Continence Management in the Community
Published: 15 August 2019
Published: 15 August 2019
To break down this number in terms of age group, incontinence affects 1 in 166 people under 65; 1 in 14 people over 65; and 1 in 4 people over 85 (Bostock 2019).
Incontinence is the name given to the condition in which a person experiences any accidental or involuntary loss of urine from the bladder (urinary incontinence) or bowel motion, faeces or wind from the bowel (faecal or bowel incontinence).
Living with incontinence can be both challenging and exhausting. Generally, the physical effects of incontinence are non-life threatening, however, consequences such as the sequelae of falls, UTIs and delirium may have life-shortening effects (Bostock 2019).
Incontinence affects both men and women, and people of all ages and backgrounds and many of the complications of this disorder are not visible, but are very capable of hindering an individual’s quality of life.
Thankfully, incontinence can be treated, managed and in many cases, cured.
There are different types of incontinence and each has a number of possible causes. The most common are:
Incontinence is a distressing, symptom-based disorder. If left untreated it can result in a profound loss of quality of life, affect sexuality and relationships, mental health and wellbeing, and cause social isolation and institutionalisation.
Creating a management plan with the patient and their family is the first step to addressing incontinence. The following should be taken into account:
The success of the management plan hinges on the strength of the patient’s trust and confidence in the continence advisor. Once this is established, this lends validity and value to the delivery of the management plan (Bostock 2019).
The management plan coordinates nurse expertise with an individual’s needs; offers clear guidelines, milestones and progress measurements; provides support and encouragement.
Careful consideration will ensure that the individual and/or their family will have ownership of the outcomes, direct the course of the plan and decide which modifiable risk factors can be ameliorated, and which are non-negotiable. Non-negotiable may include the type of food and drink they consume, or the medications they take (Bostock 2019).
In the assessment phase, discuss which aspects of incontinence are the most bothersome to the patient. Ask them to consider the following:
Keep in mind that every patient will need individualised strategies to account for factors such as age, gender, state of health, fluid restrictions, level of activity, function and mobility, among others (Bostock 2019).
Water should form the majority of fluid intake. Caffeine-based drinks such as coffee, tea and soft drinks should be restricted to a maximum of three per day (Bostock 2019).
Alcohol should only be consumed in moderation as it can contribute to the incidence of urinary incontinence. This is because alcohol acts as a diuretic and bladder stimulant (Bostock 2019).
Advise patients to reduce fluids one hour before sleep (Bostock 2019).
Constipation is known to contribute to the incidence of urinary incontinence. The pressure of an impacted rectum against the bladder causes over-activity and possible leakage, therefore it is important to include management of bowel health in the management plan (Bostock 2019).
Activity, exercise and energy expenditure are very important. Exercise promotes strength and mobility and the ability for the person to access the toilet independently is important for maintaining quality of life (Bostock 2019).
Take into consideration any other health issues the patient may be living with. Any comorbid condition has the potential to impact the chance of a patient regaining continence, particularly:
Ensure the patient has all the aid, equipment and appliances required to fully support their mobility and function.
It is very important that this equipment is regularly serviced and maintained. The services of an occupational therapist or a physiotherapist may be required to do a home and equipment assessment (Bostock 2019).
Toileting programs are useful to regulate voiding patterns, they can act as a prompt for people with a loss of cognition (as well as for people with full cognitive abilities) to visit the toilet at set intervals. The program should be based on the outcome of a bladder diary, a person’s patterns and their fluid intake (Bostock 2019).
Bladder and bowel retraining programs can be used by any person living with incontinence. The program will be developed in conjunction with the individual and their family. The program will encourage the person to extend the time in between voids; may include pelvic floor therapy; bowel retraining therapy aimed to increase anal sphincter tone, and encourage routine emptying of the bowel (Bostock 2019).
Pelvic floor therapy is a conservative treatment option. The program aims to develop or further support, the tone and flexibility of the pelvic musculature, ligaments and viscera, to decrease episodes of urinary incontinence (Bostock 2019).
Incontinence is a relatively common, treatable condition. Dignity and privacy should be key considerations in developing a management plan intended to aid a patient in achieving continence.
Your intervention could make a considerable improvement to a patient’s continence management and in effect, make a drastic improvement to their overall quality of life.
Aged Care Quality Standards: https://www.myagedcare.gov.au/aged-care-quality-standards
Ausmed, 'A Quick Guide to Paediatric Urinary Incontinence': https://www.ausmed.com/cpd/articles/paediatric-urinary-incontinence
The Continence Foundation of Australia Resources: https://www.continence.org.au/resources
The National Continence Helpline on 1800 33 00 66 is a free and confidential service and is staffed by continence nurse advisors who can provide practical information, a wide range of resources and details of local continence services.
Question 1 of 3
True or false? The bladder is able to hold up to 800ml of urine.
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