21 Aug 2019

Different Types of Incontinence: Providing Quality Care

Different Types of Incontinence: Providing Quality Care

Evidence gathered between 2012 and 2017 by the Care Quality Commission has concluded that continence care is the least satisfactory aspect of care in UK nursing homes. Based on these findings, there is a worrying risk that continence care will be further deprioritised within social care settings. There is a national concern that many basic elements of care, such as support to use the toilet and wash afterwards, changing incontinence pads and developing a care plan may not be consistently delivered.

Incontinence can be a life changing condition. It is therefore important that care residents feel safe and supported in managing incontinence. Simply understanding the fundamentals of incontinence care in care homes can have a huge impact on the quality of life of residents. As Catherine Williams from the Association of Incontinence Advice states, “high-quality continence management is essential in maintaining dignity and quality of life for older people. A lack of emphasis on the need for proactive continence care by those commissioning care placements within residential homes will have an impact on patients’ dignity. It can also affect their health and wellbeing, their ability to interact with friends and family and may contribute to depression.” She asserts, “although local continence services are able to provide advice and support to residential care homes to improve their knowledge, it can be difficult for home managers and carers to give the issue the attention it deserves.”

As care home workers are aware, the “one size fits all” ideology for taking care of residents does not work in many aspects of care. Incontinence care is no exception for this. A method called “person-centred continence care” is, therefore, the most effective alternative method. For those who are experiencing bowel or bladder incontinence, person-centred continence care is crucial in order to provide them with the most appropriate level of care.

What are the different types of incontinence?

There are many classifications of incontinence. They are carried out basing on different criteria. The most common classification was developed by the Standardization Committee of the international organization by the name of ICS (International Continence Society). It is a formal classification which includes also faecal incontinence.

Stress incontinence:

Stress incontinenceIs related to the weakening of the pelvic muscles. It is the involuntary urine loss while sneezing, coughing or during physical activity. This type of incontinence in most cases concerns women. It appears in men who had their prostate removed.

Urge incontinence:

Urge incontinenceUncontrolled urine loss preceded by the strong urge to urinate: it can take the form of minor leaks between voluntary urination, or a complete, involuntary bladder voiding.

Mixed incontinence:

Involuntary urine loss occurring during physical exercise, while sneezing, laughing or coughing, combined with the urge to urinate.

Night-time incontinence:

Involuntary urine loss during sleep – also known as bedwetting / nocturnal enuresis.

Continuous incontinence:

Continuous incontinence - Continuous involuntary loss of urine.

Reflex incontinence:

So called reflex incontinence connected with the nervous system disorders – the patient doesn’t feel the urge to urinate but his bladder voids completely in an uncontrolled way.

Overflow incontinence:

Overflow incontinenceEvery urine loss episode is caused by the bladder being overfilled (that might be caused by the urinary outlet blockage).

Extraurethral (fistular) incontinence:

Involuntary urine loss thorough a different way than the urethra.

Undefined incontinence:

Undefined incontinence - Urine loss that cannot be assigned to any other category. This is often used to describe incontinence of the mentally ill who do not have any urinary system dysfunctions.

Other types of incontinence:

Involuntary urine loss during, for instance, sexual intercourse or after controlled bladder voiding (so called PMD) etc.

  • Faecal incontinence
  • Urge incontinence
  • Urge incontinence- The person feels the urge but is not able to hold it long enough to make it to the toilet – it is often caused by weak muscles of the anal sphincter.Passive incontinence. The stool happens to leak without the urge to excrete – the most common reasons for this are nerve damage, muscle weakening or chronic constipation.

What is person-centred continence care?

Person-centred continence care is premised on a complete understanding of the individual and the causes of their incontinence. A person-centred approach to continence care means taking each person’s needs seriously and respecting the differences of every individual. Rather than attempting to provide a comprehensive approach to continence care for every resident, person-centred care includes considering individual requirements and ensuring you have the perfect solution available for them. Staff participating in person centred incontinence care should also ensure they are knowledgeable of the correct products and equipment to implement treatment for individual cases.

An important motive of person-centred incontinence care is to provide residents with a chance to have an input in discussing the treatment methods they feel comfortable with. Residents with incontinence should have the opportunity to make informed decisions about their care and treatment in partnership with their healthcare professionals. In encouraging communication in person-centred care, specialist techniques and tools should be employed to ensure that people with communication difficulties have the opportunity to receive information. This could involve different forms of communication, such as face-to-face, telephone-based, web-based, electronic, printed and audiotape.

Discussions in person centred continence care should also include one-to-one support in understanding and interpreting information. Individuals should learn and understand how continence care will benefit them. Emotional factors of incontinence should also be considered in person-centred care, such as considering how care staff can ease the embarrassment of incontinence and help maintain individuals’ dignity. Consideration of particular aids to help residents should be discussed, such as Dementia-friendly signage and raised toilet seats. It is especially important to consider the links between incontinence and diseases which can affect the brain, such as the link between Dementia and incontinence when discussing treatment.

Care homes that have adapted a person-centred approach to continence care in the past have seen outstanding levels of success, such as the award-winning Carlingwark House in Galloway. Carlingwark House staff found that most of their residents who had continence problems did not have physical problems contributing to incontinence, therefore they needed to look at other factors that were causing these issues, such as psychological factors and important life events. Carlingwark House staff were efficient in conducting in-depth, ongoing and meaningful continence assessments for their residents. These assessments looked at everything from the medications they were taking to their life history, current lifestyle and personality. This research helped the staff to establish the contributing factors for each individual developing incontinence. Adopting a person-centred approach to continence care led to an overall reduction in the number of continence care products used in Carlingwark House, not to mention an award for the ‘Best Dementia Continence Care’ at the National Dementia Awards 2013 in recognition of their work.

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