Healthcare Assistant: Managing Incontinence

Table of Contents                                                                                                             Pages

Overview                                                                                                                                03

     Stress Incontinence

     Urge Incontinence

     Overflow Incontinence

     Functional Incontinence

     Faecal Incontinence

My role as Healthcare Assistant is assisting a resident with their incontinence               04

Diet                                                                                                                                         05

Going out with Family members

Overview

Incontinence is the loss of control of bladder and/or bowel function. There are four different types of urine incontinence and they are as follows:

Stress Incontinence: Any movement that puts pressure on the bladder causes stress incontinence. In females, the pelvic walls that hold the bladder in place become weakened, so the bladder slips toward the vagina, weakening the sphincter. The sphincter is a muscle that holds the bladder closed. Laughing or sneezing can trigger your bladder if there is already a weakness. The pressure of an unborn baby also can cause stress incontinence when the uterus leans into the bladder from the weight of the baby. That pressure causes the bladder to leak or empty completely. In males, stress incontinence is caused when the prostate enlarges, thereby placing pressure on the urethra

Urge Incontinence: Patients who have urge incontinence usually have a neurogenic (nervous) bladder: Sphincter muscles become overactive, causing leaks or emptying. A neurogenic bladder is caused by anything from nervousness to a stroke, to Parkinson's disease, multiple sclerosis or a spinal cord injury

Overflow Incontinence: When someone is unable to completely empty the bladder because of a weakened sphincter, the bladder overfills, causing leaks. It's common to have both urge and overflow incontinence.

Functional Incontinence: The physical inability to get to the bathroom on time, either because of limited mobility or mental impairment causes functional incontinence. It is not caused by a dysfunction in the urinary tract.

Faecal incontinence: Faecal incontinence is the inability to control your bowel movements, causing stool (faeces) to leak unexpectedly from the rectum. Also called bowel incontinence, faecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control.

Common causes of faecal incontinence include constipation, diarrhoea, and muscle or nerve damage. Faecal incontinence may be due to a weakened anal sphincter associated with aging or to damage to the nerves and muscles of the rectum and anus from giving birth

My role as Healthcare Assistant is assisting a resident with their incontinence

The resident I have chosen to study for this assignment suffers from Dementia. She has Urge Incontinence (nervous bladder) which may occur in people with dementia for many reasons. Our brains send messages to our bladder and bowel telling them when it is necessary to empty them. Being in control of these functions depends on an awareness of bodily sensations – such as the feeling of having a full bladder – and the memory of how, when and where to respond. When there is a decline of intellect and memory as a result of dementia, incontinence may occur.

The changes in a person’s brain that occur with dementia can interfere with a person’s ability to:

• Recognise the need to go to the toilet
• Be able to wait until it is appropriate to go to the toilet
• Find the toilet
• Recognise the toilet

The above is not yet applicable to the Resident I have chosen, however it is inevitable as the Dementia progresses that this confusion will ultimately effect her recognising the toilet.

Incontinence can be very distressing for the person with dementia. It helps if the carer remains calm, gentle, firm and patient. It is important that the carer tries to accept and get over their own embarrassment in having to help the person in such an intimate way.

During my time as a Healthcare Assistant I attended a lecture given by the Nurse who specialises in incontinence wear and is employed by the company who supply the pads. She assesses each Resident using the information given to her by the staff. As a direct result of this activity an incontinence wear prescription is attached to the inside of the wardrobe so that all staff is aware of what pads each resident needs during the day and night. When it comes to toileting her I always explain what I am going to do, and whilst carrying out the work. During the day she wears what’s known as a comfort pad during day. This pad has a small amount of absorbency because this particular resident is mobile and still knows how to use the bathroom facilities. She tends to be nightly diuretic, meaning she passes a lot of urine during the night and the end result is bed wetting. As a result, she uses a heavy duty pad at night and also because bed rail is up at night which is a feature of her individual care plan assigned to her by her primary Nurse. Infection control is paramount consequently; I wear disposable gloves and aprons which I change between residents. The resident’s pads are checked and changed if needs be at 6am every morning. The pads are checked using the indicator line on pad to show when it is fully used. There is gel on the pad which soaks up the urine and takes it away from the body, reducing infections and also so the skin remains intact. Skin care is very important. Wash the skin after an accident to keep it clean and dry, and to prevent rashes. Make sure the person’s skin does not come into contact with protective plastics as this will cause soreness. I record bowel and urine output on the Epicare System. If there is anything sinister such as blood in her urine or faeces I tell the Nurse on duty. It is important to respect privacy and dignity. Losing control can be humiliating and embarrassing, and I need to be sensitive to these feelings.

Diet

Diuretic foods and drinks: tea, cucumbers and wine should be limited to avoid dehydration. It may seem counterintuitive to advise someone with urinary incontinence to drink more, but being dehydrated can make urine more concentrated and irritating to the bladder.

Going out with family members

Even if the person is wearing an incontinent pad, their clothing may still get wet. If the family is planning on venturing out in public with her who is I make sure that they bring a change of clothes for her often just a fresh pair of pants and underwear will suffice.