Managing Your Client’s Continence

Incontinence is a delicate subject for clients and their loved ones and should be approached with sensitivity and compassion. Although a common problem for men and women of all ages, continence issues can drastically reduce a person’s quality of life if not actively managed. This is why you need a continence care plan to help come to the right decisions.

What is incontinence?

You will know this from your training, however, for completeness, incontinence refers to a person’s inability to control their own bodily functions. Involuntary urination and excretion are extremely common, affecting between 15-35% of the British adult population. Though incontinence is often a part of ageing, it can be very embarrassing for your client and their loved ones, and can lead to a number of undesirable consequences:

• Social: people suffering from incontinence are often unwilling to participate in prolonged social activities, which can lead to social isolation.
• Physical: Rashes and sores can quickly develop in the affected areas, when not correctly treated.
• Environmental: left unmonitored, incontinence can also cause unpleasant smells and damage to furnishings.
• Financial: pads and other treatments can be expensive, especially if the client’s continence issues worsen.

Types of incontinence

Though incontinence can have a big impact on a client’s life, it can be successfully managed with the right products. Incontinence can be experienced in a number of ways, so it’s important to determine the type of incontinence your client is suffering from. This will allow you to identify the most effective products and treatments.

Stress Urinary Incontinence (SUI)

Stress Incontinence (SUI) refers to unexpected bladder leakages caused by physical exertion, such as coughing, sneezing, laughing, heavy lifting or exercising. SUI is a common cause of light bladder leakages, but may also result in larger releases of urine.

women suffer from SUI more than any other type of incontinence.

Urge Urinary Incontinence (UUI)

Urge Urinary Incontinence (UUI) occurs when the bladder tries to empty itself, despite an individual’s best efforts to prevent leaking. UUI is caused by a lack of communication from the bladder impulses sent to the brain. This can result in large losses of urine, and increased frequency of urination.

UUI is the most common type of incontinence that men experience and is commonly linked to an enlarged prostate or prostate surgery. UUI is also common among women, particularly those who have suffered nerve damage.

Functional Incontinence

Functional Incontinence refers to a person’s inability to reach the toilet in time due to limited mobility or mental illness (such as Alzheimer’s or dementia). Some medical conditions, such as Alzheimer’s, Parkinson’s, stroke, diabetes, and multiple sclerosis, may also result in neurological bladder disorders, where the brain fails to recognise the body’s need to urinate. Nerve damage from injuries and illnesses are often the cause of neurological bladder disorders.

For more on urinary incontinence, visit: https://www.nhs.uk/conditions/urinary-incontinence/

Bowel Incontinence

Bowel incontinence (known as faecal incontinence) is the inability to control bowel movements, causing stool (faeces) to leak unexpectedly from the rectum. The issue can range from the occasional leakage of stool while passing gas, to a complete loss of bowel control.

Nerve damage, physical damage (such as through childbirth), spinal cord injuries, strokes, or constant straining during bowel movements are some causes of bowl incontinence. Some diseases, such as diabetes, Parkinson’s, and multiple sclerosis may also lead to faecal incontinence.

For more information and guidance on bowel incontinence, visit:

• https://www.nhs.uk/conditions/bowel-incontinence
• https://www.bladderandbowel.org/bowel/bowel-problems/faecal-incontinence/

Addressing continence

You may experience mixed reactions when discussing incontinence. Though your client may be aware of their continence issues, they might not feel comfortable discussing the problem right away and may respond in a defensive or even aggressive manner. Continence issues often cause considerable embarrassment and shame, so don’t pressure clients to talk about their difficulties before they are ready. Instead, try leaving them with some leaflets which they can read through in their own time, and approach the issue again another day.

When you are able to engage them on the topic, it is important, not only to talk about measures to put in place but also how the family can support them. Your patient may not want this addressed with their family, so you may need to respect their wishes by being discreet about their issue.

Your client’s GP will also be able to refer them to their district nurse or local incontinence team, who can offer specialised guidance and support.

As an independent carer, it is your job to assist the client in accessing guidance and support from NHS professionals, such as their GP or an incontinence nurse. If required you may need to contact their GP or district nurse, to access support for them.

Incontinence is not always a chronic problem. With the right support, temporary incontinence can be treated. Allowing the client to regain their confidence and independence in every-day life.

For more information, visit: https://www.ageukincontinence.co.uk/

Continence care plan

As part of the continence care plan, you must first assess the problem to understand what type of incontinence your client is suffering from. Once you understand the situation, you will be able to successfully help them improve the issue.

How to assess continence

By assessing the problem, you will be able to identify which type of incontinence your client is suffering from. This is important as it will allow you to identify the most effective products and treatments.

You can assess the problem by answering questions such as:

• how often does the client go to the toilet and is this is different to their normal routine?
• What is their current or previous medical history? (including pregnancy and urine infections)
• Is there a possibility of physical or sexual abuse? Including FGM (female genital mutilation)
• a rough estimate of the amount of urine passed
• visual description of the faeces (normally based on Bristol Stool Chart)
• Is there a leakage? Is it urine or faeces?
• What is their diet and fluid intake like?
• Is the client on any medications? (both prescribed and over the counter)
• lifestyle factors, including recreational drugs, alcohol, smoking and weight
• ability – for example, whether the person can feed, dress and bathe on their own
• mobility – physical or environmental factors
• capacity – does the person recognise the need to go to the toilet or do they forget where the toilet is?

Now that you have assessed the problem, you should have an understanding of which type of incontinence your client is suffering from. The most common types of incontinence are stress incontinence and urge incontinence. Although they may be experienced separately, sufferers often experience both.

Continence care pathways:

• Try our solid & fluid input/output table
• NHS Continence care guidelines

Stress Urinary Incontinence (SUI)

To help strengthen the bladder and urinary tract muscles, health experts recommend a number of exercises for both men and women. Pelvic floor and kegel exercises are especially effective and are as simple as drawing up the lower pelvic muscle towards the abdomen and holding for 5-10 seconds before releasing. These exercises can be done anytime, anywhere, and can help improve bladder control as well as reduce the risk of prolapse. These simple exercises are also known to improve sexual health.

If you’re looking for a medical approach, the antidepressant duloxetine can be used for treating stress incontinence. Symptoms quickly return when the drug is stopped being used, and nausea is the most common side effect that makes people stop taking the medication.

Urge Urinary Incontinence (UUI)

To help prevent accidents you can plan scheduled toilet trips with the client so that they are less likely to have a leakage. This plan would consist of frequent trips, where time between trips can be adjusted depending on results. Pelvic floor exercises can also be effective as it may give the client a bit more control over preventing leakages.

There is also a large number of medications that could help in preventing accidents. Common side effects of most of these drugs include dry eyes and mouth, but drinking water may aggravate symptoms of  UUI. Medications include:

• Tolterodine
• Oxybutynin
• Trospium
• Solifenacin
• Darifenacin
• Mirabegron
• Fesoterodine

Functional Incontinence

Due to their inability to reach the toilet in time, the most effective solution is to have a schedule for the client, and the time between visits would be appropriate to the client’s condition. This method would reduce the possibility of suddenly needing to go to the toilet, which means there is less likely to be an accident. For clients not suffering from neurological bladder disorders should also practise pelvic muscle exercises as it may help control the situation if there is an emergency problem.

Treatment for functional incontinence also requires treating the medical conditions that contribute to or cause the problem. For example, treating arthritis appropriately may make it easier to get to the bathroom.

Bowel Incontinence

Certain foods and drinks can make bowel incontinence worse. If your client is suffering from faecal incontinence, recommend they limit their intake of the following substances:

• Alcoholic beverages
• Caffeinated drinks, and any food containing caffeine
• Dairy products (such as milk, cheese, and ice cream)
• Fatty and greasy foods
• Foods and drinks containing added fructose
• Spicy foods

Biofeedback and PTNS are two procedures that can be taken to help with bowel incontinence. Biofeedback is used to help gain a greater awareness of many physiological functions, by using instruments that give information on the activity of those same systems. The end goal is to gain control in which the client is able to manipulate them systems at will. SNS (Sacral nerve stimulation) is more effective, the procedure has the client receive the electrode and pulse generator implanted in the gluteus or the abdomen. The treatment is designed to imitate a signal sent via the central nervous system in cases where the nerves and brain are not communicating efficiently.

Medications such as bulk laxatives and antidiarrheal drugs are also available to help with bowel incontinence.

Incontinence products

There is now a wide range of specialised products on the market to help ensure the cleanliness and comfort of those suffering from continence issues.

When it comes to shopping for incontinence products, it is always worth searching for the best value for money. Remember that incontinence products can often be obtained for free through your client’s local social services.

Personal incontinence wear like pads and incontinence pants are available. But there are many products designed to protect beds and chairs, such as waterproof sheets, seat covers, and mattress protectors.

Many online vendors offer free samples, allowing you to find the most suitable products for your client. For further details, visit:

• www.depend.co.uk/sample
• www.coloplast.co.uk
• www.tena.co.uk
• www.allaboutincontinence.co.uk/sample-packs

Out and about, and just can’t wait?

For clients who are still mobile and struggling with continence issues, PrimeCarers recommends registering for a FREE ‘Just Can’t-Wait’ toilet card. The Bladder and Bowel Community issue the cards and assist individuals in accessing their nearest toilet. The cards can be taken anywhere as they are universally recognised.

To register for your FREE card, visit: