Continence Care in Dementia

This is one of the harder things to talk about, and one of the most common. If continence has become part of the picture, here's what actually helps, and what's worth trying before assuming nothing can be done.

It's often not what it first looks like

A lot of continence problems in dementia are what's called functional, not a physical inability to control the bladder or bowel, but difficulty getting to the toilet in time, managing clothing, recognising the toilet itself, or communicating the need at all. This distinction matters, because functional causes are often genuinely manageable with the right support, not something to simply accept as inevitable.

What to actually do first

See the GP. They should check for common, treatable causes before anything else:

• A urinary tract infection (UTI)
• Constipation
• A medication side effect
• An underlying, treatable medical condition

If the problem continues after these are ruled out or treated, ask for a referral to an NHS continence service, some areas allow self-referral, others need a GP referral. These are staffed by specialist nurses who can properly assess the cause and recommend genuinely useful management.

Products, and what's available for free

Following a formal continence assessment, some products, pads, disposable pants, bed and chair protection, may be available free on the NHS, though provision and quantity limits vary by local area. In the meantime, a wide range is available to buy directly from pharmacies and supermarkets, it's often worth trying a few types to find what actually works well.

Keeping dignity at the centre of this

• Keep the conversation calm and matter-of-fact, rather than embarrassed or hushed, your tone sets theirs
• Offer help with as much privacy as possible
• Keep products somewhere easy and unobtrusive to reach, rather than tucked away out of sight, which can make asking feel harder than it needs to
• Involve them in decisions about their own care wherever they're able to take part

Continence issues can bring real feelings of shame or distress, for both of you. That reaction is completely understandable, and it doesn't mean anything has gone wrong. Handling it with warmth and normality, rather than treating it as a crisis, tends to help both of you cope better.

A word from The Care Compass

This is one of the parts of caring nobody prepares you for, and one of the hardest to talk about openly, even with close family. You're not alone in finding it difficult, and there's real, practical support available, it's worth asking for it directly rather than managing this quietly on your own.

This article is for general guidance only and does not constitute medical advice. Speak to a GP for anything relating to continence changes.

You don’t have to navigate it alone.