Presentation on theme: "CONTINENCE - CAN WE DO BETTER?"— Presentation transcript:
1 CONTINENCE - CAN WE DO BETTER? Continence Advisory ServiceInverurie Hospital
2 ROLE OF CONTINENCE ADVISOR Clinical caseloadEducation/training on continence promotion, enuresis, encopresis, catheter’s, equipment etc. to professionals and the publicAdvice on equipment and productsResource CentreAudit and Research
3 Joint Continence Clinic Weekly Thursday at City hospitalMonthly at Alford, Inverurie and PeterheadPatients can self referNurses – community/practice/Gp etc can referComplete Referral form
4 FACTS AND FIGURESUrinary 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 adults in Scotland have significant problems with urinary incontinence.
5 FACTS AND FIGURESAn 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.
6 FACTS AND FIGURES53 million people in Europe have bowel control problems or faecal incontinence – more prevalent than asthma/diabetes1.4% of the population over 40 years old in the UK affected by faecal incontinenceConstipation affects between 3% and 15%1 in 5 people over 40 – overactive bladder(Bladder and Bowel Foundation – October 2009)
7 WHO WILL SUFFER FROM URINARY INCONTINENCE WHO WILL SUFFER FROM URINARY INCONTINENCE? (Royal College of Physicians 1995)Women living at home15-44years 5 - 7%45-64years %over 65years %Men living at home15-64years 6%over 65years %Men/women living inResidential homes 25%Nursing homes 40%Long stay hospitals %
8 ECONOMIC COST £737,000 per year based on 100,000 patients Drugs cost - £48,000Appliances - £122,000Pads cost - £144,000Staff cost - £395,000Surgery cost £28,000Estimate by Continence Foundation (2001)
9 COST OF INCONTINENCE Consultant/ laboratory services Diagnostic proceduresSurgeryPhysiotherapyMedicationNursing timeSupplies/productsSkin breakdownFallsAdditional care home admissionsLonger hospital staysLost productivity
10 IMPACT OF INCONTINENCE Go to the toilet just in case/know all the toilet’sWear pad just in caseFear of coughing etc.EmbarrassmentFeel dirtySocial exclusionRestrict employment, education, leisure, opportunitiesDon’t talk about itLoss of confidenceAvoid new relationshipsStop having sexDon’t go out
11 REASONS FOR NOT SEEKING HELP EmbarrassmentBelief that it is a common part of ageingAvailability of productsPoor knowledge of treatments availableLow expectations of treatmentFear of surgery
12 ASSESSMENT TOOLSEvidence 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
13 ASSESSMENT TOOLS CONTQuality Improvement Scotland - Continence Adults with Urinary DysfunctionNHS Grampian Continence Resource PackNHS Guidelines on Completion of Assessment Form
14 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.
15 DEFINITIONS - TYPES OF URINARY INCONTINENCE Incomplete bladder emptying - in the past referred to as Overflow IncontinenceDetrusor Overactivity Incontinence - Incontinence due to an involuntary detrusor contraction (in the past referred to reflex)
16 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.
17 URGE URINARY INCONTINENCE SIGNS AND SYMPTOMS UrgencyFrequencyNocturiaIncomplete emptyingIncontinenceNocturnal enuresis
18 VOIDING SYMPTOMS SIGNS AND SYMPTOMS UrgencyFrequencySlow streamHesitancyStrainingNocturiaUTIIncomplete emptying of the bladder
19 FUNCTIONAL INCONTINENCE Individuals who cannot cope with their bladder function suffer functional incontinence, factors that can contribute are:impaired mental statusimpaired mobilityimpaired dexterityunsupported environment
20 ASSESSMENT CONTINENCE ASSESSMENT Complete continence assessment formDetailed history of symptomsM.S.Q. ScoreQuality of lifeUrinalysisFluid intakeReview mobility & dexterityReview medicationBowel pattern - use Bristol Stool ChartPost void residual
21 ASSESSMENT FREQUENCY VOLUME CHART Intake/outputBladder capacityFrequency of voidsFrequency of incontinence episodesNocturiaPattern of voiding
22 TREATMENT Review environment/clothing Fluid intake of mls per dayAvoid fluids that contain caffeineDiscourage smokingAdvice on weight lossDouble voidingIndividualised toiletingBladder retrainingTreat UTI’sTreat constipation & review dietPelvic floor exercisesReview medication/anti-cholinergicsI.S.C./CatheterReferral to other agencies
23 REFER TO G.P. Exclude/treatment for vaginal atrophy Exclude/treatment for enlarged prostateExclude/treatment for prolapseTreat infectionReview of medicationPrescription of anti-cholinergicsReferral to consultant
24 Medication – Side-Effects on Bladder/Bowel Remember to check and exclude that medication side-effects are not causing or exacerbating problemUse BNF or to check side effectssuch as difficulty with micturition, dry mouth, constipation, diarrhoea, urinary frequency etc.Check which over the counter medication usedAre drugs appropriate for problem?e.g. too low a fluid intake for prescribed laxative?Request medical staff/nurse practitioner to review
25 Medications Which Can Cause Incontinence SEDATIVES – Lorazepam, DiazepamANTIPSYCHOTICS – Chlorpromazine, Flupentixol (Depixol), QuetiapineANTIDEPRESSANTS – Amitriptyline, Citalopram, FluoxetineANTICHOLENERGICS – Oxybutynin, TolterodineLAXATIVES – Movicol, LactuloseDIURETICS – Furosemide, Spironolactone
27 REFERRAL FOR ADVICE Link nurse within your clinical area Continence AdvisorContinence ClinicUrologistGynaecologistPhysiotherapistOccupationalTherapistDieticianPharmacistSpeech TherapistHorizonsOther specialist nurses
28 YES - WE CANHealth Professional should have a positive attitude to continence problemsAll patients should undergo a continence assessment before product use. Issue of products should not take the place of therapeutic interventions.SIGN