• Is incontinence a sudden, recent experience?
• Has incontinence been an ongoing problem?
• When do "accidents" occur?
• Is the person constipated?
• Does the diet include fibre
• Does the person have a bladder or urinary tract infection?
• Is the person experiencing urine retention (not emptying the bladder completely)?
• Are there signs of dehydration?
• Does the diet include adequate amounts (six cups) of liquids daily?
• Is illness or surgery affecting urine or stool production?
• Is illness or surgery affecting bladder or bowel control?
• Is mobility or accessibility a problem?
• Have there been recent changes in medication?
• How do current medications affect bladder or bowel control?
• Does the physician or health care professional have expertise in assessing or treating incontinence?
• What kinds of home/environmental changes would make it easier for the person to use the toilet?
• What treatments, continence management techniques and products are available to deal with the particular type of incontinence?
• Is the recommended treatment, continence management technique or product suitable for the incontinent person?

• Keep a bladder or bowel diary for one or two days before meeting with the physician.

  Bladder or bowel diary

  • when the incontinence occurs — time, day, night
  • what is involved — problem reaching toilet, soiled underwear, diaper change, bed-wetting
  • how often — frequency
  • how urgent — urgency
  • how much — volume : large, small
  • where — circumstances : what happened
  • why — possible reason for the accident
  • fluid intake — amount and type of fluids taken
  • type of meals — high-fibre, low-fibre
  • any other information you consider relevant

• Arrange for a medical assessment by a family physician, urologist or other specialist trained to assess and consult in incontinence.

Medical assessment

• age
• medical history : including the history of the incontinence problem, a woman's childbirth history, a man's prostate history
• physical examination
• pelvic exams: vaginal and rectal
• urinalysis: to rule out bladder or urinary tract infections
• medications
• mental assessment (if necessary)
• assessment of the person's environment

• Discuss treatment options with the physician or specialist
• Discuss side effects and risks associated with each form of treatment
• Determine the treatment the most appropriate for the incontinent person
• Learn at-home coping strategies for managing incontinence
• Learn about helpful products to manage incontinence
• Contact health associations and organizations that specialize in dealing in incontinence.

• Learn skills and strategies to prevent and manage incontinence.
• Provide cues and prompts to encourage toileting. Try to establish a bathroom schedule.
• Modify the surroundings, where possible. Keep the bathroom safe by removing clutter.
• Select clothing that is easy to undo and remove.
• Consider the comfort and dignity of the incontinent person.
• Change the diet, if necessary.
• Talk to the physician, urologist, physiotherapist, nurse, pharmacist or medical supplier about about helpful products to manage incontinence.

	Handle incontinence first with routine, consistent toileting, then diapers, then catheters.
	Reward the incontinent person for eliminating at the right time.
	Set a watch or beeper to sound at timed intervals. Place clean bedpans or bedside commodes where they can be seen easily.
	Install a higher toilet seat, possibly with armrests. Install grab bars in the bathroom.
	Jogging suits have no buttons or fasteners. Clothing that fastens in the back with Velcro may be suitable for people who are confined to bed.
	Plastic bedpans are warmer to the touch than metal bedpans. Sprinkle a little talcum power on the bedpan to prevent it from sticking to the skin.
	Ask the pharmacist for a cream for adult diaper rash.
	Include high fibre foods and six cups of fluid daily. Check with the physician before substituting herbal teas for coffee, cocoa, cola or soft drinks. Herbal teas may interact badly with certain medications and illnesses.
	Use washable cushions or slip covers and bed pads.
	Caution: Unless the physician advises it, DO NOT treat incontinence by cutting back on fluids. If the body does not take in enough fluids, the urine will become more concentrated. This highly concentrated urine will irritate the bladder and lay the groundwork for bladder and urinary tract infections.

Helpful Products

Products for continence management can be purchased from a variety of sources: pharmacies, groceries, health stores, medical supply stores, catalogues. Disposable products, such as pads and adult diapers, are particularly expensive and can cost individuals and caregivers several thousand dollars a year. Depending on the degree and type of incontinence, a combination of products may have to be used. The right products will be those that come closest to meeting the needs of the incontinent person.

Ask whether samples or trial packages are available. You may be able to save by buying in bulk. Ask about home delivery.

Continence management products

• mattress pads: washable and disposable
• chair pads
• disposable pads and liners
• disposable briefs with inserts for disposable pads or liners
• washable briefs with inserts for disposable pads or liners
• catheters for men
• urine collection bags
• yrinals: for men and women
• bedpans
• penile clamps to block off the urethra
• urethral plugs and caps for women
• vaginal pessaries or cones for women
• protective clothing with absorbent back panels
• easy-to-remove clothing with Velcro fasteners

	Menstrual pads are useful for catching drips of urine. They may also cost less than pads sold specifically for incontinence.
	Male drip collectors, called pocket pouches, are useful if a man leaks only small amounts of urine.