‍Incontinence is a problem that affects a large number of New Zealanders.  It can be either a bowel or bladder problem, or both at the same time.  It is recognised as one of the leading reasons why people place their loved ones in care facilities.  This fact sheet is designed to help carers look after someone with a continence problem, and what they can do to help resolve or manage it better.


What is incontinence?
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‍Incontinence is a loss of bladder or bowel control that may result in involuntary leakage of urine or faeces. Urgency (needing to get the toilet in a hurry) and frequency (wanting to go to the toilet often) are also common bladder control problems, although they are not necessarily associated with leakage.


Who is at risk?
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‍Incontinence is a common issue that affects nearly 1.1 million adult New Zealanders from all walks of life, regardless of their age or cultural background. It is not just a problem for older people or people with disability, though people from these two groups are at greater risk of becoming incontinent. People with poor mobility (ability to get around), memory problems and chronic health problems such as Parkinson's disease, stroke, dementia and multiple sclerosis are more likely to have continence problems.

The most important thing to remember when caring for someone with incontinence is that it is not 'normal' or 'inevitable'. Options for preventing, treating, managing and curing incontinence are available, so it is very important to seek professional help as early as possible.


Symptoms of continence problems
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- Urgency to go to the toilet – with or without leaking urine or bowel motion.
- Toileting frequently (around six times through the day and once at night is the average range of toileting).
- Leaking urine or bowel motion without being aware.
- Burning/stinging when passing urine.
- Passing small volumes of urine (adults should be able to pass around 400 – 600ml).
- Dribbling urine after voiding.
- Feeling that the bladder or bowel is not empty after toileting.
- Difficulty or straining when passing bowel motions.
- Urine flow being slow to start, and flows slowly.


‍Continence assessment
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‍The first step required to effectively manage a person's incontinence is a continence assessment. A continence assessment helps identify the type and causes of the problems being experienced by the person and assists the health professional to devise an appropriate treatment or management strategy based on the individual person's needs. There are a number of different types of incontinence and management of each of these different types varies.

A continence assessment will collect information about the person's bladder and bowel function including:

- How often they go to the toilet.How much urine is passed.
- What their bowel actions look like.
- How often and how much they leak.
- What their fluid and diet intake is, including types, volumes, and times.
- What current medications they are taking, including any supplements or over the counter medications.
- Other health problems they have.
- Their ability to perform self-care tasks such as toileting, dressing, getting to and from the toilet.
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Where to seek help or advice
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‍Your GP should be the first port of call so they can check that it is not a urinary tract infection (or other infection) causing the incontinence symptoms. Your GP may then refer on to a continence advisor to help with practical advice and management options.

Our Continence Helpline on 0800 650 659 is a free and confidential service available to anyone living in New Zealand. The helpline can provide you with a wide range of information resources and details of a continence clinic located close to the person you are caring for.


Management options
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‍There is a range of management options available to people with incontinence, which largely depend on the type of incontinence they have and the outcomes they hope to achieve. An incontinence management plan will usually consist of several of the following options:

- Adequate fluid intake (for example 1500 - 2000mls each day).
- Adequate diet (for example a fibre rich diet to prevent constipation).
- A pelvic floor muscle exercise program.
- A bladder-retraining program.
- A toileting program.
- Medication.
- Incontinence aids (for example, pads, condom drainage or catheters).


Practical tips whilst waiting for assistance

Bladder problems
‍- Prompt the person to go to the toilet every 2-3 hours.
- Find a continence pad that will keep their clothing or bedding dry for about 3-6 hours. Call our 0800 Continence Helpline for advice about the right product for you.
- Urinary infections can cause or worsen incontinence, if urinary incontinence is a new problem or if it hurts to pass urine see your doctor who can make sure it is not an infection.
- If the person suddenly CANNOT pass urine, see your doctor or go to your local emergency department, as this may be a medical emergency.
- Make sure the person is drinking adequate amounts of fluid - 1500 to 2000mls spread evenly throughout the day.
- If the person is constipated, see your doctor about different treatment options, as constipation can impact bladder control.
- Seek professional help on the cause and treatment of the incontinence.

‍Bowel problems
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- Use a continence pad for protection.Use a barrier cream to protect the person's skin (bowel leakage can make skin red and sore very quickly).
- See your doctor if diarrhoea persists for more than 24 hours (the cause of the diarrhoea could be food poisoning or certain kinds of medicine such as antibiotics). It can also indicate severe constipation.
- Wear disposable gloves (available from supermarkets or chemists) to protect yourself.
- Wash your hands carefully (even if you wear gloves) after you have had any contact with bodily fluids such as urine or faeces.
- If the person is constipated, see your doctor about different treatment options.

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Where to get help
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- Your GP
- Your local District Health Board Continence Service
- Continence NZ, Helpline 0800 650 659
- Carers NZ, 0800 777 797, www.carers.net.nz, email: info@carers.net.nz
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