Continence management Resources

The fourth and final part of the JCN continence clinical skills series identifies how continence problems, which may not have responded to conservative treatment/interventions, can be managed by the appropriate use of equipment/devices and products. The range available is vast and variable and some are more suitable to specific conditions than others. Healthcare professionals need to understand how they work to offer the best solution for individuals and their lifestyle. Products include, for example, commodes, urinals, sheaths, catheters, anal irrigation and pad products. This article specifically looks at equipment/devices and products for urinary retention, e.g. catheters; urinary incontinence, e.g. sheaths, pubic pressure devices; and faecal incontinence, e.g. anal plugs, transanal irrigation (TAI) and pad products. 

Urinary and faecal incontinence are common in the older population, yet incontinence is not a normal part of ageing. Dementia can impact upon a person’s ability to remain continent, yet incontinence is unlikely to be a symptom of dementia until the latter stages of disease progression. There is a misconception that nothing can be done if a person with dementia experiences episodes of incontinence. However, many people with dementia often experience functional incontinence caused by immobility, communication difficulties, disorientation, or the inability to find the toilet, which can all be alleviated if the right support and advice is available. Improving the identification, assessment and management of continence issues can not only enable people with dementia to maintain their dignity and improve their health, but also their sense of wellbeing and quality of life. There is also the possibility to improve relationships, reduce carer burden, and reduce the risk of a premature transition into a residential care setting. This fourth paper in the series explores some of the issues relating to dementia and continence and the impact as experienced by our two case studies, Dhriti Singh and Gregory Brewin.

Urinary incontinence (UI) is a common consequence of radical prostatectomy for which men often feel unprepared despite the provision of information about treatment and management. The aim of this study was to explore from the patient’s perspective the nature of information and support men require to aid adjustment to daily life with UI. In a qualitative study using a convenience sample, recruited men (n=35) were aged over 18 years old and were less than 18 months post radical prostatectomy. Data were collected using interviews and a thematic analysis was performed. The study identified that men need less rather than more information, which should be succinct, and focused on management of incontinence to enable them to cope with daily activities. Effective management strategies rather than an overreliance on treatment methods, which may be ineffective, were also key to enabling successful adjustment. Men need clarity about care pathways, including access to appropriate contact information. Finally, men describe the confusion experienced when choosing containment products and require clear, concise information. 

Ian Pomfret gives a basic guide to using and choosing urinary sheaths.
Ian Pomfret SRN, NDN Cert, PWT is a District Continence Adviser, Chorley & South Ribble Primary Care Trust. Article accepted for publication: April 2003

Ian Pomfret and Rona Mackenzie give an overview of the work of a continence forum in evaluating and researching the evidence base behind continence management.
Ian Pomfret SRN, NDN Cert, PWT is a District Continence Adviser, Chorley & South Ribble PCT.
Rona Mackenzie RGN, RM, NDN Cert, Cert Ed, BA (Hons) is a Clinical Nurse Specialist, Epping Forest PCT
Article accepted for publication: October 2005