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  As a healthcare professional, you may be used to having difficult conversations with patients or explaining complicated results to the parent of a young child. However, some topics can be more challenging to talk about than others. Incontinence is something many patients can feel embarrassed about and they may not know how to explain their symptoms to you because of this. This can result in patients not getting the support and advice they need to improve their quality of life. However, there are ways you can navigate conversations about incontinence and transform them into positive, constructive experiences for your patients. In this post, we will provide you with some effective tips for discussing incontinence with your patients to ensure they receive the support they need without feeling embarrassed or ashamed.The importance of effective communication When it comes to sensitive subjects like incontinence, effective communication between healthcare professionals and patients is key. While patients may seek advice for their condition, actually talking about it with you can be daunting – especially if it’s for the first time. As such, make sure you let your patient know that incontinence is a common problem and that there are numerous incontinence products and treatments available to provide relief. By effectively communicating your knowledge of the condition and providing your patient with personalised advice, you can make sure they leave the conversation feeling empowered.Challenges healthcare professionals can face There may be times when you face challenges when trying to discuss incontinence with patients. For example, some of these challenges may include: ●  The patient may not want to talk about it as it may be a ‘taboo’ subject for them ●  They might not want to admit they are experiencing incontinence ●  Feeling overwhelmed by what you’re saying ●  English might not be their first language or they communicate through sign language ●  They may have limited vocabulary or might be unable to read ●  Patients can have speech difficulties which can make it difficult to communicate ●  Feeling uncomfortable talking about it with others outside their support system Knowing when to raise the subject of incontinence is important. It’s best to bring it up when your patient is calm and can focus on your words. Try to be aware of any cues that might suggest your patient wants to discuss something with you too. As a healthcare professional, it’s crucial you understand when a patient needs to be referred to a specialist. While you can provide support and advice, sometimes their incontinence needs are best met by an incontinence specialist. Overcoming these challenges is possible and doing so can make a big difference in your patient’s overall quality of life.Top tips for discussing incontinence with patience While there are some challenges to overcome, navigating conversations about incontinence can have a huge knock-on effect on how well a patient manages their condition. You should use an empathic, matter-of-fact tone of voice. If you feel uncomfortable, don't let this show as it can make your patient uncomfortable too.  Identify and assess how they communicate and look out for non-verbal cues. Simple techniques such as using low-tech aids, signs, picture symbols and communication books can be useful if they are struggling. Here are some of our top tips to help you have these difficult conversations while instilling confidence in both yourself and your patient.Establish trust and comfort One of the most important things you can do is to establish a sense of trust and comfort with your patient. By helping them feel at ease, they may become more open to having difficult conversations or sharing any symptoms they’re particularly embarrassed about. Some patients also benefit from having the reassurance that what they say is confidential and will not be shared without consent. This helps develop trust and can make them more willing to share personal information with you.Use empathetic language Using the right language can make conversations around incontinence easier for you and your patient. Reassure them by letting them know how common incontinence is and that it’s not impossible to manage effectively. Each patient is different; some may be happy to talk about their bathroom habits, while others might not be. Therefore, it can be a useful exercise to put yourself in the shoes of a patient struggling with incontinence and think about what you would like your healthcare professional to say to you. This may help you generate some open questions and supportive phrases to help them feel more comfortable. Incontinence is a difficult condition to manage on its own and it can cause lots of negative feelings for the patient. So try to be understanding if they are closed off or shut down when you talk to them about it. By demonstrating empathy in how you talk to them, your patient may come around and feel more comfortable about opening up.Educating patients Many patients will have a strict idea of what incontinence looks like, believing many of the stereotypes and stigmas associated with it. However, by explaining the causes, symptoms and common misconceptions, you can provide your patients with the education they need to fully understand the condition. Resources can be a huge help for patients as well, especially if they feel overwhelmed or confused. Some patients need time to adjust on their own or with their loved ones, so providing them with supportive resources can make all the difference.   Have an open dialogue It’s important that during these conversations with your patients, you make them feel at ease and as though they are free to talk about their experiences. Asking them open questions rather than ones with ‘yes’ or ‘no’ answers can feel less direct. For example, asking ‘Are you experiencing any problems with going to the toilet?’ creates an opportunity for the patient to explain their symptoms without feeling as though they are being diagnosed with something straight away or put on the spot. It can take some patients a lot of courage to talk openly about their symptoms, so try to keep the dialogue open and let the conversation flow naturally without any direct questions (except when necessary).Collaborate on decision-making One final tip when discussing incontinence with patients is to involve them in the decision-making about their condition. After all, there are so many different treatments and products out there, and each patient will have unique needs and preferences. So if you simply tell a patient what they must and must not do, they can feel restricted or as though they have no say in the decision. Ask them what their preferences would be and keep them involved every step of the way. And if they have a carer with them, keep them as actively involved as possible. By making collaborative decisions with your patient about their management plan, you can help empower them to take control of their incontinence. Remember, care should be person-centred and not just focused on tasks and processes. An important element of care is to be aware of and sensitive to the features of a person’s life, including their values, feelings and beliefs and promote dignity.  Incontinence products with Attends Although incontinence is a complicated condition, conversations about it with patients don’t have to be. By providing them with knowledge and resources, promoting open, empathetic dialogue and establishing trust, you too can easily navigate conversations with patients about incontinence. When it comes to providing patients with information on incontinence products, you can also rely on Attends to be the brand that meets their needs. We offer a huge range of products that can help your patients manage their incontinence on a daily basis. Discover more about the Attends incontinence products range.Sources ●  Bladder & Bowel UK - Starting Conversations with Patients About Bladder & Bowel Health ●  The BMJ - Incontinence is Lonely & Hard to Talk About

Urinary incontinence is a common issue faced by men and women alike, often requiring visits to the doctor for extra support. Many patients with incontinence avoid drinking fluids, as they feel like it causes additional problems. As a healthcare professional, it is important to advise on the type and amount of fluid which can help to reduce symptoms and maintain bladder function. Many drinks contain caffeine, or have artificial sweeteners, which can irritate the bladder. While they may be delicious, caffeinated drinks can be a contributing factor towards incontinence during the festive season. As Christmas draws closer and the party season begins, it’s important to remind your patients that beer, wine, spirits and other alcoholic beverages can act as a bladder stimulant, and ultimately lead to incontinence. Moderation in alcohol consumption plays a crucial role in maintaining bladder health. Throughout this blog, we thought we’d unwrap the connection between caffeine and incontinence while exploring some of the best ways to encourage your patients to switch to decaf. The link between caffeine and incontinence While you may already understand the effects of caffeine, not all of your patients will. However, there is a well-established direct link between increased incontinence and caffeine – a staple in many people's morning routines. Due to its strong diuretic properties, those with incontinence issues can struggle to improve their bladder health while consuming associated products such as tea and coffee. Caffeine stimulates your kidneys and causes them to produce more urine by reducing your water absorption. This leads to an increase in both urine urgency and frequency and, if patients are experiencing incontinence already, discomfort. Caffeine also causes spasms and contractions of the bladder, something which can increase the risk of incontinence. Studies have shown, for example, that a caffeine intake of more than or equal to 240 mg per day can elevate the chances of urinary incontinence. For context, one double espresso contains around 125 mg of caffeine, so consuming just two coffees a day is more than enough to impact bladder health.Using decaf as a preventative incontinence measure Decaffeinated options can act as a shield against the diuretic effects of caffeine, alleviating incontinence issues. As healthcare advocates, it’s important to encourage patients to put proactive measures in place, empowering them to make more mindful choices. Navigating coffee shop menus full of caffeinated drinks can be easy when patients know how – and why they should be doing so. Let them know of the effects caffeine can have on their bladder and inspire them to ask for a decaf version wherever possible.  The ‘Taste The Difference’ challenge Generally, patients are offered caffeinated tea and coffee during ‘drinks rounds’ – which we know can lead to a greater risk of bladder (and even bowel) incontinence. As such, the Taste The Difference challenge was set up as a project within hospitals to encourage patients to switch to decaf. Feedback was collected from patients during the challenge, asking not only whether they could taste the difference but also if they would consider switching to decaf after finding out the health benefits. The feedback showed over 50% of patients couldn't taste the difference and over 76% of them said they would switch to decaf after learning about the health benefits. This demonstrates that knowledge is the key to unlocking the switch to decaf. Benefits of decaf in patients with incontinence Switching to decaf can provide your patients with relief from urinary incontinence, making it a much more comfortable festive season. Some of the key benefits associated with switching to decaf include: Improved bladder control – without the diuretic effects of caffeine, patients can expect a reduction in urgency and frequency of urination. This gives them greater control over bladder function and can reduce stress during a sometimes stressful time of year.  Enhanced quality of sleep – getting enough sleep is vital, especially during the busy Christmas period. However, drinking caffeine can lead to more frequent urination or loss of bladder control during the night. Switching to decaf can stop disruptions during sleep and improve mental wellbeing.  Better hydration – drinking decaf helps patients maintain their fluid intake as it prevents the kidneys from over-producing urine. Being well hydrated can also prevent bladder irritation which can lead to incontinence.  Decaffeinated beverages have come a long way in recent years and many people aren't able to tell the difference. This means your patients can still enjoy their favourite flavours without compromising their bladder health.Encouraging patients to switch from caffeine to decaf Knowing the effects caffeine has on bladder health is not something everyone will know. Whether you work in the community or a hospital setting, educating patients with incontinence on the steps they can take can make all the difference. Some effective ways to help your patients make the switch to decaf include: ●      Provide advice on which products are available as decaffeinated ●      Empower them with the knowledge of decaf's benefits and how caffeine affects incontinence ●      Have leaflets they can take away with them so they can solidify their knowledge and share it with others ●      Be prepared for pushback from patients who are content with drinking caffeine – let them know the facts so they can make an informed decision ●      Have samples they could take home and try or signpost them to great decaf options in supermarkets ●      Advise patients that the shift can be gradual to reduce the side effects of caffeine withdrawal Side effects of quitting caffeine As well as highlighting the benefits, it's worthwhile letting your patients also know about some of the side effects of giving up caffeine altogether – especially if they drink it every day, multiple times a day. Some side effects of caffeine withdrawal can include: ●      Headaches ●      Fatigue ●      Low mood ●      Irritability ●      Feeling foggy However, these side effects tend to last only a few days as the body starts to withdraw from caffeine reliance. Discover incontinence products with Attends Drinking caffeine may be something most of your patients do every day, but providing them with support and information can help them make healthy choices for their bladder health. Here at Attends, we offer a wide range of incontinence products for both men and women, as well as discreet options for those wanting to feel secure while out Christmas shopping.    Discover the power of Attends incontinence products this festive season and help your patients manage their bladder health with ease. Sources Leicester Hospitals - Taste The Difference Challenge Bladder & Bowel UK - Taste The Difference Challenge NHS - Urinary Incontinence, Best Ways to Stop Leaks

Male incontinence is a common problem that can impact men of any age, potentially leading to feelings of embarrassment, anxiety and depression. With around one in three older men having incontinence problems, it is therefore essential for healthcare professionals to address this issue with confidence. Providing men with support for their urinary incontinence can have a hugely positive impact on their lives and well-being. As a healthcare professional, you can become a beacon of knowledge and advice on the topic, helping men manage their condition and restore their confidence levels once again. Understanding male incontinence Male incontinence, or loss of bladder control, can occur for several reasons, the main ones being due to age and injury. It is important to understand the symptoms of urinary incontinence so you can provide support. The most common symptoms are: ●     Needing to pee often, both day and night ●     Having trouble starting your urine flow ●     A weak urine stream ●     Straining (using stomach muscles) when urinating ●     Feeling like your bladder is never all the way empty, even after you go ●     Discomfort when urinating ●     Pressure in your lower abdomen While male incontinence often occurs as a result of ageing, it can also be caused by other factors. A medical assessment will help when planning treatment. Some of the factors that can cause urinary incontinence in men can include: ●     Urinary tract infections ●     Medication –  for example, diuretic medications can increase the risk of urine leakage ●     An enlarged prostate can obstruct urine from passing ●     Being overweight puts extra pressure on abdominal and pelvic muscles, making it harder to avoid urine leakage ●     Diabetes can cause nerve damage to your urinary tract, causing bladder problems ●     Neurological conditions like Parkinson’s disease and multiple sclerosis ●     Neurodegenerative diseases like Alzheimer's ●     Arthritis can also cause functional incontinence as it can make going to the bathroom much more difficult There are also different types of urinary incontinence that a man can experience. The five main types are: Stress incontinence – where urine leaks out due to pressure being put on the bladder through actions like sneezing, laughing, exercising or heavy lifting Urge incontinence – feeling a sudden urge to urinate and involuntarily losing bladder control Overflow incontinence – regular or constant leaking of urine due to a bladder that doesn’t empty fully when urinating Functional incontinence –  caused by a physical or mental impairment that prevents you from reaching the toilet in time Mixed incontinence – where you experience more than one type of incontinence at the same time, such as stress and urge As the body ages, bladder control weakens and its capacity to store urine decreases. Therefore, ageing is often the main cause of male incontinence. Dealing with incontinence every day can be physically and mentally challenging. Not only does it cause temporary discomfort, but it can also lead to prolonged feelings of anxiety or low mood. Over time, male incontinence can have a devastating effect on a man’s quality of life.  Breaking the stigma – men’s mental health and incontinence Unfortunately, there is still a lot of stigma around male incontinence. That’s why it’s so important for you as a healthcare professional to understand and address it. Many men feel embarrassed or don’t want to talk about their emotions when dealing with incontinence. However, letting men express how their incontinence is making them feel and affecting their daily lives can be one of the first steps towards breaking the stigma. Normalising male incontinence products is also a brilliant way to break the stigma. Letting them know there is no shame in using them can go a long way. In general, men’s mental health is often overlooked — which is why movements such as Movember have come about. This annual event encourages men to grow moustaches throughout November to raise awareness of men’s health issues such as mental health, prostate cancer and testicular cancer. While proving mental health support should happen year-round, Movember is a good reminder that it’s vital for healthcare professionals to know how to help and where to signpost it.   Movember and men’s mental health As a significant fundraiser and awareness campaign for men’s health, Movember helps bring the problems men face into the public consciousness. It shows them that there’s nothing to be ashamed of when dealing with health problems — whether physical or emotional. Addressing male incontinence ties into the broader scope of men’s overall health. Dealing with incontinence can lead to poor mental health and this can be debilitating. By showing male incontinence is a common issue that can be effectively managed, you can help your patients grow in confidence and lead happier, healthier lives. Seeking professional help Seeking professional help for male incontinence is important as it ensures a proper diagnosis and support with different treatment options. Knowing there is an open line of communication between patients and healthcare professionals can make all the difference. Men need to know they can speak with their healthcare professional about anything — including urinary incontinence. Keeping these lines of communication open and in confidence ensures security and honest conversations.   Insights and management techniques Managing male incontinence in a clinical setting is vital within your role as a healthcare professional. Understanding the underlying cause of their incontinence means men receive the right treatment and product advice. Simple lifestyle changes can help. These can include: ●     Maintaining a healthy weight ●     Reduce caffeine, limit alcohol and carbonated drinks ●     Cut down on smoking – excessive coughing can put additional pressure on the bladder ●     Bladder retraining – to modify your bladder’s behaviour by scheduling bathroom trips at set times throughout the day ●     Strengthen your pelvic floor muscles Educating your patients is also a great way to help them effectively manage their incontinence. Many men may not know why they are experiencing incontinence, so discussing the different causes and the variety of incontinence products available can help them feel empowered. If incontinence products are a part of your management plan, we offer male incontinence products such as protective shields, pads and all-in-one briefs. At Attends, we offer a wide range of male urinary incontinence products to give back the confidence and dignity men deserve.  Some of our male incontinence products include: ●     Attends For Men Protective Shield ●     Attends For Men Protective Pad ●     All-In-One Briefs ●     Fixation Pants ●     Underpads Our products are designed to comfortably fit the contours of the body and provide absorption and protection. Discover our range of male incontinence products. Support and resources Being able to signpost your patients to the right resources can make a huge difference when they are dealing with incontinence. Some useful support and resources for male incontinence include: ●     Age UK ●     Bladder & Bowel UK ●     Bladder Health UK ●     Men’s Health Forum Having a strong network of support is priceless so encouraging men to connect with other men facing the same issues can be a big help when trying to understand male incontinence. Reaching out to places like Bladder & Bowel UK, or chatting with other men on Men’s Health Forum, can help them learn how to manage the condition, as well as talk freely about what they are experiencing. While male incontinence is affecting more men each year, by teaching men to take proactive steps towards seeking help, you can provide them with the support they need. Encouraging them to take part or support other men taking part in Movember can also be a good way to get involved and help end the stigma around incontinence.   Explore our complete range of continence products designed especially for men. Sources ●     Web MD - What Is Urinary Incontinence? ●     Web MD - Treatments for Urinary Incontinence ●     Practice Nursing - Urinary Incontinence, What You Need To Know

Urinary incontinence is a common menopausal symptom that can impact a woman’s physical and mental wellbeing. However, many women are too embarrassed to discuss this sensitive topic with their healthcare professional, mistakenly believing it to be a natural part of the ageing process and simply enduring the distress it causes. It’s important that as healthcare professionals, you encourage women to share their concerns and be proactive about their pelvic health during this natural transition in life. This blog will help you better understand the relationship between menopause and urinary incontinence, its causes, how to support women and provide the best treatments.Types of urinary incontinence in menopausal women There are three types of urinary incontinence that typically affect menopausal women: Stress Incontinence Falling oestrogen levels during perimenopause thin the urethra and weaken the pelvic floor muscles, triggering tiny bladder leaks that can occur when a woman coughs, laughs, sneezes or lifts a heavy item. Urge Incontinence (Overactive Bladder) A sudden urge to urinate that occurs on a frequent basis throughout the day. Mixed Incontinence A combination of urinary incontinence symptoms and urge incontinence.Risk factors for urinary incontinence in menopause Menopause and urinary incontinence are closely intertwined, with declining oestrogen levels during menopause having a significant impact on the pelvic muscles and tissues that support the bladder. Understanding the risk factors associated with these conditions is vital for both diagnosis and comprehensive care. Below, we delve into the key risk factors for both menopause-related urinary incontinence and its broader implications. Menopause-related urinary incontinence Hormonal Changes – menopause, characterised by declining oestrogen levels, contributes to the weakening of the pelvic muscles and supporting tissues. This structural shift can disrupt bladder control and lead to urinary incontinence. Ageing – while urinary incontinence becomes more prevalent with age, it is important to note that it is not an inevitable consequence of growing older. Postmenopausal women are approximately 50% more likely to experience urinary incontinence, often a primary symptom of genitourinary syndrome of menopause (GSM). Genitourinary syndrome of menopause (GSM) GSM is a comprehensive condition encompassing various symptoms beyond urinary incontinence. These can include: ●     Vaginal dryness ●     Decreased libido ●     Bladder issues during intercourse Diagnosis considerations When diagnosing women with menopause-related urinary incontinence, it's important to adopt a holistic approach by considering a number of potential contributory factors. These could include: ●     Number of pregnancies ●     Birthing trauma ●     Hormonal disorders ●     Obesity ●     Chronic constipation ●     Diseases that cause nerve damage, e.g. Parkinson’s disease ●     Certain drugs like diuretics ●     Previous operations The psychological and emotional impact of menopausal incontinence  Living with urinary incontinence during menopause can affect a woman’s physical and mental wellbeing – from impacting their sex life to causing anxiety and a lack of confidence when going out. Healthcare professionals can address these concerns by positively approaching urinary incontinence and encouraging women to discuss their symptoms.Early intervention and strategies for managing incontinence during menopause Although menopause and urinary incontinence remain taboo, early intervention is vital, as genitourinary syndrome of menopause can worsen over time. One of the principal steps women can take to reduce the risk of developing incontinence both during and after menopause is by performing pelvic floor exercises for at least three months. These should be practised even if women do not have incontinence symptoms, including at times like pregnancy and childbirth. Strategies for maintaining overall pelvic health include pelvic floor exercises and low-impact activities such as pilates. Healthcare professionals can also offer women practical tips to help manage incontinence during menopause. This could include the following behaviour changes: Eat Well Losing weight can help. Studies suggest a 5% weight loss reduces symptoms in obese patients. Eating more fibre can also prevent constipation, which can cause urinary incontinence, while avoiding spicy and acidic foods that irritate the bladder may help as well. Drinks A reduced consumption of caffeinated, carbonated or alcoholic drinks can help alleviate bladder irritation. Drinking 6 – 8 glasses of water per day can increase the overall capacity of the bladder. Exercise High-impact sports like running should be avoided due to the pressure they can put on the pelvic floor. If pelvic floor exercises are carried out regularly, high-impact sports can be reintroduced. Other preventative measures could include stopping smoking (coughing puts pressure on the bladder), tightening the pelvic floor when lifting objects and keeping hydrated to avoid constipation. Medical interventions and treatments  There are a wide variety of medical treatments available to treat menopausal incontinence. These include: Oestrogen Pessaries A local topical treatment inserted in the vagina to enhance skin elasticity. Recent research has shown that these can be especially beneficial in reducing or eliminating stress incontinence and supporting the urethra. Medications Antimuscarinics can calm overactive bladders, mirabegron can help the bladder relax and fill, and duloxetine can keep the urethra closed. Electrical Stimulation Used in physiotherapy to train the pelvic floor muscle by placing a small probe inside the vagina. Biofeedback Training Provides feedback on how well a patient is performing pelvic floor exercises. Bladder Training Teaches women to regain control by scheduling toilet trips and waiting longer between bathroom visits. Pelvic Floor Exercises Also known as Kegel exercises, this effective method of regaining bladder control involves squeezing and relaxing muscles in the pelvic region to strengthen them. Surgery Used as a last resort after other therapies, surgical treatments include colposuspension, sling surgery and vaginal mesh surgery. Incontinence Products These items are beneficial while awaiting diagnosis or during treatment to help promote dignity. There are a variety of products to choose from to suit individual needs, including pads and pull-up pants. All women experience symptoms of the menopause and urinary incontinence is a common symptom. However, healthcare professionals can encourage women to share their concerns and be proactive about their pelvic health during this natural transition in life. If necessary, make referrals to the appropriate healthcare professional, whether physio, GPs or urogynaecological consultants, to ensure effective management and treatment. Explore our range of continence products designed to help women manage urinary incontinence, and learn why it’s vital to ensure the correct level of absorbency. References National Library of Medicine - Urinary Incontinence in Postmenopausal Women North American Menopause Society - Urinary Incontinence Web MD - Menopause & Bladder Control Management Healthline - Menopause & Urinary Incontinence National Library of Medicine - Effectiveness of Hormones in Postmenopausal Pelvic Floor Dysfunction Kegel 8 - Is HRT Making Your Menopause Worse? NHS - Surgery & Procedures for Urinary Incontinence NHS - 10 Ways to Stop Leaks Up To Date - Urinary Incontinence Treatments for Women

Whether you work in the community or a hospital setting, managing incontinence in patients with Alzheimer's requires personalised care and sensitivity. This blog explains how healthcare professionals (HCPs) can promote best practices for incontinence management in Alzheimer's patients, who can feel anxious, frustrated and fearful without the correct support.Understanding incontinence in Alzheimer's Individuals   Urinary, faecal or double incontinence are common as Alzheimer’s disease progresses, although it is not an inevitable part of the condition. Communication between healthcare providers and the patient is one of the prime challenges in managing incontinence. The person living with Alzheimer’s may be unable to tell you they need the toilet, can’t reach it in time, or forget how to use it. Best Practices for Incontinence Management These evidence-based strategies can help you to manage incontinence in patients with Alzheimer’s.  Nutrition and fluids A balanced diet and exercise help prevent constipation. Encourage fluids, as limiting fluids could cause dehydration, which could lead to a urinary tract infection and increased incontinence. Keep to a routine Maintaining a routine for toilet use can help to avoid accident. Hygiene Ensure the skin is kept clean and dry. Check skin regularly to ensure that there isn’t excessive exposure to urine and faeces, as this may cause skin damage.  Continence products When selected/used appropriately, continence products can help maintain dignity and prevent the discomfort of fluid soaking into clothing or bedding. Medications Medications can affect incontinence — for example, diuretics or sleeping tablets and so on. It is important to review these.Maintaining Patient Dignity and Comfort Creating a supportive environment will help you to manage incontinence in Alzheimer’s patients, preserve their dignity and comfort, and reduce the likelihood of distress.  Simple design changes like these create a dementia-friendly environment: Colours – Painting the bathroom in a contrasting colour helps people identify it.  Light – Adding a night light shows a clear path to the toilet. You can also keep the doors ajar for easy access. Materials – Avoid busy patterns, which patients can misinterpret as a hole or someone jumping at them, making them feel agitated. Signage – Putting a picture of a toilet on the bathroom door (at head height) will make it more visible. Practical Adjustments – Handrails, raised toilets, and commodes make toilet use easier. Patients can recognise a lever more than a modern push button. Avoid Mirrors – reflections can be distracting if a person does not recognise their reflection. They may think that there is a stranger in the bathroom. Effective Communication Healthcare providers and caregivers must adapt to patients’ loss of communication skills as Alzheimer’s disease progresses.  Look for nonverbal cues that show the patient needs to use the toilet, such as hiding, silence, fidgeting and pacing. Use matter-of-fact language (not baby talk) to alleviate embarrassment and prevent agitation from escalating. Make a note of trigger phrases Alzheimer’s patients with incontinence use when wanting the bathroom, even if the words do not make sense to you, for example: ‘I need to go out’. Personalised Care Plans Respect the need for privacy as much as possible. When managing incontinence in Alzheimer’s patients, HCPs should personalise care plans to consider the person’s needs. It’s vital to be flexible and update the plan continually as the disease’s progression changes.  Ensure Alzheimer’s patients have a continence assessment, with referral to a Continence Specialist Nurse and Alzheimer’s specialist for additional support.Hygiene and Skin Care Keep wipes, sanitiser, continence products, disposable gloves and a disposal bin close to hand to maintain proper hygiene and skin care.  Learn how to prevent Moisture-Associated Skin Damage (MASD). Continence Products The type of continence products you need will depend on the individual’s type and level of incontinence, and the individual’s ability. For example, if the individual is passing small amounts of urine, or a dribble, a smaller product may be beneficial rather than a larger product which may cause distress to the individual. When it comes to selecting an all-in-one product, it is important to select the correct size. Please measure the individual’s waist and hips and use the larger of the two sizes to select a product size. If a product is too large, it increases the risk of leakage. You can use our product finder tool to find the most suitable type of product and absorbency level. We have nine categories at Attends, providing all-round comfort, leakage protection and odour protection. Shields for men – these incontinence pads protect against light to moderate urine leaks. Pads for women and men - can be worn day or night for light to heavy urinary incontinence.They are breathable and soft for sensitive skin. Night pads are also available for extra protection. Shaped pads – these easy-to-fit anatomically shaped unisex products are for urine and faecal leaks. Pull-up pants – our unisex Pull-Ons are disposable pants for light to moderate bladder weakness. Belted briefs – we designed the Attends Flex range to manage heavy incontinence. All-in-one – these briefs are for managing heavy incontinence in men and women. Fixation pants – used with Attends shaped pads; the Fixation range includes 6 sizes from small to XXXL. Underpads – the Cover-Dri range provides an extra layer of security and comes in different shapes/sizes to suit different needs. Other products – we produce various products for HCPs and caregivers, including bibs, cleansing gloves and dry cleansing wipes. Collaboration with Caregivers and Families If an individual has Alzheimer’s, incontinence can have a profound impact on the person and their families who may be scared about someone else handling their care.  Involving the family carer in the management plan can help to alleviate their worries. It’s also an opportunity for the HCP to learn about the patient’s likes and dislikes, so they can personalise the care plan. Education, resources and support for caregivers are available from the charity Social Care Institute for Excellence, the Alzheimer’s Society and Dementia UK.   Alzheimer’s patients require a comprehensive and compassionate approach from healthcare professionals when managing incontinence. We can do this by listening to them and their families, maintaining patients’ dignity, tailoring strategies and approaches to individual needs, creating a safe environment, maintaining hygiene, and using the correct continence products.  Explore our complete range of continence products that promote patient comfort and dignity. Sources Alzheimer's Association - Daily Care Alzheimer's Society - Toilet Problems, Continence & Dementia Bladder & Bowel Community Very Well Health - Urinary & Faecal Incontinence in Dementia Social Care Institute for Excellence - Dementia at a Glance Social Care Institute for Excellence - Dementia Friendly Environments Alzheimer's Association - Care Planning Alzheimer's Association - Cognitive Impairment Care Planning Tool Kit

Moisture-associated skin damage (MASD) is caused by prolonged exposure of skin to various sources of moisture, including urine or faeces, perspiration, wound discharge, mucus, saliva, and their contents (Gray et al, 2011; Woo et al, 2017). When skin is exposed to prolonged moisture, the natural Ph level of the skin changes and can become sore and break eventually (Gray et al, 2011; Woo et al, 2017). Other factors contributing to MASD include germs on the skin surface, and mechanical factors such as friction (Gray et al, 2011). When the skin breaks down due to the presence of moisture it is more at risk of becoming damaged due to pressure (Fletcher, 2020).Prevention of MASD MASD can be prevented by making sure: Skin is regularly washed with a pH balanced cleanser, kept as dry as possible and checked regularly. A skin barrier film or cream is used, if at risk of MASD. This forms a protective layer between the skin and external irritants and moisture (Gray et al, 2011; McNichol et al, 2018). Any pads used for incontinence meet the correct level of absorbency (Beeckman et al, 2018). Any wound dressings meet the correct level of absorbency required. Any stoma/urostomy products are well fitted and emptied regularly. Regular change of position if the ability to walk is reduced/limited (Beeckman et al, 2020). Types of MASD Incontinence-Associated Dermatitis (IAD): IAD is caused due to a chemical irritation when urine or faeces meets the skin. Ammonia from the urine and enzymes from the faeces disrupt the acid balance of the skin and eventually causes the skin to break down (Woo et al, 2017). The affected area will present with swelling, skin changes and then it may progress to painful partial-thickness sores with a weepy sometimes green or clear fluid leakage. Faeces contains enzymes which increase the risk of infection when the skin is broken. With incontinence of urine and or faeces, the risk of developing MASD increases (Beeckman et al, 2018). Other related risk factors include reduced ability to walk resulting in difficulty getting to the toilet; diuretics (water tablets) and regular urine infections. Some medical conditions can result in incontinence which increases the risk of MASD. These are Multiple Sclerosis (MS); Parkinsons; Dementia; Spinal cord injury; Learning disabilities; Alzheimer’s disease; Crohn’s disease and Ulcerative colitis (Fletcher, 2020).Intertriginous Dermatitis (ITD): This occurs when sweat is trapped in skin folds with minimal air circulation and is subjected to friction (Metin et al, 2018). This leads to inflammation and stripping of the skin, making the area more prone to infection (Kottner et al, 2020). Obese people are more at risk of ITD due to excessive skin folds, increased perspiration to regulate body temperature, and higher skin surface pH (Gabriel et al, 2019; Kottner et al, 2020).Periwound Moisture-Associated Dermatitis: The production of leakage is a normal response during the inflammatory stage of wound healing. Excessive amounts of wound exudate can cause the area around the wound (within 4cm of wound edge) to become damaged and break down (Fletcher, 2020). The presence of bacteria, specific proteins, or enzymes, and the volume of wound leakage greatly reduce the skin barrier function. Another factor affecting the occurrence of periwound damage is heavy handed removal of adhesive wound dressings, which affects the ability of the skin barrier by stripping away parts of the inner layer of the skin (Fletcher, 2020).Body Areas Prone to MASD Areas of the body prone to high risk of MASD include buttocks, groins, anal cleft and inner thighs, skin folds (e.g. under the abdomen and breasts), skin surrounding a stoma, urostomy sites and wet wounds. Signs & Symptoms of MASD MASD can be difficult to spot for people with darker skin. It's therefore useful to look out for the following (Fletcher et.al, 2020): Persistent red, sore and unbroken skin (this is not as obvious in darker pigmented skin). Skin is shiny and moist in appearance (again, not as obvious in darker pigmented skin). Multiple smaller areas of broken skin, where the skin has been stripped away. This can be superficial skin damage but can quickly extend in size and affect deeper tissues. Skin that is warm when touched. Skin that itches or stings. Wet skin. Implementing an Appropriate Care Pathway The approach to care will be similar in the first instance for all four types of moisture-associated skin damage and should focus on the following: Adopt a structured skin care regimen Use products that absorb and/or keep moisture away from the skin. Control the cause of excessive moisture. Treat infection (Voegeli, 2020). Avoid soap and water as traditional soap is made up of alkalis and fatty acids that raise the pH of the skin (Voegeli, 2020). The use of soft cloths and liquid barrier films and moisture barrier creams are recommended (Lichterfeld-Kottner et al, 2020). To learn more about skin health, please visit our free online eLearning platform - designed specifically for health and social care professionals, and you and your loved ones.References Beeckman, D., Campbell, K., Le Blanc, K. et.al (2020) Best practice recommendations for holistic strategies to promote and maintain skin integrity. Wounds International. Available online at: https://www.woundsinternational.com/resources/details/best-practice-recommendations-holistic-strategies-promote-and-maintain-skin-integrity. Beeckman, D., Smet, S., Van den Bussche, K. (2018) Incontinence-associated dermatitis: why do we need a core outcome set for clinical research? Wounds International 9(2): 21-25 Fletcher, J. (2020) Pressure ulcer education 6: incontinence assessment and Care. Nursing Times [online]; 116: 3, 42-44. Fletcher, J., Beeckman, D., Boyles, A. et al (2020) International Best Practice Recommendations: Prevention and management of moisture-associated skin damage (MASD). Wounds International. Available online at woundsinternational.com Gabriel, S., Hahnel, E., Blume-Peytavi, U., Kottner, J. (2019) Prevalence and associated factors of intertrigo in aged nursing home residents: a multi-center cross-sectional prevalence study. BMC Geriatrics 19(1): 105 Gray, M., Black, J.M., Baharestani, M.M., Bliss, D.Z., Colwell, J.C., Goldberg, M., Kennedy-Evans, K.L., Logan, S., Ratliff, C.R. (2011) Moisture-associated skin damage: overview and pathophysiology. J Wound Ostomy Continence Nursing. May-Jun;38(3):233-241. Kottner, J., Everink, I., Van Haastregt, J. (2020) Prevalence of intertrigo and associated factors: A secondary data analysis of four annual multicentre prevalence studies in the Netherlands. Int J Nurs Stud 104: 103437 Lichterfeld-Kottner, A., El Genedy, M., Lahmann, N. et al (2020) Maintaining skin integrity in the aged: A systematic review. International Journal Nursing Studies 103: 103-509. Metin, A., Dilek, N., Bilgili, S.G. (2018) Recurrent candidal intertrigo: challenges and solutions. Clinical Cosmet Investigation Dermatology. April 17;11:175-185. McNichol, L.L., Ayello, E.A., Phearman, L.A., Pezzella, P.A., Culver, E.A. (2018) Incontinence-Associated Dermatitis: State of the Science and Knowledge Translation. Advanced Skin Wound Care. November 31(11):502-513. Voegeli D (2020) Intertrigo: causes, prevention and management. Br J Nurs 29(12): S16-22. Woo, K.Y., Beeckman, D., Chakravarthy, D. (2017) Management of Moisture-Associated Skin Damage: A Scoping Review. Advanced Skin Wound Care. November;30(11):494-501.