1. CONTINENCE - CAN WE DO BETTER?
Continence Advisory Service
Inverurie Hospital

2. ROLE OF CONTINENCE ADVISOR
Clinical caseload
Education/training on continence promotion, enuresis, encopresis, catheter’s, equipment etc. to professionals and the public
Advice on equipment and products
Resource Centre
Audit and Research

3. Joint Continence Clinic
Weekly Thursday at City hospital
Monthly at Alford, Inverurie and Peterhead
Patients can self refer
Nurses – community/practice/Gp etc can refer
Complete Referral form

4. FACTS AND FIGURES
Urinary 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 FIGURES
An 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 FIGURES
53 million people in Europe have bowel control problems or faecal incontinence – more prevalent than asthma/diabetes
1.4% of the population over 40 years old in the UK affected by faecal incontinence
Constipation 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 home
15-44years 5 - 7%
45-64years %
over 65years %
Men living at home
15-64years 6%
over 65years %
Men/women living in
Residential homes 25%
Nursing homes 40%
Long stay hospitals %

8. ECONOMIC COST £737,000 per year based on 100,000 patients
Drugs cost - £48,000
Appliances - £122,000
Pads cost - £144,000
Staff cost - £395,000
Surgery cost £28,000
Estimate by Continence Foundation (2001)

9. COST OF INCONTINENCE Consultant/ laboratory services
Diagnostic procedures
Surgery
Physiotherapy
Medication
Nursing time
Supplies/products
Skin breakdown
Falls
Additional care home admissions
Longer hospital stays
Lost productivity

10. IMPACT OF INCONTINENCE
Go to the toilet just in case/know all the toilet’s
Wear pad just in case
Fear of coughing etc.
Embarrassment
Feel dirty
Social exclusion
Restrict employment, education, leisure, opportunities
Don’t talk about it
Loss of confidence
Avoid new relationships
Stop having sex
Don’t go out

11. REASONS FOR NOT SEEKING HELP
Embarrassment
Belief that it is a common part of ageing
Availability of products
Poor knowledge of treatments available
Low expectations of treatment
Fear of surgery

12. ASSESSMENT TOOLS
Evidence 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 CONT
Quality Improvement Scotland - Continence Adults with Urinary Dysfunction
NHS Grampian Continence Resource Pack
NHS 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 Incontinence
Detrusor 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
Urgency
Frequency
Nocturia
Incomplete emptying
Incontinence
Nocturnal enuresis

18. VOIDING SYMPTOMS SIGNS AND SYMPTOMS
Urgency
Frequency
Slow stream
Hesitancy
Straining
Nocturia
UTI
Incomplete 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 status
impaired mobility
impaired dexterity
unsupported environment

20. ASSESSMENT CONTINENCE ASSESSMENT
Complete continence assessment form
Detailed history of symptoms
M.S.Q. Score
Quality of life
Urinalysis
Fluid intake
Review mobility & dexterity
Review medication
Bowel pattern - use Bristol Stool Chart
Post void residual

21. ASSESSMENT FREQUENCY VOLUME CHART
Intake/output
Bladder capacity
Frequency of voids
Frequency of incontinence episodes
Nocturia
Pattern of voiding

22. TREATMENT Review environment/clothing
Fluid intake of mls per day
Avoid fluids that contain caffeine
Discourage smoking
Advice on weight loss
Double voiding
Individualised toileting
Bladder retraining
Treat UTI’s
Treat constipation & review diet
Pelvic floor exercises
Review medication/anti-cholinergics
I.S.C./Catheter
Referral to other agencies

23. REFER TO G.P. Exclude/treatment for vaginal atrophy
Exclude/treatment for enlarged prostate
Exclude/treatment for prolapse
Treat infection
Review of medication
Prescription of anti-cholinergics
Referral to consultant

24. Medication – Side-Effects on Bladder/Bowel
Remember to check and exclude that medication side-effects are not causing or exacerbating problem
Use BNF or to check side effects
such as difficulty with micturition, dry mouth, constipation, diarrhoea, urinary frequency etc.
Check which over the counter medication used
Are 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, Diazepam
ANTIPSYCHOTICS – Chlorpromazine, Flupentixol (Depixol), Quetiapine
ANTIDEPRESSANTS – Amitriptyline, Citalopram, Fluoxetine
ANTICHOLENERGICS – Oxybutynin, Tolterodine
LAXATIVES – Movicol, Lactulose
DIURETICS – Furosemide, Spironolactone

26. EQUIPMENT AND PRODUCTS
Commode and urinals
Urinary sheaths/retracted penis pouch
Washable pants/bed protection
Disposable pads - correct sizing
Intermittent self-catheterisation
Indwelling catheter - urethral/supra-pubic/catheter valves
Specialist companies

27. REFERRAL FOR ADVICE Link nurse within your clinical area
Continence Advisor
Continence Clinic
Urologist
Gynaecologist
Physiotherapist
Occupational
Therapist
Dietician
Pharmacist
Speech Therapist
Horizons
Other specialist nurses

28. YES - WE CAN
Health Professional should have a positive attitude to continence problems
All patients should undergo a continence assessment before product use. Issue of products should not take the place of therapeutic interventions.
SIGN