Continence management must be individual and based upon findings from the holistic continence assessment.
Please see the guide below to aid development of a management care plan.
The Management and Treatment options available fall into the categories in the diagram but vary based upon the initial assessment, diagnosis and if the problem is linked to bladder or/and bowel dysfunction.
All management should be individual, see below for a guide to what interventions and advice can enhance an individuals bladder and bowel functioning.
Choices we make daily impact on bladder and bowel functioning, see how below:
• To reduce urgency linked to bladder and bowel functioning - Reduce caffeine, alcohol and fizzy drinks
• An intake of at least 1.5 litres of fluid per 24 hours aids a healthy bowel and bladder
• Losing weight, if overweight, aids stress and urge incontinence as pressure is removed from the bladder and pelvic floor muscles
• Three meals a day aid a healthy bowel – balanced diet to include all food groups and fibre (18-30g per day DoH)
• NIicotine is a stimulant and can cause urgency with bladder and bowels - reducing or ceasing smoking aids management of urgency
• Increased activity for metabolism and to aid bowel function – an individual should maintain an exercise regime within their physical ability and capability
PELVIC FLOOR EXERCISES:
• Pelvic Floor Exercises should be individually tailored following an assessment of muscle status and strength. Pelvic floor exercises should not be given if an examination has not taken place (NICE 2019) and need to be part of a management plan with regular evaluation and clinical support.
Prescribed medication for bladder and bowel dysfunction includes:
• Anticholinergic or antimuscarinic medication to slow the bladder muscle down if overactive, reducing urgency and increasing capacity, aiding continence
• Laxatives to ease constipation symptoms
• Stool thickeners to aid management of faecal incontinence
APPLIANCES, TOILETING AIDS AND INCONTINENCE PADS
• Consider appliances such as anal plugs, urinary sheaths, body worn appliances (male) – all of these are on prescription
• Consider toileting aids such as commodes, bedpans and urinals – urinals work especially well for men and women with night time bladder problems
• If prescribing pads use the formacare product selector to aid appropriate product selection
• If using pads discuss underwear and skin hygiene with the patient and / or carers
• Follow manufacturers guide for fitting of incontinence pads
• Provide a full explanation of the management plan to ensure the patient understands what is expected and, therefore, aiding motivation and compliance to achieve the best possible outcome
• Regular evaluation dates should be planned either telephone or face to face consultation
• Give realistic timescales and goals