Components of treatment and care

Components of treatment and care include:

• Prevention of bladder weakness
• Clinical assessment to establish cause
• Treatment of underlying disorder
• Appropriate management of intractable incontinence

Prevention

Early advice given to those at risk is beneficial in reducing the incidence of bladder weakness This will make people more aware of services and treatments available to help their condition.

Strategies to help promote continence include:

• Avoid constipation
• Drink 1½-2 litres of fluid per twenty four hours (sufficient to keep the urine a pale straw colour)
• Empty bladder 4-8 times per twenty four hours
• Empty bladder fully
• Sit comfortably on toilet
• Do not leave it to the last minute to empty bladder
• Avoid being overweight
• Keep as fit as possible
• Exercise the pelvic floor muscles
• Do not go to the toilet “just in case”
  

Assessment

Patients suffering from bladder weakness should receive a comprehensive clinical assessment by the most appropriate healthcare professional. This may be Doctor, Registered Nurse, Physiotherapist or multidisciplinary involving input from other members of the healthcare team.

Assessment takes time and it is important not to rush the client. A mutually understood vocabulary must be established between professional and client. A suitable location maintaining the client’s privacy and dignity should be sought wherever possible.

The aim is to build up a holistic picture of the client and the incontinence, its causes and effects.

Assessment involves several stages:

• Collection of information from/about the client
• Collation and review of information from all sources
• Identification of problems and diagnosis
• Identification of priorities amongst problems

Treatment

Following assessment the client and carers where appropriate should:

• Be given a clear explanation of the diagnosis reached or further investigation required
• Be offered treatment options with full discussion of their implications

The progress of treatment should be reviewed at regular intervals. If treatment is unsuccessful at restoring continence, or does not progress as rapidly as expected, other options or referral to other healthcare professionals should be considered.

All clients should have potential access, where appropriate to:

• Advice on fluids, diet, skin care and odour control
• Pelvic floor education
• Bladder retraining programme
• Drug therapy
• Electrostimulation or biofeedback
• Intermittent self catheterisation
• Advice on catheter care (urethral or suprapubic)
• Full range of investigative procedures
• Surgical intervention
• Behavioural therapy
• Enuresis and encopresis clinics
• Advice and support on managing incontinence where treatment fails to restore full continence

Management

The minority of patients who fail to respond to treatment need techniques that will enable them to live with their bladder weakness while maintaining an acceptable quality of life.

Using the right products to help manage the condition can help people with bladder weakness maintain their dignity, self esteem, comfort and, sometimes, even their independence

In addition to arranging a supply of products and giving guidance in their use, healthcare professionals responsible for managing such patients need to consider the standard of the individual's personal hygiene and skin care and the availability of the necessary laundry and disposal facilities. Most important also is continued support for the patient and the family aimed at maintaining psychosocial functioning in the face of a long-term continence problem. Advice on any financial assistance that may be needed is available from social services departments.