Disease Management in Incontinence Care Chan Sau Kuen Continence Nurse Consultant United Christian Hospital 14/11/09
What is incontinence? Definition of Incontinence - Is the compliant of any involuntary leaking of urine or bowel (ICS 2002)
People at risk Elderly Women (Mother) Disable people Person in the institution
Prevalence of Urinary Incontinence (APCAB 1998) Country Prev. :Overall (%) Prev. :Female (%) Prev. :Males (%) China 7.4 11.6 3.4 Hong Kong 12.2 12.0 13.0 India 4.6 6.2 1.7 Indonesia 5.4 5.8 5.0 Korea 22.7 22.6 28.6 Malaysia 10 13.1 7.9 Pakistan 23.1 24.0 13.2 Philippines 12.4 13.9 8.0 Singapore 9.3 11.8 4.3 Tai Wan 7.5 7.4 7.6 Thailand 19.5 20.9 14.1 Overall 12.2 14.6 6.8
Compare the epidemiology of incontinence among Hong Kong and Western Country Pang 2005 Bringer 1996 Stress Incontinence 33.9% 21% Urge Incontinence 15.5% 15% Frequency of Micturation 19.3% 19% Voiding difficulties 7.6% 13%
Consequence of Incontinence Physical Aspect Discomfort Smelly Skin rash Bed sore Fall Dehydration
Consequence of Incontinence Psychological aspect Lost of self-esteem and self confidence Independent Worry Embarrass Depression
Consequence of Incontinence Social aspect Avoid social life Isolation
Philosophy of Continence Care Everybody has the night to be continence When true continence is not achievable, people have the right to the highest standards of continence care and incontinence management.
Objectives of Nursing Management Independence continence Dependence continence Social continence
Levels of Care Primary and Community Care Promotion of public awareness Preventive measures Identification of people at risk Secondary Care Reduction of severity of the incontinence Tertiary Care Preventing and managing complication Maintain social continence after secondary care
Management in Incontinence Assessment Explaining of the problem Psychological support Strategies of bladder / bowel management
The Goal of Assessment Confirm the presence of incontinence Identify the risk factors and causes of incontinence Make an accurate diagnosis Decide on need for further evaluation
ASSESSMENT 1.Social Background Living condition Toilet distance Toilet facilities
2.Health History Medical :DM Stroke Parkinson Surgical :Urethral dilatation TURP Bladder neck surgery Radical Prostatectomy Gynaecological : Hysterectomy Pelvic floor repair Obstetric : No. of pregnancy Types of deliveries Child birth weights
3. Medications - Diuretics -Sediatives - Anticholingerics - Antidepressants - Narcotics Analgesics - Calcium Channel Blockers - Alpha-adrenergic Blockers
4. Urinary signs and symptom - Duration - Frequency of voiding - Voiding amount - Frequency of incontinence - Amount lost - Urgency - Hesitancy -Stream -Dysuria -Haematuria - Smell of urine
5. Bowel Symptoms - Frequency - Normal Pattern - Character - Constipation - PR bleeding - Control 6. Continence Aids 7. Fluid and diet intake
8. Physical Assessment - Mobility - Functional activity - Mental state - Communication 9. Attitude towards incontinence
10. Physical exam. - Abdominal - Skin condition - PR: anal tone faecal loading prostate size mass - PV:pelvic floor muscle grading prolapse atrophic vaginitis
11. Ix - Frequency volume chart - Urinalysis -MSU - Post voiding Residual Urine - X ray Abd - Urodynamic study - Cystoscopy 12. Psychosocial Aspect 13. Economical Aspect
Explaining the problem Better understanding Better motivation Make decisions on treatment options
Psychological Support Trusting relationship Sympathetic ear
Strategies of bladder / bowel management Treat the reversible causes : D Delirium I Infection A Atrophic P Pharmacologic P Psychological E Excessive urine output R Restricted Mobility S Stool Impaction
Stress incontinence Pelvic floor exercise Prevent constipation Appropriate aids Lifestyle modification Surgery
Urge incontinence Lifestyle modification Bladder training Biofeedback Appropriate aids Skin care Medication Surgery
Absorbent products
Overflow incontinence Empty the bowel Intermittent catheterization Indwelling catheter
Nelaton Catheter
Functional incontinence Toilet training Appropriate aids Life-style modification
Constipation Lifestyle modification Bowel training Medication
Faecal incontinence Anal sphincter exercise Treat constipation Appropriate aids Skin care Surgery
Anal plug
Lower Urinary Tract Syndrome Lifestyle modification Pelvic floor exercise Bladder training Urethral massage Medication Surgery
Enuresis Lifestyle modification Prevent constipation Bladder training medication
Bed protection
Refer to related specialtist for further investigations / interventions Urologist Colorectal Surgeon Urogynaecologist Geriatrician Occupational Therapist Physiotherapist Medical Social Worker
Management Process Evaluation Assessment Management Plan