Continence is a sensitive issue. Clinicians need to actively listen to the patient and avoid making judgments
It is essential to respect the patient’s right to choose the most appropriate treatment option.
- Do you leak urine before you get to the toilet?
- Do you have to wear pads?
- Do you suffer from constipation or diarrhea?
- Do your bowels or bladder ever cause you embarrassment, pain or concern?
- Are you rushing to the toilet or looking for the toilet all the time?
- Are you going to the toilet every half an hour? (in addition to leaking urine, overflow incontinence can also be identified by frequency)
- Was this an issue before you were ill or has it become worse?
If a patient answers YES to any of these questions, they should be assessed for incontinence.
If the person has a pre-existing cognitive impairment or is experiencing delirium, confirm their answers with their family or carer. If applicable, contact the patient’s residential care facility to obtain their continence plan. This information will help identify the risk of episodes of incontinence during their stay.
The next step might include some investigation of the symptoms. It is a good idea to go into this assessment prepared by thinking about symptoms and perhaps even using a chart such as a bladder diary to record some of the symptoms. List of current medications, diet, medical history and timeline on when symptoms started are all helpful
A starting point might be to contact a continence nurse at the Continence Foundation. They are available to discuss any concerns with you and direct you to the right specialist for you They are open 8am -8pm on 1800 330 066
Continence assessment includes
- Identifying the type of incontinence (ie urgency, stress-related, mixed)
- The severity (number and size of pads used, preferably pad weights) and the impact on activity or quality of life.
In patients who have mixed incontinence, such as urgency and stress incontinence, it is important to determine which is more bothersome.
In the presence of complicated lower urinary tract dysfunction, symptoms such as haematuria, recurrent UTIs, dysuria and pain will require further investigation or specialist referral to exclude malignant or infectious pathology.
Addressing conditions such as diabetes, ischaemic heart disease or congestive cardiac failure, neurological conditions, chronic pulmonary disease, and obesity, can exacerbate OAB and SUI symptoms may not eliminate incontinence, but it may lessen the severity.