Module 5 Management Of Urinary Incontinence

Transcription

1 Management Of Urinary Incontinence V3: Last Reviewed September 2017

2 Learning Outcomes Outline conservative management options Discover the options available to manage the different types of incontinence Recap and summary with questions, evaluation and certificate

3 Section 1 Introduction

4 Introduction From previous modules and additional reading, you will already be familiar with the different types of incontinence and their causes and assessment Once the continence assessment has been carried out, a management plan can then be devised Treatments and correct management can relieve symptoms and improve a person s quality of life, as well as promote independence and dignity This module will cover the treatment options and management for the five main types of urinary incontinence

5 Section 2 Treatment Options

6 Types of Urinary Incontinence

7 Stress Incontinence Pressure Leakage

8 Stress Incontinence Treatments Pelvic Floor Pelvic Floor Muscle Exercises (PFME) are the first line of treatment for stress incontinence in both men and women (Thirugnanasothy, 2010) Pelvic floor exercises should be carried out for at least three months Motivation and cognition are important, and for those that cannot contract their pelvic floor muscles, biofeedback and electrical stimulation can be used (NICE, 2010) The continence nurse or specialist physiotherapist will ensure the exercises are done correctly and they will also monitor patient progress All women should be offered pelvic floor exercise treatment in their first pregnancy to prevent postnatal stress urinary incontinence (NICE, 2013)

9 Other Stress Incontinence Treatments Treat constipation if present, as this can reduce the strain on the pelvic floor muscles (Thirugnanasothy, 2010) Ensure sufficient and appropriate fluid intake Weight reduction If conservative management is not effective Urethral injections to bulk (ICS, 2013) Surgery to support the neck of the bladder and urethra Medication if previous surgery has failed or not appropriate

10 Other Stress Incontinence Treatments Artificial sphincter (ICS, 2013) if previous surgery has failed Appropriate containment aids: - Disposable pads - Washable underwear - Sheaths (Newman & Wein, 2009)

11 Urge Incontinence Nerve impulse Detrusor muscle instability Leakage

12 Urge Incontinence Treatments Bladder Retraining Bladder retraining is the first line of treatment in both men and women for urge incontinence, and must be tried for at least a six week period (NICE, 2012) The aim is to extend voiding intervals to allow the bladder to fill more, increasing the volume and also giving control over the need to void (UroGynecology Specialty Center, 2014) Once a pattern is identified, bladder retraining can be used to predict and avoid incontinence (NICE, 2012)

13 Other Urge Incontinence Treatments Botox can be suitable for those with detrusor over activity who have not improved with conservative management. They involve injections into the bladder wall/detrusor muscle. Some people may find it difficult to void post Botulinum Toxin Type A, therefore, they must be taught and be able to do intermittent selfcatheterisation for as long as necessary. Percutaneous sacral nerve stimulation involves an implant that controls the sacral nerve supply to the bladder, allowing the person to control voiding. The person can carry it out in their own home. This is suitable for those who conservative management has not helped, and cannot perform intermittent selfcatheterisation (NICE, 2013)

14 Mixed Incontinence The principle symptom is treated first. Bladder training and pelvic floor exercises should be included (Mevcha and Hashim, 2009)

15 Overflow Incontinence Possible detrusor under activity Possible obstruction Leakage The treatment will depend on the reason. It may be either caused by bladder outlet obstruction, or detrusor under activity, or both.

16 Overflow Incontinence Treatments Toileting position Allow enough time for voiding Double voiding Bowel management, treat constipation Fluids (limit caffeine intake) Intermittent catheterisation or indwelling urethral catheter Medication review Surgery: prostate surgery/prolapse/fibroids/urethral stricture (Newman, Slack and Wein, 2011)

17 Time for Myth or Fact Understand the importance of a comprehensive continence assessment Discuss in detail the key elements of the continence assessment Outline the baseline investigations carried out as part of a continence assessment List some additional investigations that may be performed by the specialist nurse or doctor Appreciate the importance of effective interpersonal and communication skills when discussing continence issues with an individual V4: V4: Last Last Reviewed V4: Last September Reviewed May This 2017 This programme This programme has has been been has accredited been accredited by by the the RCN by RCN Centre the Centre RCN for Centre for Professional for Professional Accreditation Accreditation until until 4 th 4 th until September 7 th June Accreditation applies only only to to the the educational content of of the the programme and and does does not not apply apply to to any any product.

18 Myth or Fact? Urinary incontinence will improve if left untreated Myth or Fact?

19 Myth or Fact? Myth If left untreated, symptoms will only become worse and lead to unnecessary anguish

20 Myth or Fact? Nursing staff need a knowledge of urinary incontinence and treatment options Myth or Fact?

21 Myth or Fact? Fact Nurses need to have an understanding of the types, causes, assessment and treatment options available in order to promote dignity, independence and quality of life

22 Myth or Fact? Surgery is unavoidable in treating urinary incontinence Myth or Fact?

23 Myth or Fact? Myth Pelvic floor muscle training and behavioural therapy can greatly reduce or even eliminate symptoms

24 Section 2 Treatment Options Continued

25 Functional Incontinence

26 Functional Incontinence Treatments When a person you are caring for is incontinent, always ask yourself Can they get out of their bed or chair easily? Does the person need assistance? Ensure they can summon assistance if needed. Do they communicate with body language or sounds that indicate they need to go to the toilet? Watch for non-verbal cues such as pulling clothing, agitation or wandering. Do they know where the toilet is? Is there adequate lighting and signs? Are the floor surfaces clear or hazards / slippery surfaces? Can clothing be easily removed or adjusted? Footwear should be well fitting and non slip. Is the toilet clean and private? Are there adequate hand washing facilities?

27 Section 3 Toileting Programmes

28 Toileting Programmes When choosing a behavioural management programme, take into account that prompted voiding and bladder retraining are particularly suitable for people with cognitive impairment A bladder/voiding diary can identify if the person can feel when their bladder is full and also how often voiding is indicated (Shenot, 2014) Assisted toileting takes place at set times or on request, usually when the person is dependent on help to get to the toilet and often with those that have limited mobility or who are confused

29 Toileting Programmes Scheduled / timed toileting means voiding urine according to the time, rather than waiting for the need or urge to void (Mayo, 2014) The person goes to, or is prompted or taken to the toilet at a scheduled time before they have the urge to void Scheduled toileting can be time established by evaluation of fluid charts or after meals, on waking, midmorning, mid afternoon and before settling Scheduled toileting reinforces healthy habits and can be used with those who are confused

30 Section 4 Recap

31 Recap There are multiple treatments for each type of urinary incontinence The use of pads, appliances and catheters are not a treatment for urinary incontinence. They should only be used following assessment and treatment of reversible causes (Wagg, 2007). They can also be used during the treatment/management phase, but stopped once continence has been achieved

32 Assessment Test your knowledge of this module by using the interactive quiz in step two of the elearning tool A certificate will be available on a pass rate of 80% or over Good luck!

33 Section 5 References

34 References ICS. (2013). ICS Fact Sheets: A Background to Urinary and Faecal Incontinence. Available: [Online] [Last accessed ] Mayo Clinic. (2014). Treatments and Drugs. Available: [Online] [Last accessed ] Mevcha, A. and Hashim, H. (2009). Bladder Training Urinary Incontinence - Good Clinical Care Foundation. Foundation Years Journal. 3 (5), p 36. NICE. (2010). Lower urinary tract symptoms: The management of lower urinary tract symptoms in men. Available: [Online] [Last accessed ] NICE. (2012). Urinary incontinence in neurological disease: Management of lower urinary tract dysfunction in neurological disease. Available: [Online] [Last accessed ] Newman, D, K., Wein, A, J. (2009). Managing and Treating Urinary Incontinence. 2nd Ed. Health Professions Press: Baltimore.

35 References Shenot, P, J. (2014). Urinary Incontinence in Adults. Available: [Online] [Last accessed ] Newman, D, K., Slack, A., Wein, A, J. (2011). Fast Facts: Bladder Disorders. 2nd Ed. Health Press Limited: Oxford. Thirugnanasothy, S. (2010). Managing Urinary Incontinence in Older People. BMJ. C3835, p 341. UroGynecology Specialty Center (2014). Urinary Incontinence. Available: [Online] [Last accessed ] Wagg, A. (2007). Continence. Available: [Online] [Last accessed ]