1 Practice Nurse Forum Presented by: Jenny Stuart Continence Nurse Specialist/Lead Telephone Number:

4.5 million people in the UK are incontinent of urine or faeces Compare this to……. 2

3 UK Prevalence of Incontinence

4 Clients who have a positive response to the trigger question “does your bladder or bowel ever/sometimes cause you problems?” Should always be offered an initial bladder and bowel continence assessment (DOH, 2000).

5 Types of Incontinence Stress Urge Mixed Faecal

6 Continence Assessment Review of symptoms and their effects on quality of life Assessment of desire for treatment alternatives Examination of abdomen for palpable mass or bladder retention Examination of perineum to identify prolapse and excoriation and to assess pelvic floor contraction Rectal examination to exclude faecal impaction Urinalysis to exclude infection Assessment of manual dexterity Assessment of the environment “Identification of conditions that may exacerbate incontinence e.g. chronic cough” (DOH, 2000) “A three day continence chart to aid diagnosis and care planning and as a record of progress and effectiveness of treatment” (Winder 1996, NICE 2006)

7 When to Refer to Secondary Care Haematuria – Macroscopic Microscopic Sterile Pyuria Recurrent UTI’s (Proven) PSA Prolapse (Symptomatic) Altered Bowel Habit

8 Management Techniques Exclude urinary tract infection Patient specific pelvic floor muscle exercises Fluid intake – advise on reducing caffinated drinks. Caffeine is a stimulant and a diuretic. It can irritate the bladder, particularly if fluids are being restricted Cola, other fizzy drinks and chocolate also contain caffeine Advise on reducing alcohol intake Increase fluids. For an average adult 8-10 drinks (1.5-2 litres) per day. Concentrated urine can irritate the bladder. (A low fluid intake can increase the risk of UTI)

9 Management Techniques Clothing Toilet aids Hand held urinals Pelvic floor exercises Bladder retraining Medication Bowel management Appliances… Pads only if unable to treat or unable to participate in a treatment programme

10 Appliances Penile sheaths Pubic pressure devices Body worn urinals Catheters (only if clinically indicated) (Equipped to care 2000, MDA)

11 Bowel Management Bowel habit – Normal Faecal incontinence Constipation – Urinary incontinence and OAB can increase Any change in bowel habit needs investigating before referral to the continence service – RED FLAGS – BLEEDING PR Bowel assessment – Diet / fluids Defaecation dynamics Medication Stool consistency – bristol stool chart or stool diary Evacuation difficulties Containment

12 Management of Constipation Encourage good fluid intake Privacy to use toilet Factors causing constipation – e.g medication, secondary effects of illness Regular review of medication Oral Medication Stimulant e.g sena, bisacodyl Softener e.g sodium docusate May be necessary to combine Osmotic laxative e.g Movicol/Laxido (Remember liquid – Movicol)

13 Management of Constipation Rectal DRE if administering rectal medication Suppositories – stimulant or softenener Microlax enema Consider Autonomic Dysreflexia above T6 (Spinal cord compression)

14 Useful Websites radar-shop.org.uk

15 Thank you for listening, are there any question? Jenny Stuart – Continence Nurse Specialist /Lead Telephone Number –