Continence Management in the Community
Published: 29 September 2022
Published: 29 September 2022
Incontinence is estimated to affect about one in four adults, and over 5,000,000 Australians overall (Continence Foundation of Australia 2022a).
Incontinence is the involuntary loss of bladder and/or bowel control. There are two categories of incontinence:
(Continence Foundation of Australia 2022a)
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, urinary tract infections (UTIs) and delirium may have life-shortening effects (Bostock 2019).
Incontinence can affect people of all genders, ages and backgrounds. While the symptoms of this disorder are often not visible, incontinence can considerably impact a person’s quality of life and cause embarrassment that prevents them from seeking help (Better Health Channel 2021).
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:
(Better Health Channel 2021; Continence Foundation of Australia 2022b)
(Continence Foundation of Australia 2022b)
A person with incontinence might experience some of the following symptoms:
(Better Health Channel 2021)
Incontinence is a distressing, symptom-based disorder. If left untreated it can result in a profound loss of quality of life; affect sexuality, 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:
(Bostock 2019)
The success of the management plan hinges upon 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; and 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-negotiables may include the type of food and drink they consume, or the medicines 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:
(Bostock 2019)
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).
The following is indicated as promotive to optimal bowel health:
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:
(Bostock 2019)
Ensure the patient has all the aids, equipment and appliances required to fully support their mobility and function.
It’s crucial that this equipment is regularly serviced and maintained. An occupational therapist or physiotherapist may be required to do a home and equipment assessment (Bostock 2019).
Aids and equipment required by the patient may include:
(Bostock 2019)
Toileting programs are useful to regulate voiding patterns, as they can act as a prompt for people 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 may encourage the person to extend the time in between voids; include pelvic floor therapy and 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 in order to decrease episodes of urinary incontinence (Bostock 2019).
Habits of a healthy bladder:
(Continence Foundation of Australia 2021a)
Habits of a healthy bowel:
(Continence Foundation of Australia 2021b)
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 therefore, make a drastic improvement to their overall quality of life.
Question 1 of 3
True or false: The bladder is able to hold up to 800 ml of urine.