Incontinence Care at Home: A Practical Guide for Caregivers

Incontinence care at home is the everyday routine of keeping someone clean, dry, comfortable and respected when they can't fully control their bladder or bowel. Most of it is simple and repeatable: a toileting schedule, prompt changes, gentle skin care, a bed that is easy to strip and wash, and a calm, matter-of-fact manner. MedlinePlus, the US National Library of Medicine's health site, suggests changing pads or incontinence underwear at set times 2 to 4 times a day, even when they seem dry. Down-Under Wool, a family business, has supplied washable, urine-resistant wool bedding to caregivers since 1988, and this guide is the practical routine we talk families through.

If you want to know which type of incontinence your family member has and why, start with our guide to urinary incontinence types and causes. This page is about the care.

Should you see a doctor first?

Yes. The NHS advises seeing a GP for any type of urinary incontinence, and MedlinePlus recommends talking with a provider before choosing products, to confirm the cause and the treatment options. Some causes, such as a urinary tract infection, constipation or a new medicine, can be treated, and the leaks may settle once they are.

Take a bladder diary to the appointment: NIDDK suggests 2 to 3 days of drinks, bathroom trips and leaks. A doctor can also refer you to a continence nurse or service.

What does a daily incontinence care routine look like?

A daily incontinence care routine is built around regular bathroom trips, prompt changes and a daily skin check. A simple plan:

1. Offer the toilet on a schedule. The National Institute on Aging (NIA) recommends regular bathroom breaks, and describes timed voiding: going at set times, then slowly stretching the gap.
2. Change pads and underwear at set times, 2 to 4 times a day as MedlinePlus suggests, and straight away when they are wet or soiled.
3. Clean and dry the skin after every episode (see the skin care steps below).
4. Change soiled sheets and clothing right away. MedlinePlus lists this as part of protecting the skin.
5. Keep fluids up, but choose them well. NIA advises against limiting water, while cutting back on caffeinated coffee, tea and sodas, and limiting drinks close to bedtime.
6. Look at the skin every day, as MedlinePlus advises, especially the buttocks and the bony areas where Mayo Clinic says bedsores most often form: heels, ankles, hips and tailbone.
7. If the person is in bed or a chair most of the day, help them change position at least every 2 hours in bed and shift their weight every 15 to 20 minutes in a wheelchair, as MedlinePlus advises.

Keep a small kit by the bed (gloves, cleanser, soft cloths, clean pads, a bag for soiled items) so each change is quick.

How do you care for the skin?

You care for the skin by cleaning it gently and promptly after every episode, drying it well and protecting it. These steps come from MedlinePlus's guide to skin care and incontinence:

• Clean and dry the area right away after urine or stool.
• Use mild, dilute soap and water, rinse well and pat dry; don't rub. Soap-free cleansers that don't dry the skin are another option, and some don't need rinsing.
• Avoid products that contain alcohol, which can irritate the skin.
• Creams or ointments with zinc oxide, lanolin or petrolatum form a protective barrier. Reapply after each clean.
• Don't use baby powder. If the skin is moist most of the time, ask about a powder with an antifungal medicine.

MedlinePlus also warns that diapers and other products can make skin problems worse, so pads are no substitute for prompt changes. Wet skin breaks down more easily under pressure; our guide to bed sore prevention in incontinent patients explains the link between moisture damage and pressure ulcers, and the bed sores page covers the stages.

How should you set up the bed and chair?

Set up the bed so that a spill reaches as few layers as possible and those layers come off quickly. MedlinePlus describes waterproof bed and chair pads, often called "Chux" or blue pads, in reusable and disposable versions. A practical setup, from the mattress up:

1. A waterproof mattress protector.
2. A disposable or washable underpad across the middle of the bed, where leaks land.
3. For someone who spends long hours in bed, a urine-resistant wool pad on top, with the person lying directly on the wool.

Keep the number of layers under the person to a minimum. Fewer linen layers is one of the standard hospital prevention practices tracked in the US pressure injury prevalence survey, and MedlinePlus advises keeping sheets smooth so they don't bunch up under pressure points.

Our Hospital Wool Fleece Bed Pad is urine resistant, covers the body from shoulders to feet (30 x 60 in) and can be machine washed and dried; its product notes suggest a blue pad underneath to protect the mattress. For a chair or wheelchair, the XD1900 Cushion-It is not harmed by urine or feces. See the whole range of incontinence bedding.

Washable or disposable bedding: which is better?

Washable and disposable bedding each have a place, and many households use both. Disposables save laundry; washables may save money, as MedlinePlus notes, and wool adds comfort for someone who lies on it all day. A comparison:

Wool can absorb up to 33% of its own weight without feeling wet, while synthetic fibers absorb very little, so a wool pad under the person stays drier to the touch. It is still not a replacement for a waterproof layer under it. Before you buy any sheepskin for an incontinent person, read urine-resistant vs non-urine-resistant products: our own Healthcare Lambskin, for example, is not urine resistant and is meant for continent users.

How do you wash incontinence bedding?

Wash incontinence bedding promptly and keep enough sets that one is always clean and dry. For urine-resistant wool pads and medical sheepskins, the care steps on our product pages are:

• Small spills: wipe with a damp cloth straight away.
• Machine wash when the pad smells or after a large spill, on a gentle or wool cycle, with a sheepskin wash such as Woolskin, which cleans, disinfects and conditions the wool. Avoid household detergents with enzymes, bleach or alkali, which can damage sheepskin leather.
• Dry on low heat and low agitation, or air dry away from direct sun and heaters. Take wool out while it is still slightly damp; it does best with about 15% moisture left in it. A medical sheepskin usually takes about 24 hours to air dry.
• Keep two or three, as many caregivers do, so one is on the bed while another dries.

HiTemp UR medical sheepskins can be washed hotter than ordinary sheepskins. Full temperatures and step-by-step instructions are in our guide on how to wash sheepskin, and drying is covered on our drying sheepskin page.

How do you protect the person's dignity?

You protect a person's dignity by treating incontinence as an ordinary health matter, giving privacy, and letting them do as much for themselves as they can. NIA notes that bladder control problems can be embarrassing and lead people to avoid their normal activities, and the NHS stresses it is nothing to be embarrassed about. In practice:

• Keep your tone calm and matter-of-fact; no scolding, no fuss.
• Close the door, draw the curtain and cover the parts of the body you are not washing.
• Let them choose clothes and do what they can, such as wiping or washing their own face and hands.
• Choose clothing that is easy to get on and off, as NIA suggests, and absorbent underwear for trips out so they can keep seeing friends.

Look after yourself too: night changes and laundry are tiring, so ask the doctor or nurse what help is available.

Caring for someone with dementia and incontinence

People in the later stages of Alzheimer's disease often have urinary incontinence because they don't realize they need to go, forget to go, or can't find the toilet, according to the National Institute on Aging. NIA's tips:

• Avoid caffeinated coffee, tea and sodas, but don't limit water.
• Keep hallways clear and the bathroom clutter-free, with a light on at all times.
• Provide regular bathroom breaks rather than waiting to be asked.
• Use underwear that is easy to get on and off.

A sudden change in continence in someone with dementia can have another cause, such as an infection, so mention it to the doctor.

When should you call a doctor or nurse?

Call a doctor or nurse if you see a skin rash or sores, or signs of infection such as burning when urinating, fever or chills; MedlinePlus lists these as reasons to contact a provider. Also call about foul-smelling drainage, severe skin irritation, or reddened areas that don't turn white when you press them, which can be an early pressure sore. Don't treat broken skin or an open sore yourself; ask the nurse or doctor how to care for it.

Incontinence care FAQs

How often should incontinence pads be changed?

Incontinence pads should be changed at set times, 2 to 4 times a day according to MedlinePlus, even if they seem dry, and straight away whenever they are wet or soiled.

Are washable bed pads better than disposable ones?

Neither is better for everyone: washables may save money and wool adds comfort for someone in bed all day, while disposables save laundry and suit travel. Many families keep both.

Should you limit drinks for someone with incontinence?

No, don't limit water. NIA advises cutting back on caffeinated drinks and on drinks close to bedtime instead. NIDDK advises drinking enough to need the bathroom every few hours, and too little fluid can lead to constipation, which can make leaks worse; ask the doctor how much the person should drink.

Can you use baby powder for incontinence?

No. MedlinePlus advises against baby powder on skin affected by incontinence. Use a barrier cream with zinc oxide, lanolin or petrolatum, or ask the nurse about an antifungal powder if the skin stays moist.

What bedding is best for an incontinent person?

The best bedding is easy to strip and wash, keeps moisture away from the skin and doesn't add bunched layers: a waterproof protector, an underpad and, for long hours in bed, a urine-resistant wool pad on top.

The short version

Good incontinence care at home comes down to a regular toileting schedule, prompt changes, gentle cleaning and drying, a barrier cream if the nurse advises one, a simple layered bed that is easy to wash, and a calm, respectful manner. See a doctor first to rule out treatable causes, and call a nurse about any broken or red skin. Questions about washable, urine-resistant bedding? Contact us; we have helped caregivers since 1988.