GUIDELINES FOR ADULT URINARY INCONTINENCE.

Contents:

Supporting Information to Guidelines

Continence Treatment Plan

Adult Urinary Incontinence

Dept of Urology Chart

 

On presentation of a continence problem the client is seen by the General Practitioner or member of the Health Care Team (P.H.C.T)

1. A history and physical examination are undertaken.
2. An M.S.S.U. should be obtained. Urine should be  tested with a lab stick.
3. The client should be instructed to keep an input and output chart for the next week.
4. Explanation of the treatment guidelines should be given to the client. An appointment for assessment should be made two weeks after the initial assessment.

• Prior to the assessment the M.S.S.U result should be obtained and any necessary action taken..

5. Assessment interview undertaken by any member of P.H.C.T.
6. Continence questionnaire is used to establish an initial diagnosis.

• If the history points to stress incontinence, urge syndrome or a mixed picture of the two, one of the outlined treatment plans should be followed.

• Alternative diagnosis or complicated presentations should be discussed with the clients G.P or the Continence Advisor. Where referrals are indicated for special care, the continence record should be sent as the referral document.

7. Treatment plans should be followed for three months with a minimum of three progress consultations during this period.

• If urge syndrome has been identfied the clients G.P will be requested to prescribe an antichobnergic if appropriate to the individual client.

• The client will receive an individual reformation sheet outlining their treatment plan.

8. All clients are reviewed at three months.

• If cured or client satisfied with outcome they can be discharged.

• If improvement noted continue to support client with treatment plan.

9. If no improvement or deterioration discuss with G.P. and refer to the Continence Advisory Team or the Consultant. The continence record should be sent as the referral document.

SUPPORTING INFORMATION TO CONTINENCE GUIDELINES

The guidelines have been created to provide a clear pathway for health professionals to follow when a client presents with continence problems. Research studies have shown that a cure/significant improvement rate of up to 70% can be achieved by the primary health care team without referral to secondary care.

The guidelines focus on the treatment of people experiencing stress incontinence and urge syndrome. Complicated cases may be referred directly to the Continence Advisory Team or to Consultant care. The assessment and treatment can be undertaken by any qualified member of the Primary Health Care Team. It is felt that the G.P. should be the referrer to the specialist services and the person who remains aware of his/her patients progress along the guideline.

Presentation can be to any health care professional but the G.P. should be informed. Physical examination is felt to be essential to exclude any abnormalities which may warrant urgent referral to secondary care.

Utero/vaginal displacement need not warrant an initial referral to the gynaecologist if incontinence is the only complaint.

Hormone replacement therapy may be prescribed either systematically or locally. The evidence is equivocal on the benefits of H.R.T. in the improvement of continence problem It is felt that the decision should be left between the G.P. and the client.

An M.S.S.U. should be obtained to exclude or treat urinary tract infection prior to commencement on a treatment plan. The urine should also be tested with a multi stix to exclude other abnormalities. The M.S.S.U. should be repeated after the treatment if infection is present

Fluid Input and output charts are invaluable for assessing the extent of the problem and identifying retraining program baselines.

The Assessment Interview can be undertaken by any of the healthcare professionals identified. In the interests of continuity of care it is recommended that the person undertaking the assessment should also commence the treatment plan and undertake the progress reviews up to the three month period. Staff undertaking the assessment should be aware of the time commitment involved.

The questions identified have been drawn from the available literature and are felt to be the minimum necessary to establish a diagnosis. On completion of the questionnaire, the health professional should be able to establish a diagnosis.

When identifying the clients drug therapy the services of the community pharmacist may be used to advise on drug interactions.

On completion of the assessment the health professional can commence the client on a treatment plan. If the case Is complicated they can ask the Continence Advisory Team for advice or refer the client to the G.P informing them of the assessment.

Treatment Plans are based on available research and from centres already using similar guidelines.

If urge syndrome has been identified, the G.P will be requested to prescribe an antichomergic, if they feel it appropriate to the particular client. Research shows that anticholinergics are effective at the commencement of treatment.

If treatment plans are followed for a minimum of three mouths there should be some improvement by this time

Many clients will be improved enough to be discharged after three mouths and others may need a longer period of support by the P.H.C.T. Clients who have shown no improvement will be referred to the Continence Advisor.

The Continence Advisory Team provides specialist assessment and support. The team will have access to physiotherapy services and with G.P. approval, urodynamic assessment. Specialist equipment such as trophic stimulators, vaginal cones etc, are available. The Continence Advisory Team will keep the G.P. informed of the client's progress and will advise on appropriate referrals to secondary care.

Bolton Primary Care Trust

CONTINENCE TREATMENT PLAN.

NEED	ACTION	COMMENT
Intake	Advise 1.5 Litres daily Advise against caffeine
Bowels	Assess patterns Treat constipation Advise re diet
Mobility	Consider walking aids Correct height chair
Manner of Dexterity	Consider clothing adaptations
Toilet Facilities	Consider grab rails, raising seat, Commode, urinal
Smoker	Advise
Motivation	Positive attitude

 

Strengthen Pelvic Floor	Assess pelvic floor Explain and teach pelvic floor exercises Set base rate and give booklet.
Increase bladder capacity	Explain aim of treatment Use baseline chart to establish toileting frequency Advise protection may be needed increase toileting tiines at 15 min intervals Refer GP for anticholinergics (if small frequent volumes and empty bladder) Give information booklet.

 

DATE	PROGRESS	SIGNATURE
First Review	Severity Score:
Second Review	Severity Score:
Third Review	Severity Score:

Refer to GP or consider Continence Advisory Service Referral.

Adult Urinary Incontinence