My name is Jane Fothergill and I'm a physiotherapist.
I work closely with occupational therapists.
Some occupational therapists and physiotherapists are trained to assess the needs
of the person and advise on the right equipment for the person's situation.
Assessment by these therapists will often complement assessments by other continence specialists.
It's important to consider the whole picture when planning how to manage bladder and bowel problems,
as there may be more than one factor contributing to the issue.
Incontinence affects people of all ages and is often linked with other health issues or disabilities,
such as arthritis or dementia.
Sometimes physical, intellectual or environmental issues contribute to a person experiencing incontinence.
This is commonly called functional incontinence.
Some of the causes of functional incontinence include problems with walking,
such as arthritis or cerebral palsy
and sometimes with memory or learning such as dementia and intellectual disability.
For example not being able to get up and walk to the toilet easily
or when the toilet is hard to get to or use
or clothing that's hard to remove in the toilet
or not being able to find the toilet without help
or finding the toilet in the dark.
In this video I will outline some of these issues and suggest some ways to manage them.
Mobility issues impact on a person's ability to get to the toilet in time.
Poor balance also can mean an increase risk of falls,
especially when rushing to the toilet.
It's important to use an appropriate walking aid to maximise safety,
improve balance, and reduce the risk of falling.
There are many types of walking aids including walking sticks,
static frames and wheeled walkers.
An occupational therapist or physiotherapist can provide advice about
which type of walking aid may be suitable.
It is important that the walking aid is adjusted correctly for the person using it.
Most walking aids feature adjustable handle height.
Handles should be set at the wrist crease height
to promote a natural upright posture when walking.
It can be difficult for some people to get themselves to the toilet,
for example getting out of bed or up from a chair.
To increase a person's independence in getting to the toilet
it is important to consider the height of furniture including the toilet, bed and chairs.
If a bed is too low to the floor, it will be more difficult
and take longer for the person to get up,
which can also impact on the ability to get to the toilet in time.
As a general guide when seated with feet flat on the floor,
hips should be just above the height of the knees.
A toilet seat raiser can be placed over a low toilet to raise the seat height.
Toilet seat raisers may have arms rests which also facilitate an independent transfer.
A toilet surround may be an option where the existing toilet seat height is okay,
but the person may need extra support to push themselves up.
Specially designed blocks can be placed under the legs of some chairs or beds
to safely raise the height.
A person may be incontinent if there are problems relating to grasping,
reaching and managing fine motor tasks like undoing zippers.
Consider ways to help with the undressing process, for example
replacing fiddly buttons or zippers with Velcro tabs that are easier to manage.
There is a wide range of adaptive clothing available with features like open backs,
elastic waist bands and easy fastenings
which may help a person undress and get to the toilet more quickly.
Small aids like bottom wipers can help if grasping or manipulating toilet paper is difficult.
Also consider where the toilet paper is located and ensure that it is easy to reach.
Memory issues, confusion, lack of insight or an inability to communicate the need to go to the toilet,
can all be significant factors contributing to incontinence.
Further assessment is advisable to explore the extent of these issues
and develop strategies to address them.
Use of visual cues, communication cards, or other reminder devices may be some of the strategies to consider.
For safe access to the toilet it is important to create a clear walkway with no trip hazards.
Remove loose floor mats or rugs and consider removing furniture that might be blocking the way.
Make sure there is enough room to pass through with the walking aid that the person plans to use.
Good lighting is also important, especialy at night time when it's easier to become disorientated.
Consider installing night lights in positions that shed light in hallways and bathroom or the toilet area.
Sensor lights can be a handy option as they turn on only when movement is detected
and do not need to be manually switched on or off.
Home modifications are more permanent option to improve access to the toilet.
Grab rails may help with balance and transfers.
Slip resistant floor treatment may improve safety on tiled surfaces,
especially if the floor is likely to become wet and slippery with urine on the floor.
A therapist can provide recommendations regarding minor home modifications
that may help in your specific situation.
It may not always be practical to use the toilet itself,
for example at night if the toilet is located a distance from the bedroom.
Equipment alternatives may provide a safer option,
allowing quicker access for toileting and reducing the risk for falls.
A commode can be positioned next to a person's bed or nearby within the bedroom.
This can be very helpful if the toilet is reasonably far away
and mobility issues may prevent the person from getting to the toilet in time.
A urine bottle may be a good option to consider if bed transfers are difficult,
as the bottle can be used whilst in bed or from a seated position on the edge of the bed.
Both female and male versions are available.
Bed pans are designed to be used from a lying position in bed,
and can be particularly useful for carers assisting a person
whose mobility and transfers are difficult
and they would otherwise have trouble accessing a toilet or commode.
Bidets are available in a range of different styles,
including fully electronic systems with automatic water spray
and air dry functions for hands free cleaning and drying after toileting.
These systems can be worth considering if motor issues such as reaching and grasping
prevent a person from adequately cleaning themselves.
There are a number of equipment options designed for travelling,
including portable or disposable urinal bottles and foldable toilet seat raisers and commodes.
If travelling interstate you may consider hiring equipment at your destination.
Independent Living Centres Australia have nine locations across the country,
staffed by health professionals, including occupational therapists and physiotherapists.
The Independent Living Centres have a large range of equipment on display for you to view and trial,
and they can provide detailed information about where to buy equipment.
If you'd like to visit an Independent Living Centre,
it is advisable to phone ahead and book an appointment.
See ilcaustralia.org.au for your nearest location
or call 1300 885 886.
You can purchase or hire equipment directly from a healthcare equipment supplier.
There are a number of funding schemes which may be available to help
with the cost of essential equipment.
Call the National Continence Helpline on 1800 33 00 66 to discuss your options.
For more information, phone the National Continence Helpline on 1800 33 00 66.
It's a free confidential phone service staffed by continence nurse advisors
providing information and advice on continence management,
continence funding schemes, continence services, and continence products and resources.
The Helpline operates Monday to Friday 8am to 8 pm Australian Eastern Standard Time.
You can also visit the Continence Foundation of Australia website at continence.org.au.
Thank you for taking the time to view this video.