Post on 26-Mar-2015
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CONTINENCE - CAN WE DO BETTER?
Continence Advisory Service Inverurie Hospital
01467 672748
ROLE OF CONTINENCE ADVISOR Clinical caseload Education/training on continence
promotion, enuresis, encopresis, catheter’s, equipment etc. to professionals and the public
Advice on equipment and products Resource Centre Audit and Research
Joint Continence Clinic Weekly Thursday at City hospital Monthly at Alford, Inverurie and
Peterhead Patients can self refer Nurses – community/practice/Gp
etc can refer Complete Referral form
FACTS AND FIGURES Urinary incontinence is a symptom resulting
from one or more underlying conditions. 70% of patients with urinary incontinence
can be improved or cured. Urinary incontinence in older females may be
associated with an increased risk of falls and fractures.
Estimate that 210,000 - 335,000 adults in Scotland have significant problems with urinary incontinence.
FACTS AND FIGURES An estimated 1:3 women in the UK have
symptoms of stress urinary incontinence. SUI is the most prevalent type of urinary
incontinence. Only 25% of women in the UK have
consulted their Doctor. Over 25% of women with urinary
symptoms wait more than 5 years to seek advice.
FACTS AND FIGURES 53 million people in Europe have bowel
control problems or faecal incontinence – more prevalent than asthma/diabetes
1.4% of the population over 40 years old in the UK affected by faecal incontinence
Constipation affects between 3% and 15% 1 in 5 people over 40 – overactive bladder(Bladder and Bowel Foundation – October 2009)
WHO WILL SUFFER FROM URINARY INCONTINENCE?(Royal College of Physicians 1995)
Women living at home 15-44years 5 - 7% 45-64years 8 - 15% over 65years 10 - 20%
Men living at home 15-64years 6% over 65years 7 - 10%
Men/women living in Residential homes 25% Nursing homes 40%
Long stay hospitals 50 - 70%
ECONOMIC COST £737,000 per year based on 100,000
patients Drugs cost - £48,000 Appliances - £122,000 Pads cost - £144,000 Staff cost - £395,000 Surgery cost - £28,000 Estimate by Continence Foundation
(2001)
COST OF INCONTINENCE
Consultant/ laboratory services
Diagnostic procedures
Surgery Physiotherapy Medication Nursing time Supplies/products
Skin breakdown Falls Additional care
home admissions Longer hospital
stays Lost productivity
IMPACT OF INCONTINENCE
Go to the toilet just in case/know all the toilet’s
Wear pad just in case
Fear of coughing etc.
Embarrassment Feel dirty Social exclusion
Restrict employment, education, leisure, opportunities
Don’t talk about it Loss of confidence Avoid new
relationships Stop having sex Don’t go out
REASONS FOR NOT SEEKING HELP Embarrassment Belief that it is a common part of
ageing Availability of products Poor knowledge of treatments
available Low expectations of treatment Fear of surgery
ASSESSMENT TOOLS Evidence that patient care could be
improved by enhanced training. Effective treatment depends on thorough assessment and diagnosis.
Assessment, treatment and referral should be offered to all patients with urinary incontinence problems.
Scottish Intercollegiate Guidelines Network Management of Urinary Incontinence in Primary Care - SIGN 79 www.sign.aca.uk
ASSESSMENT TOOLS CONT Quality Improvement Scotland -
Continence Adults with Urinary Dysfunctionwww.nhshealthquality.org
NHS Grampian Continence Resource Pack
NHS Guidelines on Completion of Assessment Form
DEFINITIONS - TYPES OF URINARY INCONTINENCE Urinary Incontinence - is the complaint
of any involuntary leakage of urine. SUI - Stress Urinary Incontinence - is
the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing.
UUI - Urge Urinary Incontinence - involuntary leakage accompanied by or immediately preceded by urgency.
DEFINITIONS - TYPES OF URINARY INCONTINENCE
Incomplete bladder emptying - in the past referred to as Overflow Incontinence
Detrusor Overactivity Incontinence - Incontinence due to an involuntary detrusor contraction (in the past referred to reflex)
STRESS URINARY INCONTINENCE - SIGNS AND SYMPTOMS
Leakage of urine e.g. coughing, sneezing, increase in physical activity.
Amount of urine passed can be small.
May have urinary frequency and urgency.
URGE URINARY INCONTINENCE SIGNS AND SYMPTOMS
Urgency Frequency Nocturia Incomplete emptying Incontinence Nocturnal enuresis
VOIDING SYMPTOMS SIGNS AND SYMPTOMS Urgency Frequency Slow stream Hesitancy Straining Nocturia UTI Incomplete emptying of the bladder
FUNCTIONAL INCONTINENCE Individuals who cannot cope with
their bladder function suffer functional incontinence, factors that can contribute are: impaired mental status impaired mobility impaired dexterity unsupported environment
ASSESSMENT CONTINENCE ASSESSMENT Complete
continence assessment form
Detailed history of symptoms
M.S.Q. Score Quality of life Urinalysis
Fluid intake Review mobility &
dexterity Review
medication Bowel pattern -
use Bristol Stool Chart
Post void residual
ASSESSMENT FREQUENCY VOLUME CHART Intake/output Bladder capacity Frequency of voids Frequency of incontinence
episodes Nocturia Pattern of voiding
TREATMENT Review
environment/clothing Fluid intake of 1500-
1800mls per day Avoid fluids that
contain caffeine Discourage smoking Advice on weight
loss Double voiding
Individualised toileting Bladder retraining Treat UTI’s Treat constipation &
review diet Pelvic floor exercises Review medication/anti-
cholinergics I.S.C./Catheter Referral to other
agencies
REFER TO G.P. Exclude/treatment for vaginal atrophy Exclude/treatment for enlarged
prostate Exclude/treatment for prolapse Treat infection Review of medication Prescription of anti-cholinergics Referral to consultant
Medication – Side-Effects on Bladder/Bowel Remember to check and exclude that
medication side-effects are not causing or exacerbating problem
Use BNF or www.bnf.org to check side effects such as difficulty with micturition, dry mouth,
constipation, diarrhoea, urinary frequency etc. Check which over the counter medication
used Are drugs appropriate for problem?
e.g. too low a fluid intake for prescribed laxative?
Request medical staff/nurse practitioner to review
Medications Which Can Cause Incontinence SEDATIVES – Lorazepam, Diazepam ANTIPSYCHOTICS – Chlorpromazine,
Flupentixol (Depixol), Quetiapine ANTIDEPRESSANTS – Amitriptyline,
Citalopram, Fluoxetine ANTICHOLENERGICS – Oxybutynin,
Tolterodine LAXATIVES – Movicol, Lactulose DIURETICS – Furosemide,
Spironolactone
EQUIPMENT AND PRODUCTS Commode and urinals Urinary sheaths/retracted penis pouch Washable pants/bed protection Disposable pads - correct sizing Intermittent self-catheterisation Indwelling catheter - urethral/supra-
pubic/catheter valves Specialist companies
REFERRAL FOR ADVICE Link nurse within
your clinical area Continence
Advisor Continence Clinic Urologist Gynaecologist Physiotherapist
Occupational Therapist
Dietician Pharmacist Speech Therapist Horizons Other specialist
nurses
YES - WE CAN Health Professional should have a
positive attitude to continence problems
All patients should undergo a continence assessment before product use. Issue of products should not take the place of therapeutic interventions.
SIGN 79 2004