1.5 Explain how a change of environment may increase incontinence

This guide will help you answer 1.5 Explain how a change of environment may increase incontinence.

Incontinence occurs when someone loses control over their bladder or bowels. This can happen in varying degrees, from minor leaks to a complete loss of control. Many factors, including a change in environment, may make incontinence worse.

Understanding the impact of an environment change on incontinence is key to supporting individuals in health and social care. This guide covers how different environmental changes can influence the condition.

Interrupts Familiar Routines

A new environment often disrupts a person’s day-to-day habits. Routines play a significant role in managing continence for individuals who already experience some bladder or bowel difficulties. For example, they may be accustomed to using the toilet at specific times or in response to specific triggers. When placed in an unfamiliar setting, these routines may be hard to maintain.

Key points include:

• Confusion about where the nearest toilet is.
• Not recognising cues for when it’s time to use the toilet.
• Feeling uncertain about whether they can or should ask for assistance.

For instance, a resident moved to a care home may need time to adjust to where toilets are located and the new cleaning or care schedules. During this adjustment phase, episodes of incontinence may increase.

Associated Anxiety or Stress

Moving to a new environment often triggers feelings of anxiety or stress. Emotional pressure can worsen bladder or bowel control. Stress has a direct connection to incontinence in two main ways:

1. Physical Impact: Stress causes tension in muscles, affecting urinary and bowel function.
2. Mental State: Worry about how to find a toilet or ask for help may delay attempts to manage continence effectively.

An example of this is a hospital admission where patients are stressed about their health, the schedules of medical practices, or interacting with unfamiliar staff. This anxiety can contribute to greater difficulty managing incontinence.

Unfamiliar Toilet Facilities

Getting used to unfamiliar surroundings can be intimidating. Individuals may face challenges recognising or accessing the toilets in a new place. Common issues include:

• Toilets that look different than expected.
• Confusion over unlabelled or poorly signposted facilities.
• Difficulty reaching toilets placed too far away.

For people with mobility limitations, changes in the type or placement of toilet aids, such as handrails or raised seats, may also lead to accidents or hesitancy in seeking assistance.

New Environment-Related Confusion

For someone with conditions like dementia, confusion in a new environment can be especially distressing. They may:

• Forget where toilets are located, even after being shown multiple times.
• Struggle to recognise unfamiliar objects such as new toilet signs or seats.
• Feel disoriented and avoid asking for help, increasing the risk of incontinence episodes.

Dealing with confusion in these cases requires a patient, step-by-step approach to reintroduce a sense of familiarity.

Different Social Expectations

Some people feel embarrassed about their continence issues in a new environment. This discomfort tends to occur when adjusting to new people, such as fellow residents in a care home or roommates in a hospital ward. Potential outcomes include:

• Hesitating to use the toilet openly.
• Delaying toileting needs, leading to accidents.
• Avoiding access support from carers or staff out of shyness.

Supporting individuals through positive reinforcement and reassurance becomes essential to help them feel more comfortable.

Barriers in Communication

A change in environment may also create communication challenges. This is significant for individuals who rely on others for assistance, such as those with cognitive impairments, speech difficulties, or sensory disabilities.

For example:

• A person with a speech disorder may struggle to describe their urgency in a new care setting.
• Language barriers, such as being placed in a care facility where staff speak a different primary language, may lead to unaddressed needs.
• Staff who do not yet know the person may misunderstand their gestures or signals.

Such issues can delay accessing the toilet in time. Establishing clear modes of communication is necessary to tackle this problem.

Impaired Access to Clothing or Toileting Supplies

Changes in environment might affect access to essential resources like appropriate clothing, toileting equipment, or incontinence pads. Discrepancies in such provisions can lead to increased discomfort or leaks. Examples include:

• Care homes where clothes are laundered but not returned promptly, leaving residents short of usable options.
• Temporary accommodations where individuals cannot store spare incontinence supplies conveniently.

Settling these logistical concerns helps individuals feel better prepared and reduces avoidable episodes of incontinence.

Changes in Sleeping Arrangements

Moving to a new setting can also mean different sleeping arrangements. If the toilet is further away or the lighting is poor, some individuals may avoid getting up to relieve themselves at night to avoid a fall. This may lead to bedwetting.

Care workers can help by ensuring good lighting and placing essential aids like commodes closer to bedsides to reduce the likelihood of accidents.

Dehydration from Fear of Accidents

In a new environment, some people might drink less fluid intentionally to minimise the risk of incontinence. While this seems logical to them, dehydration concentrates urine, which can irritate the bladder and make incontinence episodes worse. It can also lead to constipation, increasing the likelihood of bowel incontinence.

Educating individuals about proper hydration and its impact on bladder and bowel health can support better management and prevent unnecessary problems.

Physical Health Conditions

For some individuals, a change of environment coincides with illness or recovery from surgery. If they are weakened or less mobile due to health issues, they may find accessing toilets more challenging. This can result in more frequent accidents.

Providing extra support through temporary aids like bedpans or urinals can help reduce incontinence in these situations.

Access to Professional Care or Support

The presence and quality of care in a new location also play a role. In home settings, people may have family members who understand their needs. In a care home or hospital, staff may not yet know the person’s toileting schedule, preferences, or mobility support needs, causing delays in assistance.

Encouraging open communication between the individual, their family, and care staff provides a smoother transition during environmental changes.

Adapting to External Stimuli

The physical environment itself—temperature, noise levels, and air quality—can also have an indirect impact on incontinence. For example:

• Colder environments may make someone more prone to urgency.
• Noisy or chaotic surroundings may create stress, exacerbating control issues.
• Poor lighting can make finding or accessing toilets harder.

Adjusting these external factors may support easier continence management.

Supportive Practices

While a change of environment can increase incontinence temporarily, care workers can implement practical steps to ease this transition. These include:

• Conducting walk-throughs of the building to familiarise individuals with facilities.
• Using clear signage in large fonts or with pictures to mark toilets.
• Placing portable aids, like grab bars or commodes, in convenient locations.
• Encouraging a consistent toileting routine.
• Building trust by reassuring individuals that incontinence is natural and they will be supported.

Gradually, individuals can regain a sense of security and control, reducing the frequency of incontinence episodes.

Final Thoughts

A new environment can be a challenging adjustment for anyone, but for those with existing continence problems, it often adds additional stress and physical difficulty. By understanding factors such as unfamiliar facilities, interruptions to routines, anxiety, and communication barriers, you can provide care that meets their needs empathetically and effectively.

Being proactive, patient, and resourceful helps individuals regain confidence and maintain dignity during environmental transitions.