Continence clinic

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