How to manage incontinence with dignity?

My father-in-law has started having episodes of incontinence and I feel like every time I help him change, he gets embarrassed. How can I deal with this without making him feel humiliated?

Urinary and faecal incontinence is common in the moderate to advanced stages of dementia and is associated with cognitive changes that make it difficult to recognise the need to go to the toilet in time, find the way, or unfasten clothes independently. It is also one of the most delicate situations for a person's dignity, and the way the carer reacts makes all the difference.

Why it happens

Incontinence can result from the progression of the disease, but also from treatable causes such as urinary infections, constipation, reduced mobility that prevents reaching the toilet in time, or even difficulty in locating or recognising the toilet. Therefore, before assuming it is "normal" for dementia, it is always worth ruling out reversible causes.

Practical strategies

• Toilet routine: suggest going to the toilet at regular times (every 2 or 3 hours), even without an explicit request.
• Clear signage: place a sign or image on the bathroom door and keep the path well-lit and clear, especially at night.
• Easy-to-remove clothing: prefer trousers with elasticated waistbands instead of buttons or zips, which delay access to the toilet.
• Appropriate absorbent products: use incontinence pads or pants adjusted to the degree of leakage, changing regularly to prevent skin irritation.
• Preserve privacy: close the door, speak in a discreet tone, and avoid commenting on the episode in front of other people.
• Skin care: always clean with lukewarm water and mild products, and apply barrier cream to prevent maceration and sores.

"I learned to change my mum as if it were the most normal thing in the world, without rushing and without looking distressed. She senses when we are uncomfortable, and that only makes her shame worse."

What NOT to do

• Do not scold or show visible frustration about the accident — the person has no voluntary control over this.
• Do not discuss the matter in front of visitors or other family members unnecessarily.
• Do not restrict fluids as a way to "solve" the problem — this increases the risk of dehydration and urinary infections.

When to seek professional help

If incontinence appears suddenly, or is accompanied by pain, fever, or strong-smelling urine, consult a doctor to rule out a urinary infection. A continuing care nurse can also help define the best plan for absorbent products and skin care, and arrange for eventual home support for this task.