resolve it, a referral to the local NHS continence service. These services exist in every area, are staffed by specialist continence nurses, and are free — and they are chronically under-used because people do not know to ask.
A proper assessment involves a bladder diary (three days of fluid in, urine out and leaks — tedious, and the most informative thing you will produce), a urine test, a check for constipation, a medication review, a bladder scan to measure what is left after voiding, and for men a prostate examination. NICE recommends conservative treatment first: pelvic floor muscle training taught properly by a specialist, bladder training for urgency, timed toileting, and only then medication.
The outcome matters practically as well as clinically. Where someone is eligible, the NHS continence service provides continence products free — the assessment is the gateway. Provision and quantities vary between areas, and what is supplied is usually a fixed daily allowance rather than unlimited, so many families top up privately. But going straight to the supermarket without an assessment means paying for products you might get free, using the wrong type, and never finding out what was actually wrong.
Products: get the right ones
The wrong pad is worse than no pad. Common mistakes: using a light pad for heavy leakage so it floods, using a heavy pad for light leakage so the skin stays damp all day, using a product designed for women on a man, and buying by price rather than absorbency rating.
Three principles. Match absorbency to actual output, which the bladder diary tells you. Change promptly rather than on a schedule that suits the visit times. And separate the day product from the night product — night-time needs are different and a single product rarely covers both.
Bladder & Bowel UK runs a free confidential helpline staffed by specialist nurses and product experts, covering adults and children, and is the best independent source on choosing products. It also issues the “Just Can’t Wait” card, which gets someone access to toilets not normally open to the public — a small thing that puts people back on buses and into shops. Age UK West Sussex can help with the benefits side; Attendance Allowance at £76.70 or £114.60 a week is not means-tested, and help with the toilet at night is exactly the kind of need the higher rate exists for.
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Catheters and stomas: the basics
A urinary catheter is not a treatment for incontinence and should not be used as one where anything else will work. It is appropriate for retention, for certain wounds, and sometimes in end-of-life care. Catheters carry a real infection risk, and long-term catheterisation is a decision for a clinician, not a convenience.
Where one is in place, district nurses manage changes and problems. The things a family should know: keep the bag below bladder level so urine does not flow back; keep fluids up; do not pull on the tube; use a leg bag by day and a night bag on a stand; and treat no urine draining for several hours, with abdominal pain, as urgent — call the district nursing team or 111.
A stoma — colostomy, ileostomy or urostomy — is a different situation, and people manage them independently for decades. Everyone with a stoma should have a named stoma nurse, and that nurse is the first call for leaks, sore skin or a change in output, not the GP. Prescription supplies are free. For someone who becomes unable to manage their own bag, a care worker can be trained to help, but the training has to be specific and signed off, and the person’s own routine should be followed exactly — they know it better than anyone.
Skin: the part that becomes serious fast
This is where continence stops being a dignity issue and becomes a clinical one. Skin in prolonged contact with urine or faeces breaks down — incontinence-associated dermatitis — and damaged skin over a bony area becomes a pressure ulcer quickly, particularly in someone who is thin, immobile or poorly nourished. Pressure ulcers are painful, slow to heal and a common route into hospital.
What prevents it:
- Change promptly. Contact time is the thing that matters most.
- Clean gently. Water or a pH-balanced skin cleanser, not soap, which strips the skin. Pat dry, do not rub.
- Use a barrier product — cream, film or spray — prescribed or recommended rather than whatever is in the cupboard. Thick layers of zinc cream clog pads and stop them absorbing.
- Look every time. Redness that does not fade when pressed, over the tailbone, hips or heels, needs reporting to the GP or district nurse that day.
- Keep moving and keep eating. Pressure relief and protein both matter more than any cream.
Carers should be recording skin condition at each visit. If a care plan has no skin section, ask for one.
Dignity, language and the practical fixes
How this is talked about determines whether someone accepts help or hides the problem until it is a crisis. Say “pads” or “continence products”, not “nappies”. Say “accident” rather than anything that implies fault, or better, say nothing and deal with it matter-of-factly. Do not discuss it in front of visitors. Do not talk over the person to the carer. Ask before touching. And do not make someone apologise — many people apologise repeatedly, which is a sign the shame is already doing more damage than the incontinence. Our guide to dignity in personal care goes further.
The environmental fixes are unglamorous and effective: a clear, lit route to the toilet with a nightlight; a raised toilet seat and grab rails; clothing with elastic waists rather than buttons; a commode or urinal bottle beside the bed; a washable chair pad; and a toilet door left ajar so it is obvious which one it is, which matters a great deal in dementia. For someone with dementia, a contrasting coloured toilet seat and a clear sign on the door solve a surprising number of “incontinence” problems that were really navigation problems.
Why this decides whether someone stays at home
Continence problems, particularly at night, are one of the biggest drivers of care home admission — not because they are untreatable, but because they exhaust the person doing the caring. A family carer getting up three or four times a night to change bedding runs out long before the person they care for does.
Home support can often delay or prevent that move, and the useful interventions are specific: a morning and evening personal care visit, absorbent night products matched to actual output, waterproof mattress protection, a commode by the bed, and — where nights are the problem — an overnight care arrangement, at roughly £210 for a sleeping night and £260 for a waking night. Hourly care in West Sussex runs £28–£38, live-in care £1,400–£1,700 a week, against £1,100–£1,600 a week for a residential home. See home care versus a care home.
Before any of that, get the free things: the continence assessment, the GP medication review, a care needs assessment from West Sussex County Council, and an occupational therapy referral for the bathroom. And look after the carer — carer burnout is what actually ends most home arrangements.
Frequently asked questions
Is incontinence a normal part of getting older?
No. The bladder does change with age, but incontinence is a symptom with causes, not an inevitability — plenty of people never develop it. Common reversible causes include urinary infection, constipation, medication, poorly controlled diabetes and prostate enlargement. Anyone told simply to buy pads without an assessment should ask the GP again.
Are continence products free on the NHS?
Where someone is eligible, yes. The local NHS continence service supplies products free following a continence assessment, usually as a fixed daily allowance rather than unlimited, with provision varying between areas. Many families top up privately. Ask the GP for a referral to the continence service rather than buying blind at the supermarket.
What is a continence assessment?
A specialist assessment, usually by a continence nurse, covering a three-day bladder diary, a urine test, a check for constipation, a medication review, a bladder scan for incomplete emptying and, for men, a prostate check. NICE recommends conservative treatment first — pelvic floor training, bladder training and timed toileting — before medication.
Can a home carer help with catheters or a stoma?
Care workers routinely empty catheter bags and support stoma care where they have specific, signed-off training for that task and that person. District nurses manage catheter changes and problems, and everyone with a stoma should have a named stoma nurse who is the first call for leaks or sore skin. Follow the person’s own established routine.
Does incontinence mean a care home is next?
Not necessarily. It is a major driver of admission, but usually because night-time changing exhausts the family carer rather than because the problem itself cannot be managed. Treating reversible causes, getting the right products, bathroom adaptations and overnight or twice-daily visits often keep someone at home considerably longer.
The Care Panel is an independent publication. We are not a care provider and are not regulated by the Care Quality Commission, because we do not deliver care. Always check a provider’s own CQC registration and inspection report before you commit.
Written and fact-checked by The Care Panel. Last updated September 2026. Sources: NHS guidance on urinary and bowel incontinence and on urinary catheters, NICE guidelines on urinary incontinence and on lower urinary tract symptoms in men, NHS England’s Excellence in Continence Care, Bladder & Bowel UK, and gov.uk for Attendance Allowance. General information, not medical advice.