Clinical update
Urinary incontinence Essential Facts
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Many women suffer in silence with urinary incontinence (UI). A common and often distressing complaint, it affects women of all ages with a wide range of severity. Incontinence can have a serious impact on a woman’s physical, psychological and social wellbeing.
What’s new The National Institute for Health and Care Excellence (NICE) has updated its clinical guidance on the care of women with UI. It takes into account new developments and treatments that regulate bladder control, including the use of botox (injected into the bladder muscle), sacral nerve stimulation (an electrical device implanted beneath the skin in the upper buttock) and synthetic tape procedures (used to provide extra support for the urethra). The new guidance should help women access a wider range of treatments.
Causes/risk factors Risk factors include pregnancy, vaginal birth, obesity, family history and increasing age. Some types of medication can contribute to forms of UI, as can constipation, a weak pelvic floor and drinking too much alcohol or caffeine. Conditions affecting the brain or spinal cord, such as multiple sclerosis or dementia, can also increase the risk, although the new NICE guidance does not cover neurological causes.
Signs and symptoms UI is defined as any involuntary leakage of urine. The different types covered by the NICE guidance are as follows: Stress UI – this is caused by effort or exertion, or when sneezing or coughing. Urgency UI – leakage is accompanied or immediately preceded by an urgent desire to pass urine. Mixed UI – urine leakage is associated with both urgency and exertion, sneezing or coughing. Overactive bladder (OAB) – a feeling of urgency that may or may not lead to incontinence, usually with frequency (going to the toilet often) and nocturia (waking more than once during the night to go to the toilet).
Expert comment Irene Karrouze is lead nurse for continence at King’s College Hospital NHS Foundation Trust in London
How you can help your patient Treat UI seriously and be proactive. Women should have access to community continence services and, if necessary, specialist services in hospital. The NICE guidance lists the symptoms that should lead to women being referred to specialist services urgently. NICE emphasises that incontinence pads are not a treatment, but a coping strategy to be used prior to or during treatment. At the initial consultation, the type of incontinence should be identified and treatment started depending on this. Patients should be encouraged to keep a bladder diary for at least three days.
‘Urinary incontinence in women is more prevalent than reported as, sadly, some women just accept it as part of ageing or as a side effect of giving birth. But women should be treated proactively – they do not have to put up with it. They should be cared for first of all by their GP or community continence team, which will often take self-referrals from
NICE guidance 2013 Urinary incontinence: the management of urinary incontinence in women publications.nice.org.uk/ urinary-incontinencethe-management-ofurinary-incontinence-inwomen-cg171 NICE guidance 2012 Urinary incontinence in neurological disease guidance.nice.org.uk/CG148 Bladder and Bowel Foundation www.bladderandbowel foundation.org RCN guidance Improving continence care for patients – the role of the nurse. Go to www. rcn.org.uk and search for ‘improving continence’ Article from Nursing Standard: Treatment of patients with urge or stress urinary incontinence Hanzaree Z, Steggall M (2010) Nursing Standard. 25, 3, 41-46. http:// dx.doi.org/10.7748/ ns2010.09.25.3.41.c7990
patients. Then they can be referred to a specialist urogynaeocology service. ‘UI can have a huge effect on patients. Some women become depressed and do not want to go out. They may have problems with their body image too. Professionals should be asking women about their bladder health and taking it seriously if they say they are incontinent.’
NURSING october :: vol 28without no 9 ::permission. 2013 19 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Dec 02, 2015. For personal use only. No30 other uses Copyright © 2015 RCNi Ltd. All rights reserved.
Urinary incontinence Essential Facts
Find out more SCIENCE PHOTO LIBRARY
Many women suffer in silence with urinary incontinence (UI). A common and often distressing complaint, it affects women of all ages with a wide range of severity. Incontinence can have a serious impact on a woman’s physical, psychological and social wellbeing.
What’s new The National Institute for Health and Care Excellence (NICE) has updated its clinical guidance on the care of women with UI. It takes into account new developments and treatments that regulate bladder control, including the use of botox (injected into the bladder muscle), sacral nerve stimulation (an electrical device implanted beneath the skin in the upper buttock) and synthetic tape procedures (used to provide extra support for the urethra). The new guidance should help women access a wider range of treatments.
Causes/risk factors Risk factors include pregnancy, vaginal birth, obesity, family history and increasing age. Some types of medication can contribute to forms of UI, as can constipation, a weak pelvic floor and drinking too much alcohol or caffeine. Conditions affecting the brain or spinal cord, such as multiple sclerosis or dementia, can also increase the risk, although the new NICE guidance does not cover neurological causes.
Signs and symptoms UI is defined as any involuntary leakage of urine. The different types covered by the NICE guidance are as follows: Stress UI – this is caused by effort or exertion, or when sneezing or coughing. Urgency UI – leakage is accompanied or immediately preceded by an urgent desire to pass urine. Mixed UI – urine leakage is associated with both urgency and exertion, sneezing or coughing. Overactive bladder (OAB) – a feeling of urgency that may or may not lead to incontinence, usually with frequency (going to the toilet often) and nocturia (waking more than once during the night to go to the toilet).
Expert comment Irene Karrouze is lead nurse for continence at King’s College Hospital NHS Foundation Trust in London
How you can help your patient Treat UI seriously and be proactive. Women should have access to community continence services and, if necessary, specialist services in hospital. The NICE guidance lists the symptoms that should lead to women being referred to specialist services urgently. NICE emphasises that incontinence pads are not a treatment, but a coping strategy to be used prior to or during treatment. At the initial consultation, the type of incontinence should be identified and treatment started depending on this. Patients should be encouraged to keep a bladder diary for at least three days.
‘Urinary incontinence in women is more prevalent than reported as, sadly, some women just accept it as part of ageing or as a side effect of giving birth. But women should be treated proactively – they do not have to put up with it. They should be cared for first of all by their GP or community continence team, which will often take self-referrals from
NICE guidance 2013 Urinary incontinence: the management of urinary incontinence in women publications.nice.org.uk/ urinary-incontinencethe-management-ofurinary-incontinence-inwomen-cg171 NICE guidance 2012 Urinary incontinence in neurological disease guidance.nice.org.uk/CG148 Bladder and Bowel Foundation www.bladderandbowel foundation.org RCN guidance Improving continence care for patients – the role of the nurse. Go to www. rcn.org.uk and search for ‘improving continence’ Article from Nursing Standard: Treatment of patients with urge or stress urinary incontinence Hanzaree Z, Steggall M (2010) Nursing Standard. 25, 3, 41-46. http:// dx.doi.org/10.7748/ ns2010.09.25.3.41.c7990
patients. Then they can be referred to a specialist urogynaeocology service. ‘UI can have a huge effect on patients. Some women become depressed and do not want to go out. They may have problems with their body image too. Professionals should be asking women about their bladder health and taking it seriously if they say they are incontinent.’
NURSING october :: vol 28without no 9 ::permission. 2013 19 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Dec 02, 2015. For personal use only. No30 other uses Copyright © 2015 RCNi Ltd. All rights reserved.
