Incontinence affects millions of people, especially women after childbirth, older adults, and people with neurological conditions. It causes embarrassment, social isolation, skin damage and falls. In hospitals and care homes, it is too often managed simply with pads or a catheter, without asking why it’s happening or whether it can be improved. Good continence care is a core part of dignified nursing.
Types of urinary incontinence
| Type | Features | Common causes |
|---|---|---|
| Stress | Leaking with coughing, sneezing, laughing or exercise | Weak pelvic floor after childbirth, menopause, obesity |
| Urge (overactive bladder) | Sudden strong need to pass urine, not reaching the toilet in time | Overactive bladder, UTI, caffeine, neurological conditions |
| Mixed | Stress and urge together | |
| Overflow | Dribbling, incomplete emptying | Enlarged prostate, constipation, medicines, nerve damage |
| Functional | Can’t reach the toilet in time | Mobility problems, dementia, environment, slow help |
Obstetric fistula, an injury from prolonged obstructed labour that causes continuous leakage of urine and/or faeces, remains a major cause of incontinence among women in parts of sub-Saharan Africa and South Asia. It is treatable by surgery; women should be referred to fistula repair services.
Assessment
- Ask sensitively and privately: many people won’t raise it themselves.
- History: when it started, triggers, frequency, amount, fluid intake (including caffeine and alcohol), bowel habits, medicines, childbirth history, mobility.
- A bladder diary for 3 days: times, volumes, leaks, drinks.
- Urinalysis to check for infection; bladder scan for residual urine.
- Check for constipation, a common, overlooked cause of urinary and faecal incontinence.
- Check skin.
Interventions
- Pelvic floor muscle training for stress incontinence: supervised for at least 3 months is recommended by NICE as first-line for women.
- Bladder training for urge incontinence: gradually extending the time between toilet visits.
- Fluids: enough fluid (restricting fluid makes urine concentrated and irritating); reduce caffeine and fizzy drinks.
- Toileting programmes: prompted or scheduled toileting for people with dementia or limited mobility.
- Treat constipation.
- Review medicines (e.g. diuretic timing, sedatives).
- Environment: clear routes to the toilet, raised seats, commodes, call bells answered promptly.
- Specialist referral for medicines, devices or surgery as needed.
Skin care
Incontinence-associated dermatitis (red, sore, sometimes broken skin) can develop quickly. Clean gently after each episode with a pH-balanced cleanser (not soap and water scrubbing), dry carefully, and apply a barrier product. Change pads promptly and avoid layering multiple pads. See our pressure ulcer guide.
Avoid catheters for convenience
Indwelling catheters are not a treatment for incontinence and increase infection risk. See our catheter care guide.
Dignity
- Respond quickly to requests for the toilet.
- Use respectful language: “pads”, not “nappies”.
- Provide privacy and same-gender carers when requested.
- Respect religious practices around cleanliness, such as washing with water.
Based on NICE NG123 (Urinary incontinence and pelvic organ prolapse in women), NICE CG49 (Faecal incontinence) and WHO/UNFPA information on obstetric fistula. Educational content.