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Continence clinic
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Continence Clinic
All members of the primary health care team should be actively involved in
the identification of patients with continence problems, following the new care
pathways.
Posters and leaflets will be placed in the surgery and in the patients/staff
toilets in order to encourage self referrals.
District nursing team members with relevant training will run the clinic
taking referrals from all member of the PHCT and self referrals. The clinic will
operate from Tweedmouth Clinic.
Continence advisors:
- Tracy Redpath
- Judy Fairbairn
- Christine Straughan
Clinic times:
- Tuesday afternoon [two weekly] from 2.00 pm to 4.00pm
Appointment times:
- 30 minutes for 1st and 2nd appointments.
- 15 minutes for follow ups/reviews
Aims of the Clinic
- Long term:
- To reduce the incidence of incontinence within
our Practice.
- Reduce the need for pads in the elderly of the
future and therefore reduce costs.
- Short term:
- Assess continence needs of patients attending the
clinic.
- Manage problems. Give information, education and
advice.
Routine procedure offered to each patient at initial
assessment/appointment
- History
- Medical history pertaining to continence.
- Surgical history pertaining to continence.
- Obstetric history.
- Family history of enuresis.
- Drug assessment.
- Mobility assessment/manual dexterity.
- Fluid intake.
- Degree of incontinence.
- Problems with constipation.
- Examination
- General assessment of weight, mobility, manual
dexterity.
- Vaginal examination - preferably by GP.
- Pelvic floor assessment by clinic nurse.
- Rectal examination.
- Routine urine test.
- Bladder scan may be arranged if appropriate or
residual urine performed.
- Management:
- Frequency volume chart
- Advice on fluid intake and diet
- Stress incontinence-pelvic floor exercises,
vaginal cones, biofeedback with aid of
perienometer.
- Urgency/frequency - bladder retraining/drugs.
- Over flow - intermittent self catheterisation.
- Other - advice on aids.
- Referral to the GP and subsequently to
Physiotherapy, Urologist, Gynaecologist,
Continence Adviser as deemed necessary
- Follow up
- Check understanding of information given.
- Reinforcement of advice with bio feedback.
- Support of relevant life style changes.
Some interesting facts:
There are two main types of urinary incontinence:
- stress incontinence and
- detrusor instability
which together account for more than 80% of all cases of urinary
incontinence. Urinary incontinence is 8 times more common in women than in men.
- 5% of girls under 15 years may have urinary incontinence.
- 1 in 5 of the mobile, actively, elderly population is wet - disastrously
wet so that their quality of life is affected.
- 40-50% of the elderly in nursing/residential homes have incontinence
- The problem is worldwide, e.g. in Japan, 8.5% of the population aged 17-19
are incontinence
- The latest Mori poll shows that 14% of women are incontinent at some
stage, this increases with age
- 42% of incontinent women have had incontinence for 4-6 years without
seeking help for it and 25% for more than 16 years — even though in 50% of
this group the problem affect their quality of life
Randomized controlled trails have found that pelvic floor muscle exercises
reduce symptoms of stress incontinence, and that high intensity exercise is more
effective than low intensity. Pelvic floor exercises are more effective than
electrical stimulation of the pelvic floor or vaginal cones.
Reference
Coop, J. & Monga, A 2000 Evidence, A compendium of the best available
evidence for effective health care, British Medical Journal, December 2000 page
11 48-I 159
Scowen, P. 1996 Childbirth and Continence: I, Professional Care of Mother &
Child. Vol. 6,No. 4, page 91-123
Judy Fairbairn