Assessment and Treatment of Urinary Incontinence
As mentioned in this blog article about urinary incontinence there are several types of incontinence. Because of this the treatment will vary and be dependent on the type of incontinence the person is experiencing. This also means that, for treatments to be effective, the person should see a qualified continence health care professional who can conduct a thorough assessment to advise the correct treatment options.
The aim of the continence assessment is to identify the problems causing incontinence. During the assessment the continence health care professional should ask about the person's medical history and review how they are managing their incontinence. The person experiencing incontinence (and/or their support workers or family) are usually asked to complete bladder and/or bowel diaries, often before their scheduled appointment.
Further information collected during the assessment can include:
- whether the person has urinary or faecal incontinence
- how often the person goes to the toilet to urinate and empty their bowels
- how much urine the person passes when they urinate
- what their faeces looks like
- what the person eats and drinks
- a list of the person’s medications, including prescription - over-the-counter and herbal
- any current health problems
- how much the person can care for themselves, e.g. whether the person can feed, dress and go to the toilet on their own
- whether or not the person recognises their need to go to the toilet or remembers where the toilet is.
The assessment will also usually include a physical examination which may include a vaginal and/or rectal examination.
All the information gained through this assessment process is then used to devise an individually tailored treatment or management program.
Common Treatments for Urinary Incontinence
People with stress incontinence are often taught how to do pelvic floor exercises so they can continue with an ongoing exercise program. Although these can be described in pamphlets and online it is advisable to see a qualified continence health care professional who specialises in incontinence as many people who try to do these exercises through just reading or being told about them do not do them correctly.
Other treatments for stress incontinence could be suggestions about healthy lifestyle changes such as quitting smoking, losing excess weight or treating a chronic cough. They could also be taught about bladder training if the person has a combination of other bladder problems such as urge incontinence. They may also be referred to a specialist doctor who may investigate if there is need for surgery.
People with this problem often need to suddenly go to the toilet especially when they arrive home after being out or if they hear the sound of water e.g. a running tap. There are many causes for urgency and urge incontinence and these people should see their doctor or pharmacist to have their regular medications reviewed. For example, diuretic medications will cause toilet urgency so they may need to time their activities away from home in the afternoons rather than in the mornings when they will need the toilet more often.
One of the main treatments for urinary urge incontinence is bladder training. This involves a review of their fluid intake and their output. As part of bladder training and investigation of much fluid the person is drinking they may be advised to space their intake of fluids more evenly throughout the day.
A person who has urgency or urge incontinence should also be assessed for constipation and then treated if this is a problem.
People who are reliant on others to help them to toilet should be watched for signs indicating their need to use the toilet (e.g. extra movement, trying the remove their clothes, pacing etc). These people should not be toileted unless they need to go (and not taken not “just in case”) and their carers should check that any continence aids are worn correctly (if they are needed as part of their care plan) as well as ensuring that any other aids (e.g. walking frame, urinal or commode chair) are within reach. The person should be encouraged to choose clothes which are easy to remove when they need to toilet and if the person needs a toilet for the disabled when they go out they should get a Master Locksmith Access Key (MLAC) which can unlock disabled public toilets.
Incontinence Associated with Chronic Retention
Incontinence associated with chronic retention can cause serious damage to the bladder and kidneys. People with this problem should always be treated and monitored by a qualified continence health care professional.
If a person has this issue their bladder will usually need regular artificial emptying to prevent damage to the bladder or kidneys as a result of the backflow of urine. Treatment for acute urinary retention often starts with catheterisation to relieve the distress of a full bladder and to prevent further bladder damage.
After assessment the doctor/specialist may offer further treatment of urinary retention with urethral dilation, urethral stents, prostate medications (male) and sometimes surgery. However this also depends on the type and cause of the urinary retention.
If these treatments for chronic urinary retention don’t work, there may be a need for occasional or long-term catheterisation or instruction on how to self catheterise to drain urine when necessary.
It is important that this condition is properly treated and monitored because complications of urinary retention can include urinary tract infections, bladder damage, kidney damage and untreatable urinary incontinence.
Functional incontinence happens when the person either has physical problems getting to the toilet in time, or when they have problems getting to the toilet, or being able to remove their clothing, or transferring onto a toilet in time to use it.
To address these problems the person’s toileting issues need to be checked to see if they need any toilet or bathroom modifications. Their toileting patterns should also be assessed so they can be assisted to use the toilet when they normally need to (e.g. they may need to have their bowels open after breakfast).
The aim of treatment and management plans for functional incontinence is to address the toileting needs before there is an accident through regular, scheduled toileting trips. The times for these trips are also found by examining the bladder and bowel diaries and then planning the scheduled toileting round these times. Therefore, bladder and bowel diaries are invaluable in this process as they provide the evidence of when toileting is more likely to be needed.
A person with functional incontinence may also need to be assessed to see if they need bladder training (see urge incontinence). This highlights their need for a thorough assessment to check for underlying bladder issues (such as infections) and possibly a need for a medication review.
For treatment and management plans to be successful it is important that the person experiencing incontinence is properly assessed by a qualified continence health care professional who can devise an individually tailored continence plan.
It is also important that the person experiencing incontinence follows the advice provided and returns to their health professional for follow-up reviews.
Article written by our resident continence expert Dr Lorraine
RN, Grad Cert Ad Ed & Trng, Grad Dip Nur (Cmm Hlth), MN, DN
Nurse Practitioner, Continence