Hello. My name is Kylie Wicks.
And I'm the clinical services manager of ParaQuad NSW.
In this video, I will focus on what is incontinence
and how to manage incontinence for a person with a disability,
including the use of product and aids.
I will also cover the importance of a continence assessment,
which takes into account people's lifestyles and goals.
This information will help NDIS planners, local area coordinators
and other service providers
assist NDIS participants
to consider their continence needs when completing an NDIS plan.
Incontinence is the involuntary leak of urine from the bladder,
called urinary incontinence,
or faeces from the bowel, called faecal incontinence.
The degree of leakage can range from mild to severe.
The limitations and impact of incontinence on a person's life
is not only related to severity,
it can also depend on personal characteristics,
such as age, gender and lifestyle choices.
There are many different causes of both faecal and urinary incontinence.
However, incontinence experienced by people with a disability
is usually functional or neurogenic in nature.
Functional incontinence is the result
of a physical or cognitive or environmental issue -
for example, the inability
to communicate the need to go to the toilet,
not being able to get up and walk to the toilet easily,
when the toilet is too hard to get to or use,
clothing that is hard to remove in the toilet,
not being able to find the toilet without help.
Some of the causes of functional incontinence include:
Incontinence can occur as a result of disease or trauma
to the spinal cord, the brain or the peripheral nerves
associated with urination and defecation
and affects the filling, storage and/or emptying capabilities
of the bladder and the rectum.
Examples of disability types which are neurogenic in nature
and may result in incontinence
include, but are not limited to:
Incontinence caused
as a result of functional issues
or in the presence of neurological disease, or a combination of both,
needs to be assessed and managed appropriately
for the immediate and long-term health and wellbeing of the person.
A continence assessment ensures that a tailored continence management plan
will be effective, practical, reliable and socially acceptable.
A thorough continence assessment
assesses the urinary system, which includes:
A continence assessment will also assess
for the presence of urinary tract infection, diarrhoea or constipation.
The continence management plan must be time-efficient,
and the environment and social factors
and the client's personal preferences must also be taken into account.
It is very important that a continence assessment is conducted
by a clinician experienced in the area of continence management.
This clinician is usually a continence nurse adviser
or a disability-specific nurse consultant.
The continence professional who develops
the continence management plan for a client with a disability
is required to have detailed knowledge
of the pathways involved in urination and defecation
and the impact the disability has on those pathways.
The continence nurse adviser also needs to have knowledge
of the range of continence equipment available
to suit the unique needs of people with a disability.
The assessment will provide a tailored management plan
considering the associated equipment, the projected cost
and any training requirements for the client and/or their family or carers
in the use of continence products and aids when required.
For people with incontinence resulting from a spinal cord injury
or some neurological diseases,
it is preferable that the continence assessment is performed
by a clinician who has additional specialised training -
for example, with spinal cord injury or multiple sclerosis.
For information about local continence clinics
offering continence assessments,
call the National Continence Helpline on 1800 33 00 66
or go to continence.org.au.
A continence review examines the effectiveness
of an existing continence management plan
by assessing any changes in the person's condition
or other factors which may affect their continence management.
A routine review is important to ensure the person's management plan
keeps pace with changes in management technique and product advancement.
Prior to a continence review,
the person needs to consider the following three questions:
Continence products are not designed
to replace a continence management plan but, rather, to support it.
Not all continence assessments result in the need for continence products.
However, generally speaking, people with incontinence
resulting from functional causes or neurological disease or injury
often require the use of continence aids and products.
Every person is different,
and their expectations and needs should be considered
when creating individualised continence management plans.
A client's comfort, convenience, sexuality, quality of life,
along with their mobility, dexterity, independence and desired goals,
should be taken into account.
For example, two people who both have a spinal cord injury
may have different management plans.
Their level of independence will also influence
choices in continence treatment and management, including use of product.
One client may be best managed by intermittent self-catheterisation.
This type of catheter means that they are able
to empty their bladder independently, without the assistance of a carer.
The other person may use an indwelling catheter
which drains into a leg bag.
This leg bag needs to be emptied regularly by a carer.
To increase their independence, it may be recommended
to use an electric leg bag opener or modified taps.
These different management plans need to be taken into account
when planning the level of support each of these people need
in managing their incontinence.
Evidence-based practice necessitates
that the nurse, when considering product selection,
needs to reflect on their clinical experience,
evaluate the resources available and analyse the research evidence
and continence product guidelines
in conjunction with the individual's goals
to facilitate appropriate continence product selection.
If a continence management assessment has resulted
in the need for continence products and aids,
it will guide not only the category of product prescription
but also the individual features required by that product
to meet the person's lifestyle choices.
Urinary products fall into a number of categories.
Absorbent products can either be disposable or washable.
They can be used on beds and chairs or worn by people
and include pads, pull-ups and nappy-style products.
In some cases,
a combination of washable and disposable absorbent products
will be used at the same time.
Some men use uridomes, also known as condom drainage,
which are penile sheaths which have a funnel
that connects to a leg bag to collect urine externally from the body.
Uridomes come in a variety of widths and lengths,
and the penis size needs to be measured
by an appropriate health professional prior to use.
Intermittent catheters are used to manually empty the bladder
and are classified into non-coated, pre-lubricated
and hydrophilic styles.
Intermittent catheters have further feature classifications
such as specialised tips, non-touch, bagged or kit
and come in a variety of package options.
Indwelling catheters cover those catheters used
for urethral indwelling or suprapubic use.
The consideration in this category include catheter size, balloon size,
catheter material, tip length and tip design.
All indwelling catheters need to be secure to prevent tugging.
There are a variety of catheter fixation devices.
A continence assessment will also identify
the type of leg bag best suited for the individual
or which catheter valve is a suitable option for the individual.
Products used to manage faecal incontinence
may include body-worn disposable products such as pads.
In addition, some people will use oral medication
to assist with the management of a bowel program
or enemas and suppositories that help expel the faeces from the rectum.
When these systems fail,
some people may move on to anal irrigation systems,
which wash the faeces out of the rectum,
or in some cases, people may require the use of a colostomy.
A colostomy is a surgical opening of the abdomen
which allows access to the bowel via a stoma.
Incontinence, whether it be urinary or faecal,
is difficult for many people to discuss and seek help for.
Due to the stigma surrounding incontinence,
many people do not like to discuss the issue
and may not bring it up in an NDIS planning meeting.
It is vital that anyone that is helping a participant with a plan
discuss incontinence with the participant.
If continence management requirements,
including assessment and products and aids,
are not discussed and included in an NDIS plan,
the participant may be at risk of not having their continence needs met,
which will negatively impact the rest of their plan.
If the topic is brought up in a matter-of-fact manner,
without embarrassment by the planner,
generally, the participant will be much more at ease
and will be more likely to talk openly about this issue.
Some people with disabilities do not talk about their incontinence
because they do not think anything can be done
to help manage the symptoms better
or that help is not available.
When developing a plan, it is always good to ask the participant
if they have incontinence issues,
if they use products or aids
to assist with the management of incontinence
and when was the last time they had an assessment.
Technology and management styles continue to develop,
and regular review is advisable.
As I have mentioned earlier, it is important
that they have a continence assessment
from an appropriately qualified nurse,
such as a continence nurse adviser or disability-specific nurse consultant.
However, sometimes there may be a waiting time
before an assessment can occur.
The National Continence Helpline, 1800 33 00 66,
can provide planners,
local area coordinators,
participants and their family and friends advice
about continence management to help better manage the situation
while awaiting a continence assessment.
Whilst awaiting an assessment, it's a good idea
for the person to consider how their incontinence affects
their day-to-day living and wellbeing.
For more information to help in planning for the NDIS,
go to continence.org.au/NDIS.
Phone the National Continence Helpline on 1800 33 00 66.
It's a free, confidential phone service
staffed by continence nurse advisers
providing information and advice on continence management,
continence services, continence products and resources.
The helpline operates Monday to Friday,
8am to 8pm, Australian Eastern Standard Time.
The Continence Foundation of Australia website, continence.org.au,
is also a great source of information.
The website has a wide range of resources available for download,
including Easy English versions of some of the most popular fact sheets.
A wide range of educational videos with closed captions
are also available on the website.
In the absence of the right advice or a continence assessment,
people will try to self-manage.
Over the years, I've seen a number of product adaptions
created by people whose continence management plan has been ineffective
and hinders their lifestyle.
It's important that people seek a continence assessment or review,
not only when their continence plan is not working
but also when it is restricting them
from engaging in their chosen lifestyle choices
or from achieving their goals.
Thank you for taking the time to watch this video.