This chapter addresses the fundamental role of continence management as a core nursing activity. Every nurse should possess the knowledge and skills to carry out an essential, but simple, continence assessment, as well as to select and implement evidence-based strategies to manage continence in all care settings (including hospital and community), and to review the effectiveness of these to inform any necessary changes in care. Despite being essential for dignity and compassionate care, continence needs are often not prioritized as highly by nurses as they are by patients and their relatives. For adults, the ability to control bladder and bowel emptying is very important to self-esteem and dignity. Continence is a complex specialty involving a number of disciplines, including specialist nurses, specialists in urology, gynaecology, physiotherapy, and elderly care, yet the prevalence of continence problems means that much depends on you as a registered nurse taking responsibility for initiating assessment and management. Continence issues frequently arise as a result of other healthcare problems, and you should remain constantly aware of this, identifying patients who are at risk of incontinence and helping embarrassed patients to seek help. Bladder and bowel control are taken for granted by most of us. Once continence is achieved during childhood, we expect to remain in charge of these bodily functions for the rest of our life. Temporary loss of continence commonly accompanies acute illness or hospitalization, particularly if mobility and/or cognition become impaired (Resnick et al., 1989), or if the disease or injury impacts directly on bladder or bowel function. If the bladder fails to function normally (such as an overactive bladder), lower urinary tract symptoms may be experienced, and these may include incontinence. If bowel habits are disrupted, this may result in faecal incontinence (FI), constipation, or both. Incontinence is also associated with long-term conditions, in particular those affecting the neurological system (Fowler et al., 2010). Dealing with incontinence is a very common activity for nurses, and it is easy to become inured to this, forgetting that, for the patient, the experience can be devastating. It is noteworthy that the International Continence Society defines urinary incontinence (UI) as being any involuntary leakage of urine (Abrams et al., 2002), and it is therefore a symptom (however slight) that you should never ignore.
Re-imagining the role of the physiotherapist when managing people with long-term conditions