Topic Progress:

Managing Incontinence

The ultimate goal for any clinician caring for an individual with urinary or faecal incontinence is to alleviate and control bowel/bladder function (Cooper, 2011). In order to do this, the clinician needs to establish the cause of the incontinence and implement a plan of care. A clear patient history should be taken when assessing a patient with incontinence. (Ousey, 2017)

A multi-disciplinary approach involving specialists, e.g. continence specialists and dieticians, can be used when planning a treatment and management plan.

Possible causes of faecal incontinence:

  • Anal sphincter damage or weakness
  • Obstetric trauma to anal sphincter muscles and surgery such as lateral sphincterotomy, haemorrhoidectomy and anal stretch
  • Neurological conditions
  • Spinal cord injury, multiple sclerosis, Parkinson’s disease, spina bifida and stroke
  • Impaction with overflow
  • Frail or immobile patient and physical disability
  • Cognitive impairment, e.g. dementia
  • Anorectal pathology
  • Rectal prolapse, congenital abnormalities and anal/recto-vaginal fistula
  • Diarrhoea/intestinal hurry
  • Crohn’s disease, ulcerative colitis and drugs, e.g. antibiotics

Possible causes of urinary incontinence:

  • Stress incontinence
  • Pelvic floor muscles damaged or weakened
  • Urethral sphincter damage
  • Urge incontinence
  • Urinary tract infection
  • Neurological conditions as above
  • Bladder cancer
  • Increasing age
  • Bladder outlet obstruction/stones
  • Benign prostatic hypertrophy (men)
  • Unknown cause
  • Overflow incontinence
  • Enlarged prostate gland (men)
  • Bladder stones
  • Constipation
  • Surgery to the bowel or spinal cord
  • Weak bladder muscles
  • Nerve damage
  • Some medications

Medications associated with urinary incontinence:

  • Alpha-adrenergic agonists
  • Alpha-adrenergic blockers
  • Angiotensin-converting enzymes
  • Diuretics
  • Cholinesterase inhibitors
  • Some medications with anticholinergic effect
  • Hormone replacement therapy
  • Opioids
  • Sedatives and hypnotics

(Bianchi, 2012)

A multidisciplinary approach may be required, with the continence advisor included in the team of clinicians involved in planning care (Bianchi, 2012).

The range of treatment options for managing incontinence include:

  • Continence devices (including containment devices, e.g. appropriate use of incontinence pads)
  • Faecal management systems
  • Catheterisation

For reversible causes, options include non-invasive interventions such as toileting techniques or nutritional and fluid management. (Ousey, 2017)

Incontinence, especially acute diarrhoea, does represent a significant threat to perianal skin integrity and, if not managed appropriately, is likely to lead to the formation of a moisture lesion and/or moisture associated skin damage (Beldon, 2008). Appropriate skin care can assist in the prevention and treatment of MASD.