CONTINENCE AND INCONTINENCE

Importance Of Assessment In The Promotion Of Continence And Management Of Incontinence



Importance Of Assessment In The Promotion Of Continence And Management Of Incontinence

In this paper I will focus on the importance of assessment in the management of incontinence urinary and promotion of continence. For this purpose in the first par of the paper for promotion of continence I will eloberate its importance with the help of a case of patient. Incontinence is distressing, unpleasant and socially disruptive (Getliffe and White, 2003) and is defined as 'the complaint of any involuntary leakage of urine' (Abrams et al, 2002). Incontinence is a symptom of an underlying disorder and a continence assessment is essential to identify possible causes and to plan treatment or referral for specialist advice. This requires the assessment of the whole patient rather than just his or her urinary symptoms. Incontinence is distressing, unpleasant and socially disruptive (Getliffe and White, 2003) and is defined as 'the complaint of any involuntary leakage of urine' (Abrams et al, 2002). Incontinence is a symptom of an underlying disorder and a continence assessment is essential to identify possible causes and to plan treatment or referral for specialist advice. This requires the assessment of the whole patient rather than just his or her urinary symptoms. The assessor needs to adopt a positive and empathetic approach that motivates the patient (Colley, 1996). This article describes how a continence assessment and subsequent treatment plan enabled a patient to be actively involved in improving her urinary symptoms.

Case history

Mary Sims is 56 years old and is married with one adult son. She was referred to the continence adviser by her GP who suggested that she had urge urinary incontinence (a sudden compelling desire to pass urine, which is difficult to defer). The GP had diagnosed a urinary tract infection that was treated with antibiotics.

Assessment

During Ms Sims' first visit to the continence adviser, a detailed medical and social history was discussed and recorded. She had reflux indigestion, which was treated with lansoprazole; hypertension, which was treated with doxazosin; and she had been prescribed paroxetine for depression. Her weight had increased by 16kg over recent years. She was a non-smoker, did not drink alcohol, and was sexually active. Her husband was very supportive of her condition.

Ten years ago, Ms Sims had had a total hysterectomy and in 1997 had a lumbar disc removed due to chronic back pain. She now walks independently with crutches but has no problems with accessing the toilet at home. We used the Bristol Stool Scale (Heaton and O'Donnell, 1994) to assess her bowel function and identified that she did not have constipation.

Urinary symptoms

Ms Sims reported increased daytime frequency with urgency, and nocturia up to six times at night (Box 1). She also reported leaking urine when she coughed. She had experienced bladder problems since her hysterectomy, and in recent years they had become much worse. As a result of her urinary symptoms, she had restricted her fluid intake to 2-3 mugs of tea ...