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Effective management of urinary incontinence

Kathy Lowry
RN NDNCert
Continence Manager
Homefirst Community Trust

Carol Curran
MSc BSc RN DipN
NDNCert PGDip RNT
Lecturer in Nursing
Course Director Community Nursing Programme
University of Ulster at Jordanstown

Incontinence is a condition in which urine loss can be defined as a social or hygienic problem.(3) There are, however, many misconceptions about UI, such as it being a natural part of ageing with management centred on controlling wetness and smell rather than modifying urine loss. UI is highly treatable and rather than relying on methods of controlling wetness, the implementation of therapeutic and rehabilitative strategies can often lead to improvement and cure.(4)
 
It is important to recognise that incontinence is a symptom rather than a disease, and assessment must be aimed at uncovering the cause of the symptom. To remain continent, individuals must be able to achieve the following steps:

  • Recognise the need to void.
  • Know where it is appropriate to void.
  • Retain the urine in the bladder until that place is reached.
  • Reach the appropriate place, adjust clothing and position correctly for bladder ­emptying.
  • Initiate micturition.

It is widely acknowledged that accurate and complete assessment of UI is the foundation of effective management. Identifying which of the above steps has failed is a significant objective. Local protocols are in place across much of the UK to ensure that individualised comprehensive assessments become the reality for patients and clients. It is recommended that the assessment process should include:

  • The psychological impact of urinary symptoms.
  • A full medical history inclusive of presenting ­urinary symptoms and duration of problems.
  • Current medication.
  • Cognitive and physical ability/disability.
  • Investigations to eliminate any possible organic cause of the urinary symptoms requiring ­immediate onward referral. These should include a physical examination (to identify enlarged prostate, prolapse, palpable bladder, signs of vaginal ­atrophy, etc), urinalysis, charting of baseline fluid intake and output, ­residual urine, bowel history.
  • Environmental/social circumstances/family support.
  • Urodynamic studies to investigate bladder filling and voiding functions and help in the assessment of the severity of dysfunction. These studies are not essential for all patients but are a valuable tool in evaluation, providing objective functional tests of bladder and urethral function.(5)

Causes, treatment and management
The causes of UI are multifaceted, and a range of different types of incontinence may present. Recent advances in drug therapy for continence care have enabled treatment to be effective and appropriate dependent on the symptoms and diagnosis.

Within primary care, conservative strategies play a major role in the promotion of UI. Effective management strategies include bladder training, reducing caffeine intake and pelvic floor muscle exercises (leaflets available from The Continence Foundation). A holistic, multidisciplinary approach puts practice and community nurses alongside GPs as active continence promoters. Current continence promotion focuses on conservative therapies. Effective management will ensure that limited resources are directed at those in need of more invasive therapeutic strategies. It is important that the cycle of reliance on pads is broken and that proactive continence promotion becomes the business of all healthcare professionals.

Resources
Association for Continence Advice T:020 8692 4680
E:info@aca.uk.com
W:www.aca.uk.com
The Continence Foundation (for local continence advisors)
T:020 7404 6875
E:continence.foundation@dial.pipex.com
W:www.continence-foundation.org.uk

References

  1. Royal College of Physicians. Incontinence: causes, management and provision of services. London: RCP; 1995.
  2. Saddler S. Combating incontinence after childbirth: conference report.Br J Nursing 1996;5(7):448-9.
  3. Feneley RCL, Shepherd M, Powell PH, Blannin J. Urinary incontinence: prevalence and needs. Br J Urol 1979;51:493-6.
  4. Vinsnes AG, Harkness GE, Haltbakk J, Bohm J, Hunskaar S. Healthcare personnel's attitude towards patients with urinary incontinence.J Clin Nursing 2001;10(4):455-62.
  5. Chapple CR, MacDiarmond SA. Urodynamics Made Easy. London: Churchill Livingstone; 2000.