Investigation and management of continence issues in the aged care facility setting 1.

Definition: Incontinence is a term that describes any accidental or involuntary loss of urine from the bladder (urinary incontinence) or bowel motion, faeces or wind from the bowel (faecal or bowel incontinence). 2. Types Urinary incontinence Urinary incontinence (or poor bladder control) is a common condition, that is commonly associated with pregnancy, childbirth, menopause or a range of chronic conditions such as asthma, diabetes or arthritis. stress incontinence urge incontinence overflow incontinence, functional incontinence. Faecal incontinence Faecal incontinence is a term used to describe leakage from the bowel due to poor bowel control. Causes of faecal incontinence long term straining medications, e.g. antibiotics, drugs for arthritis and diabetes lifestyle, e.g. heavy lifting leading to weak pelvic floor muscles weak back passage muscles due to having babies, getting older, some types of surgery, or radiation therapy diabetes bowel disease, e.g. Coeliac disease, Crohn's disease nerve disorders resulting from MS and Parkinson's severe diarrhoea, or constipation. Complications: Fall Psychosocial effect Skin breakdown and infection around perineum Risk factors for urinary incontinence pregnancy (both pre- and post-natal women) younger women who have had children menopause obesity urinary tract infections constipation specific types of surgery such as prostatectomy (removal of all or part of the prostate) and hysterectomy (removal of all or part of the uterus and/or ovaries) reduced mobility preventing you from getting to or using the toilet neurological and musculoskeletal conditions such as multiple sclerosis and arthritis

health conditions such as diabetes, stroke, heart conditions, respiratory conditions, and prostate problems, and some medications.

Risk factors for faecal incontinence A risk factor for faecal incontinence is urinary incontinence. Other risk factors are similar to those of urinary incontinence, but also include: chronic diarrhoea, and dementia. Screening/ Assessment History, physical examination, investigation/diagnostic evaluation 1. Urinary questions - polyuria >6times/day - nocturia >twice a night - Urine leakage - Dysuria , retention etc - underlying cause of incontinence > determine type of incontinence. 2. Faecal questions - lost control of bowel movements or leakage - other bowel symptoms > constipation or diarrhoea 3. Pad use - using any pads - how often pads may be soiled/wet > use bowel or bladder chart to determine further information. ~fluid consumption, other factors that may interfere; mobility, dementia. Management 1. Eliminate contributing factors (infection, cough, medication) 2. Physical and behavioural mobility aids, assistance, prompted toileting, physio/pelvic floor exercise, bladder training 3. Diet adequate fibre and fluid intake 4. Skin care 5. Medication? > anticholinergic medication in urge incontinence. Avoid anticholinergic agents in people with dementia because of the risk of cognitive decline and delirium Reference 1. What is Incontinence, 2012, Continence Foundation of Australia, <http://www.continence.org.au/pages/urinary-incontinence.html> 2. Dawson C, n.d, The Diagnosis and Management of Urinary Incontinence. 3. NPS Medicine Wise, 2013, Managing Incontinence in Aged Care, <http://agedcare.nps.org.au/clinical_info/feature_topics/topics/managing_urinary_incontinence>