Quick summary
This is the thing families put off asking about longest, and the thing carers deal with most matter-of-factly. Incontinence is common, it is not an inevitable part of ageing, and much of it can be improved or treated. Ask the GP for a referral to the continence service before assuming pads are the answer.
It is not an inevitable part of getting older
Bladder and bowel problems become more common with age, but they are not a normal feature of it, and a great many can be improved with assessment and treatment.
Treatable causes include urinary infections, constipation, prostate problems, side effects of medicines including water tablets, weak pelvic floor muscles, diabetes, and simply not being able to get to the toilet in time because of mobility.
Sometimes the problem is the walk, not the bladder, and the answer is a downstairs toilet, a raised seat, a commode or a grab rail rather than anything medical.
Start with the GP
Ask for two things: an assessment of the cause, and a referral to the local NHS continence service, which is a specialist nursing service that assesses bladder and bowel problems and advises on treatment and products.
It helps to take a three-day diary: what went in, what came out, when, and what happened just before any accidents. Patterns are hard to see from memory and obvious on paper.
Ask specifically about a medication review too, since diuretics, sedatives and some other medicines contribute. Our piece on what to check at home covers how these things tend to cluster.
What usually helps
- Treating the cause. Infection, constipation and prostate problems are all treatable.
- Not cutting back on fluids. The common instinct, and it makes things worse by concentrating urine and irritating the bladder, as well as risking dehydration, confusion and falls.
- Reducing caffeine and alcohol, which irritate the bladder.
- Dealing with constipation, which affects both bladder and bowel.
- Pelvic floor exercises, which work for many people and need to be taught properly.
- Bladder training, guided by a continence specialist.
- Making the toilet easier to reach: lighting at night, a clear route, a raised seat, rails, a commode, or a downstairs toilet.
- Clothing that is easy to manage, which sounds trivial and prevents a lot of accidents.
- Timed prompting, particularly with dementia, where the difficulty is often recognising the need or finding the toilet.
Products, and what the NHS provides
Products are the last step, not the first, and they matter once the cause has been addressed.
Some NHS continence services provide pads free after assessment, and availability and eligibility vary considerably between areas. Ask the continence service directly rather than assuming either way. Bladder and Bowel UK publishes independent advice on product types.
Practical points families work out the hard way: get the absorbency right for night versus day, buy products designed for the right anatomy, use a waterproof mattress protector, and keep a spare set of everything within reach of the bed. Skin care matters as much as absorbency, since prolonged dampness causes sore skin quickly, and any redness or broken skin should go to the district nurse or GP promptly.
Talking about it
The embarrassment is usually the biggest obstacle, and it belongs to everyone in the room.
- Raise it sideways. “The GP could look at that, it’s really common” is easier to hear than a direct observation.
- Be matter of fact. Embarrassment is contagious, and so is calm.
- Do not make it about the washing. Even when the washing is the reason you noticed.
- Let them keep control of who helps and how. This is the most private thing anyone will accept help with.
- Offer the professional route. Many people find it easier to accept help from a trained carer than from their own son or daughter, and that preference is worth respecting rather than overriding.
If the conversation is going badly, our guide to raising difficult subjects may help.
How carers handle it
Plainly, and without commentary. Continence care is a routine part of the job, done many times a day, and it is the single most common worry new carers have that stops being an issue within a fortnight.
What good looks like:
- No fuss and no running commentary.
- Doors closed, towels used, dignity protected.
- The same small group of carers, because this is the part of care where familiarity matters most.
- A choice about who does it, including a preference for a female or male carer.
- Enough time. Rushing this is how people end up sore, wet or humiliated, which is one more reason our minimum visit is an hour.
- Skin checked and changes reported to the district nurse or GP.
When to seek help sooner
- Blood in urine or stool.
- Pain or burning when passing urine, or a sudden change in continence, which can indicate infection.
- Sudden confusion. The NHS advice is to go to A and E or call 999, as our piece on sudden confusion explains.
- Being unable to pass urine at all, which needs urgent medical attention.
- Broken or very red skin.
- A new problem after a fall, a stroke or a change of medication.
Frequently asked questions
Is incontinence just part of getting older?
No. It becomes more common with age and it is not inevitable, and many causes are treatable. It is always worth an assessment.
Should she drink less?
Usually not. Restricting fluids tends to make symptoms worse and brings its own risks including dehydration and falls. Ask the continence service about sensible timing instead.
Can we get free pads?
Some NHS continence services provide products free after assessment, and it varies by area and by assessed need. Ask the service directly.
Can carers help with this?
Yes. Continence care is routine personal care and part of most care plans, including changing pads, helping to the toilet and skin care.
Can we ask for a female carer?
Yes, and it is one of the most common requests. It may limit which times are available.
What about at night?
Night-time products, a commode by the bed and good lighting help. Where someone needs help several times a night, that is a conversation about overnight or live-in support.
About Visiting Angels Cheshire East
Visiting Angels Cheshire East provides care at home across Macclesfield, Wilmslow, Knutsford, Congleton, Alsager and the surrounding villages of East Cheshire, along with Buxton, Whaley Bridge and the Staffordshire Moorlands towns.
- You choose your caregiver, including a preference for a female or male carer, and you meet them before care starts.
- No visit is ever shorter than an hour, because personal care done at speed is done badly.
- You see the same faces. Our carer turnover is 12 per cent, against a sector figure of 23.7 per cent (Skills for Care, 2025), which matters more here than anywhere.
- Carers trained in dementia, Parkinson’s, stroke recovery and complex care.
- Overnight and live-in care available.
Alan’s wife is supported at home, and this is what he wrote:
“Excellent in every respect. Staff are caring, friendly and helpful. [Our carers] do everything they can to make my wife’s life easier. Management and staff are flexible in their approach and do the unpleasant jobs with a smile and willingness which is commendable. They are always willing to ‘go the extra mile.'”
Alan Hallett, Google review
Not sure what you need yet? Start with a free assessment
Our free home care assessment is a visit at a time that suits you, with no obligation afterwards. In it we will:
- Talk about this without embarrassment, and directly with the person if they would rather.
- Work out the times of day help is actually needed.
- Look at the money with you, and point you towards the funding, benefits and grants you may be entitled to.
- Tell you honestly if the GP and continence service should come first, because very often they should.
If this is the thing nobody has said out loud yet, call us on 01625 720157. You can also send an enquiry, and you can see what our services cover.
Authored by Kim Blissett, Registered Manager, Visiting Angels Cheshire East.
Published 27 September 2026. Last updated 27 September 2026.
This article is general information, not medical advice, and no substitute for assessment by a GP or NHS continence service. Do not restrict fluids or start treatments without advice. Provision of continence products varies by area and assessed need. If there is blood, pain, an inability to pass urine, broken skin or sudden confusion, seek medical help promptly, and call 999 in an emergency. Visiting Angels Cheshire East provides personal care at home rather than medical or nursing care. To the fullest extent permitted by law, GB Care at Home Ltd accepts no liability for any loss or injury arising from reliance on this article.
