Incontinence: Empowering personal choice

The conversation last week started as a phone call for advice. A registered manager contacted me about a lady she was supporting who had full capacity but didn’t want support with her incontinence, including any incontinence aids and was happy to sit in soiled clothing. What would you do?

What is incontinence?

Incontinence affects an estimated 7 million people in the UK, although due to the stigma, this figure could be a lot higher.

If you’re supporting someone who has a concern about their bladder or bowel, you should encourage them to speak to their GP who can assess the symptoms, identify any causes and discuss the treatments available.

Diagnosis may include one or more of the following:

• Physical examination
• Keeping a diary of bladder/bowel habits
• Urine samples, blood tests and/or ultrasound.

Once the cause has been identified, treatment can be recommended and could include:

• Exercises
• Re-training the bladder/bowel
• Medication and/or surgery.

There are a number of products available to support people with incontinence, including:

• Incontinence pads (washable and disposable)
• Absorbent underwear (for people slightly leaking)
• Bed and chair protectors.

Some of these products are available on the NHS, so it’s important that you refer people to the incontinence team who can complete an assessment.

You should also look at supporting the person to be referred to a dietician as research has shown that ensuring people receive adequate hydration and high fibre diets can help the person. It’s not uncommon for people who are urine incontinent to not want to drink, due to fear of not making it to the toilet which can cause other health issues such as dehydration etc.

The impact of neglecting incontinence

Going back to the lady I mentioned at the beginning of this blog. She had full capacity and didn’t want support but wanted to engage in activities with other people in her care home.

As a service, you have to consider how the situation could be interpreted:

• Social
  It wouldn’t be socially accepted that someone soiled would be walking around in the community and could easily lead to allegations of abuse against any care workers supporting her, questioning from the regulator, local authority and/or family and friends.
• Health
  Urine and faeces can burn and very quickly turn into rashes, sores and skin breakdown.  Again, this could lead to allegations of abuse.
• Environmental
  Incontinence can leave unpleasant smells and most of us have been in a ward or care home where the smell of urine is overpowering, and this could lead to complaints from other people you support, staff, relatives and visitors.

One common thing people living with incontinence request is a catheter, however this shouldn’t be the first control measure that should be put into place. Catheters can increase the risk of infection due to bacteria growing, internal damage from the tube pulling, increased risk of bladder stones, bladder cancer and damage to the urethra.

Incontinence for some people can be a behavioural, more commonly with people living with a learning disability, but there are professionals that can support with this through Positive Behavioural Support.

Regulated vs unregulated

We must remember people’s capacity and right to live, but this has to be balanced with social norms and impact it can have on other people they are living with.

Regulated or unregulated, we must do all we can do ensure the people we support are empowered, supporting people to understand their condition whilst ensuring our teams are upskilled.

We must also remember that every person we support will take differing times to come to terms with incontinence, learning to adapt to any new support being received.