Introduction

Although every human being answers the ‘call of nature’ several times a day, continence is still a taboo subject. As people age, they typically become less mobile (Mottram et al, 2008) and/or need more frequent ‘comfort breaks’ (Milsom et al, 2001) so maintaining continence becomes a challenge. While incontinence is not a direct consequence of ageing, urinary incontinence affects 55% of women over 65 and 20% of men (Holroyd-Leduc et al, 2004). The prevalence of faecal incontinence is around 1% in the general population, rising to 17% in the very old and as much as 25% in care homes. Many factors contribute to making this condition a major problem for large numbers of older adults. Several studies have shown that urinary system function declines with age (Holm et al, 1995; Pfisterer et al, 2006; Gibson and Wagg, 2017). Another factor is the increase with age of concomitant diseases (such as congestive heart failure, Parkinson’s, Alzheimer's and so on) that can result in problems with continence. In addition, mobility problems are increasingly common in older people; limitation in mobility is likely to cause difficulties with continence simply because the older person finds it difficult to reach the toilet and transfer onto it (Fonda et al, 2005).

Faecal incontinence can often be successfully treated with dietary interventions, careful bowel management regimes, and review of medication, although a small minority of people will continue to suffer with faecal symptoms. Urinary incontinence can be relieved by pharmacological, physiotherapeutic or surgical treatments, but often these treatments do not provide a complete cure and may not be appropriate for some patients, resulting in large numbers of older people needing to cope with urinary continence management issues on a daily basis. Thus, finding effective methods to enable older people to manage continence needs, especially when outside the home, is essential for successful ageing and for the maintenance of a good quality of life (Temml et al, 2000).

The impact of continence difficulties is far more than just the physical effort and expense of continence management; the problem is strongly associated with reduced self-esteem, social isolation and depression (Shaw, 2001). Problems managing continence can be extremely distressing and may all but end wider social life (Cassells and Watt, 2002; Hogg and Godfrey, 2007).