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.