Incontinence is an unusual acute presentation, but it presents a risk factor for adverse outcomes. Incontinence can affect bowel, bladder or both. It can present as a new onset or deterioration of a known problem.
The Silver Book warns of “abuse of urine dipstick testing leading to erroneous diagnosis of infection, inappropriate antibiotics and increased risk of complications such as clostridial diarrhoea.” This highlights the potential for medications to be a contributory factor.
Skin integrity is also an important consideration. Close examination of the surrounding skin to look for associated breaches which may result in skin infections and ulcers is important.
The joint British Geriatrics Society and Royal College of Nursing 2012 Campaign for Dignity in Continence Care highlighted the following:
- Find out about people’s normal bowel and bladder routine.
- Make sure toilets are clearly signposted, by pictures and words.
- Remember that people who are restless, agitated and appear uncomfortable may need to go to the toilet; they may not be able to tell you.
- Remember that even when people are immobile it is better for them to be assisted to use the toilet.
- Encourage people to move around and ensure that walking aids are available and accessible.
- Use fluid charts to check how much people are drinking during the day. Fluid intake should be encouraged.
- Change pads and pants regularly.
The NICE pathway for faecal incontinence and associated documents can be accessed here
NICE Information for the public on faecal incontinence is here
NHS England published Excellence in Continence Care in November 2015. It can be accessed here and reviewed below.