Breaking the silence
Author: Jessica Dougherty, Ontex Australia Pty Ltd
Urinary continence is always a sign or symptom of an underlying condition. It is embarrassing, and effects people socially, emotionally, physically, economically and sexually.
4.8 million Australians (26%) suffer from urinary incontinence and is one of the three reasons that someone is admitted into aged care along with dementia and immobility.
Not only is it costly to the person but costly to the aged care facilities, hospitals and government.
Sometimes urinary incontinence can be cured and other times it can be managed better with the right advice or treatment.
What is continence?
“…having the ability to store urine in the bladder or faeces in the bowel and to excrete voluntarily where and when it is socially appropriate”
What is Urinary Incontinence?
“The complaint of any involuntary leakage of urine”
How is a urinary incontinence assessed?
Before any management plan can be established, a urinary assessment is required. A continence assessment involves a healthcare professional reviewing the person’s medical, surgical and obstetric history, medications, behavioral patterns, cognitive ability, mobility and how they have been managing their problem up to this time.
A 3 day bladder diary is also warranted as this reflects what is happening to the person over a 3 day period. Included in a 3 day bladder diary is the person’s fluid input (amount and type), their output (measuring their urine each time) and any incontinent episodes.
Once all of this has been done, the healthcare professional should be able to identify what type of urinary incontinence the person is experiencing and then set up a management plan.
How is urinary incontinence managed?
There are at least 6 different types of urinary incontinence and a person may experience a mixture of different types of incontinence. For each type on urinary incontinence there are specific management strategies, however there are 4 strategies that should be encouraged whether a person is incontinent or not.
- Good Toileting Techniques
A person should be encouraged to only go to the toilet when their bladder is full, if a person constantly goes ‘just in case’, the bladder will become smaller.
We need to remember that it takes time to empty the bladder, so we should not hurry the person and ensure that the bladder is empty. This can be done by coughing prior to getting up from the toilet.
Sitting well on the toilet will help to drain the bladder. A person should sit with their hands or elbows on their knees, leaning forward, back straight and a footstool can help bowel evacuation.
- Maintain adequate fluid intake
Assuming that there are no other health issues, drinking 6-8 glasses of fluids per day has many health benefits including helping to prevent urinary incontinence and constipation. Fluids such as alcohol, tea, coffee and fizzy drinks are known as bladder irritants.
- Avoid constipation
Constipation can cause urinary incontinence therefore it is important to ensure that bowel motions are keep soft and easy to evacuation. Fibre, fluids, light exercise and the above mentioned footstool all help.
- Maintain good hygiene
To prevent urinary tract infections and skin irritations it is important that personal hygiene is attended to by ensuring that the person cleanses with a pH neutral soap, wiping from front to back and avoiding the use of talc.
Different types of urinary incontinence and their management:
Once a healthcare professional has identified the type of incontinence the person is experiencing there are specific management strategies for each type along with the 4 previously mentioned.
- How to manage “Transient or Reversible” issues:
Each different cause of ‘Transient or reversible’ incontinence needs to be treated. For example, urinary tract infections might need antibiotics, diabetes will need to be controlled, medications will need to be reviewed, pain will need to be treated and an acute cough (eg flu or cold) might need medication.
- How to manage “Stress Incontinence” (The complaint of any leakage of urine on coughing sneezing etc)
Pelvic floor muscles (the sling of muscles that support the pelvic organs) need exercise as does all muscles. To discover how to do this correctly or for more information: www.pelvicfloorfirst.org.au
Vaginal oestrogen replacement and weight reduction can also improve stress Incontinence.
- How to manage “Urge Incontinence” (“the complaint of involuntary leakage (of urine) accompanied by or immediately preceded by urgency” )
Pelvic Floor muscle exercise can also improve urge incontinence. Other strategies include avoiding ‘just in case’ by delaying the time between each toileting episode (bladder training), wearing clothing that is easy to remove and some medication may also help eg: Oxybutynin, Botox.
- How to manage “Retention with Overflow” “Involuntary loss of urine associated with over distension of the bladder”
Quite often people with this condition can acquire urinary tract infections, therefore this must be identified and treated as indicated. Other management tactics can involve double or triple toileting, medication review, intermittent catheterisation and sometimes surgery.
- How to manage “Functional Incontinence” “urine loss caused by problems outside the urinary tract, such as immobility and/or cognitive impairment”
This type of incontinence can be divided into two management strategies for mobility issues and cognitive issues.
- Mobility: it is important that a person’s mobility issues are assessed and addressed as required. Some ways of managing mobility issues are treatment the underlying disease, manage the person’s pain, toileting program such as prompted or scheduled, and a urinal or commode beside the bed. Having a physiotherapist or occupation therapist review could prove very useful.
- Cognitive impairment can make it very difficult for a person to find and use the toilet correctly. It is important that care staff identify why the person the person can’t toilet correctly and assist where necessary. This would include watching for any external clues that might indicate that the person wishes to toilet, placing pictures or items that will remind the person of the toilet, and remove and inappropriate toilet receptacle. Prompted or scheduled toileting can also be beneficial.
- How to manage “Nocturia” “the complaint that the individual has to wake at night one or more times to void”
Once again it is very important that a 3 day bladder diary is attended to as there are different types of Nocturia.
Some of the basic management plans for Nocturia can include ensuring that the recommended 6-8 glasses of fluid are consumed earlier in the day, no fluids after 5 or 6 pm, reduce caffeine, resting in the afternoon with the legs elevated, spending less time in bed (settling later in the evening) and having a medication review.
While there are some common treatments for all types of incontinence, it cannot be stressed highly enough that it is imperative that a health care professional performs a comprehensive continence assessment which will ensure that a personal management plan is created.
Toileting is an important part of management, however continence aids can assist with improving the person’s dignity and their quality of life.