The Continence Foundation - Symptoms and Treatment - Essay Example

The Continence Foundation Symptoms and Treatment: A complex System: We all depend on food and drink to grow, keep our bodies in good shape and generate energy. But not everything we eat and drink is used, and the body has a clever but complex system for getting rid of the waste. Take the urinary system. It depends on careful co-ordination of fluid "engineering", with some muscles relaxing to let the bladder fill while others keep the outlet tightly closed, nerve signals to tell the brain how full the bladder is, monitoring by the brain, and recognition of the right time and place to signal the muscles to open the outlet and squeeze the bladder empty. For most people, once they learn in infancy how to keep dry, the whole system works almost automatically the rest of their lives. But, in a complex system like this, things can go wrong. And they do - for many more people than most people realise. In fact, as many as 1 in 3 adults will have problems at some time in their lives. Difficulty with the bowels affects fewer people but can be even more of a problem to live with. But most problems can be cured - and in the meantime there are useful products to help. How common are Bladder and Bowel Problems In the United Kingdom, at least 3 million adults cannot control their bladders as they would wish. That's twice as many as have diabetes.. (And about 500,000 children over the age of 5 have similar problems, especially with bedwetting). About 500,000 adults have similar trouble with their bowels. That's four times as many as have Parkinson's disease. And as many as 1 in 3 of us will have such problems at some time in our adult lives. It is NOT just a problem for the elderly: - in a group of seven or eight middle aged women, the chances are one will have an experience of loss of bladder control; - similarly, in a group of ten or twelve men aged over 65 one will have a problem, - as will one in thirty men under retirement age. The best estimate of how many people are affected was made in 1995 by the Royal College of Physicians. They looked altogether at 24 different studies for bladder leakage (urinary incontinence) and bowel leakage (faucal incontinence) and collated their results. The graphs show the results - for men and women living at home at various ages and for both sexes together living in residential care homes, nursing homes or in long-stay hospitals for the elderly and elderly mental infirm. (Some of their estimates were ranges - shown in the graphs as extensions of the bars.) PREVALENCE OF URINARY INCONTINENCE source: Royal College of Physicians (1995) R N H = Residential home, Nursing home and long-term Hospital care Percentage of adults with urinary incontinence Age Percent Women living at home: 15-44 5-7 % 45-64 8-15 % 65 + 10-20 % Men living at home: 15-44 3 % 45-64 3 % 65 + 7-10% Men & women in: Residential homes 25 % Nursing homes 40 % Long-stay hospitals 50-70 % PREVALENCE OF FAECAL (BOWEL) INCONTINENCE source: Royal College of Physicians (1995) R N H = Residential home, Nursing home and long-term Hospital care Percentage of adults with faecal incontinence Age Percent Men & women living at home: 15-44 0.4 % 45-64 3-5 % 65 + 15 % Men & women living in: Residential homes 10 % Nursing homes 30 % Long-stay hospitals 60 % Products to help with Incontinence: Most people with bladder and bowel control problems can be treated. This is much preferable to living with the problem. The products described in this section are not a cure. But they may be used as part of a treatment or to control leaks so you can carry on your life as usual. Many (but not all) are available on the NHS, and some can also be bought in high street pharmacies and by mail order. Check out how to obtain your products. But it is important that you get medical or nursing advice. Do not just rely on products. A professional assessment will probably lead to treatment that can cure you or at least bring about a big improvement in your condition. That said, for many people products such as those described here make all the difference between a very restricted life and a quite normal one. Making the right Choice There is a wide range of products of many types: pads of various kinds, urinals, catheters, sheaths, and so on: over 2,500 different makes, types and sizes are listed in the Continence Foundation's Continence Products Directory. What will suit you depends not just on your condition but also to some extent on your lifestyle - whether you go in for sport, travel a lot, or have help for your personal care, for example. Consider mixing and matching products, from day to night, or according to your activities, or if your needs vary. Some products are easier to use than others. If you have difficulty using your hands, dressing or undressing, or your eyesight is not good, think about how you are going to apply, use and remove the product. Shopping around before buying large quantities of a throw-away (disposable) product can save money. Some companies sell trial packs of disposable pads, and you may be able to borrow some products through your local continence service - things like urinals, for example. Most importantly, do not be put off if one product does not work well for you: be prepared to try others. Newer and better products are being constantly introduced. THE CONTINENCE FOUNDATION Continence Foundation is a national charity that helps anyone who experiences bladder or bowel problems. It aims to provide advice and expertise, raise awareness about bladder problems and influence policy-makers and service providers. Aims and Activities: Our aims are to help people with incontinence and to improve public understanding of the condition. Our main areas of activity are: Advice - providing information and advice, not only to people who have problems of bladder and bowel control and their relatives but also to those professionally concerned Awareness - raising public awareness of incontinence and promoting media coverage, and Advocacy - promoting better policies for continence services and campaigning for continence to be given a higher priority in NHS and other budgets. Advocacy and Public Campaigns Work on a political level is an important concern: the foundation press for higher priority for continence services and for improved policies and organisation. Their campaign about inadequate NHS services was a major factor in the decision by Ministers to set up the review which has recently produced a new progressive policy on continence services. They are in touch with a number of MPs, take up individual cases, suggest Parliamentary Questions, correspond with Ministers and submit evidence to Parliamentary and other enquiries. Cooperation with other Companies Continence Foundation are part of the UK Continence Alliance - an informal network of voluntary and professional organisations concerned with incontinence, the other members of which are more specialised organisations than the Foundation. They include the Association for Continence Advice, the Royal College of Nursing Continence Care Forum, the International Continence Society (UK), the Continence Products Evaluation Network, the Enuresis Resource and Information Centre (ERIC), In contact (the consumer group), and others. The foundation also liaises with foreign and international groups. Achievements and Activities since January 1999 1999 January Published factsheets "Controlling Wind and Smells", "Skin Care for People with Bowel Problems" and "The Unstable Bladder". February Published factsheets "What is Urodynamics" and "Sphincter Exercises for People with Bowel Control Problems". Published third edition of Friends' Newsletter. March Received largest ever volume of calls to the Helpline in a single month - 1,900 (217 on 2 March alone!) following BBC2 "Trust Me - I'm a Doctor" programme. April Promoted the work of the Foundation at the annual meeting of the International Continence Society (UK Section). May Published fourth, revised & expanded edition of "Continence Products Directory" (listing all continence products available in the UK). Promoted the work of the Foundation at the annual conference of the Association for Continence Advice. Published factsheet "Pelvic Floor Exercises for Men". June Published new "Index of Continence Services" (listing contact details of all Continence Services in the UK) and circulated free copies to all Continence Nurse Specialists. July Published fourth edition of Friends' Newsletter. Published "The Well Behaved Bowel" leaflet; reprinted "The Well Behaved Bladder" leaflet, Helpline poster and loo-door sticker in preparation for September's Awareness Campaign. August Promoted the work of the Foundation at the International Continence Society's conference in Denver, Colorado. Published the Code of Good Practice for Employers and distributed this and other materials for September's Awareness Campaign to all UK Continence Services. September Launched the annual National Continence Awareness Campaign; issued press release to national and local media; launched audio press release promoting the Code of Good Practice for Employers. October Published Annual Report 1998/99 and held Annual General Meeting. Published and distributed first (free) supplement to "Continence Products Directory" (4th edition). Attended and exhibited at the Incontact user group's 10th anniversary conference and AGM. Promoted the work of the Foundation at the Royal College of Nursing Continence Care Forum conference in Wolverhampton. November Recorded largest ever volume of Helpline enquiries over a twelve-month period: 13,500. Started preliminary work on "Making the Case for Investment in an Integrated Continence Service" for continence nurse specialists, working in conjunction with the Association for Continence Advice, the Incontact user organisation and the Royal College of Nursing Continence Care Forum. December Progressed work on the new Foundation website. Evaluated draft of Coping Strategies self-help leaflet with pilot group of users. Started work on revised reprint of Continence Resource Pack Completed final draft of first issue of the "Continence Foundation Review" - publication for health professionals. 2000 January Published Helpline advertisement in "The Good Non-Retirement Guide"; released Pre-Retirement Factsheet to major employers and organisers of pre-retirement courses. Published and distributed second supplement to "Continence Products Directory" (4th edition). Exhibited at Key Advances in the Effective Management of Detrusor Instability Symposium at Royal College of Physicians. February Published fifth issue of Friends' Newsletter. Published first issue of "Continence Foundation Review" for health professionals and distributed it with all copies of Pulse with offer of free subscriptions. Published factsheet "Surgery for Female Stress Incontinence". Published "NCAC News" - Awareness Campaign circular. March Reprinted Urgent Card which people can use to ask discreetly in shops etc for use of a lavatory. April Published sixth issue of Friends' Newsletter with detailed summary and critique of the Department of Health's "Good Practice in Continence Services". Promoted the work of the Foundation and exhibited at the annual meeting of the International Continence Society (UK Section) in Belfast. May Published "Making the Case for Investment in an Integrated Continence Service" and "Incontinence - a challenge and an opportunity for Primary Care". Published fifth, revised & expanded edition of "Continence Products Directory" (listing all continence products available in the UK). Promoted the work of the Foundation at the annual conference of the Association for Continence Advice in Harrogate. June Lobbied 30+ MPs to press for Department of Health monitoring of the implementation of its guidance on continence services. Exhibited at British Association of Urological Surgeons' annual meeting and exhibition in Birmingham. Spoke at the launch of PromoCon 2001 awareness week, Ormskirk. Attended launch of publications to promote continence for women from Indian subcontinent produced by working party (of which the Foundation Director was a member) convened by Tower Hamlets Health Strategy Group. July Launched and publicised to national and local media a revised edition of "Adult Bedwetting" leaflet and new Adult Bedwetting poster. August Published seventh issue of Friends' Newsletter. Promoted the Foundation at the International Continence Society's conference in Tampere, Finland. Published second issue of "Continence Foundation Review". Distributed publicity materials and new literature for September's Awareness Campaign to all UK Continence Services. September Launched Pregnancy, Birth & Continence National Continence Awareness Week (published" Expecting a Baby" leaflet, publicity posters and toilet stickers, issued press release to national and local media). Released revised version of the Continence Resource Pack. Published the "Index of Continence Services 2000" and circulated free copies to all continence nurse specialists. October Published Annual Report 1999/2000 and held Annual General Meeting. Published factsheet "Nocturia". Began shooting for "An Everyday Problem", our video for people with bladder and bowel control problems. Became a founder member of the UK Continence Alliance of non-commercial organisations in the continence field. November Contributed to think-tank on the future of continence services. Lobbied 126 targeted MPs to call for a VAT cut on continence pads. Published factsheets "An Introduction to Bladder Control Problems" and "The Pelvic Floor and Stress Incontinence". December Awarded finance for a joint venture with the RCN to monitor the implementation of the Department of Health guidelines on continence services. 2001 January Provided advice and support for Channel 4's "Embarrassing Illnesses - Incontinence" programme. Submitted evidence to a Department of Health review of the remuneration system for appliance dispensing contractors. Published eighth issue of Friends' Newsletter. Submitted evidence to Customs and Excise on VAT on continence pads sold in the high street. February Dr Judith Wardle succeeds David Pollock as director of the Foundation. March Delegation to Customs and Excise learns of probable concession on VAT on continence pads sold in the high street. Recent and Future Public Awareness Campaigns: Incontinence is a hidden condition. Few even among the four million adults in the UK affected by it realise how common it is. The continuing stigma attached to it inhibits discussion so that most people have little understanding of how much can be done to help. As a result many people with problems do not seek treatment, coping by themselves with great detriment to their quality of life - some even become virtual recluses. The aim of the Continence Foundation is to normalise incontinence so that it is seen as an ordinary medical condition for which people can routinely obtain treatment. The aim is to run one main public awareness campaign in the last week of September and one or two minor campaigns each year. Having very limited resources, we ask local NHS continence services and other interested parties - including relevant other organisations - to help promote the campaigns and we provide them with materials and ideas. The foundation has the benefit of a campaign steering group on which are representatives of several allied organisations including the the Association for Continence Advice, the RCN Continence Care Forum, PromoCon 2001 and In contact. Code of Good Practices for Employees The National Continence Awareness Campaign in September 1999 focussed on a Code of Good Practice for Employers that we prepared in consultation with allied organisations. This five-point Code, publication of which was assisted by a grant from Coloplast Ltd, suggested simple ways for employers to create 'bladder and bowel-friendly' working environments for their staff. The foundation sent every NHS Continence Service in the UK a campaign pack containing copies of the Code with a draft covering letter for them to send to a dozen local employers, together with quantities of our posters, leaflets and toilet stickers, which were reprinted with financial assistance from Astra Tech Ltd and Bard Ltd. The pack also included a draft press release about the Code for distribution to local media, and a 'do-it-yourself' guide to generating local publicity. At national level, copies of the code were sent to all local authorities and to the UK's largest 125 employers. Thanks to an educational grant from Pharmacia Ltd, the foundation was able to issue a press release about it to almost a thousand publications and news agencies and to send 30 selected radio stations a pre-recorded tape featuring Linda Cardozo (Professor of Urogynaecology and Chairman of our Trustees) discussing the Code. Articles appeared in newspapers throughout the UK and radio coverage was similarly widespread. Many Continence Services took up the campaign with enthusiasm, publicising it to local employers and media, and the Foundation has ever since received a steady flow of requests for copies of the Code and other material from companies as diverse as a clearing bank, an engineering firm and a carpet manufacturer. Enquiries have also been received from a range of county councils, including Somerset, Staffordshire and Sheffield, and (interestingly) from many countries round the world.. Information sheets for Pre Retirement Packs The Continence Foundation continued the employment theme established with the Code of Good Practice for Employers with a mini-campaign in January 2000 featuring a factsheet designed for use in the packs issued to people attending courses to prepare them for retirement. The glossy sheet with its full-colour illustration advises that as you get older bladder and bowel control problems become more common but that they can usually be cured and can always be well managed, so that they very rarely need affect your lifestyle in retirement. A supply of copies of the factsheet was sent to individuals and companies that organise pre-retirement courses, and a version of the sheet was published as an advertisement in the Good Non-Retirement Guide 2000. The foundation quickly received orders for several thousand copies and shall continue to publicise it to course organisers. Adult Bedwetting July 2000 we launched a new edition of the Adult Bedwetting booklet. This publication gives information about the causes of adult bedwetting, the help that is available and tips on practical management. A complementary A4 poster was also launched, which promoted the foundation's Helpline number. To publicise the new leaflet, copies were sent to 'agony aunts' and the health correspondents of national and local newspapers. All Continence Services also received a sample supply of the booklet and poster, together with a draft press release for them to customise for their local media. The leaflet and poster were sponsored by Ferring Pharmaceuticals. Pregnancy, Birth and Continence Although as a subject it is rarely discussed, being pregnant and giving birth can leave a mother with difficulties controlling her bladder and bowel. But incontinence should never be accepted as an inevitable consequence of pregnancy" Said CLAIRE RAYNER at the launch of National Continence Awareness Week 2000. Claire summed up precisely the message of the campaign. The initiative, which ran from 25-29 September 2000, had three broad aims: to raise public awareness of the continence problems that can arise from pregnancy; to highlight the professional help that is available; and to emphasise that in most cases the problems can be cured without surgery or medication. At the heart of our efforts was the publication of a glossy colour leaflet for mothers-to-be. Called Expecting a Baby, it emphasises the importance of pelvic floor exercises as part of every woman's ante- and post-natal regime, provides advice to help minimise the chance of bladder or bowel problems and gives details of the help available should a problem occur. To maximise media coverage of the new leaflet opted for a two-tier campaign. The Foundation held a London event for the national press and magazines, while Continence Services throughout the UK targeted their local media. To assist all colleagues in the field, the foundation provided all the tools necessary to mount a publicity drive in their area. Supplies of Expecting a Baby were sent free to all local NHS Continence Services and other interested parties a month before the launch date. The pack also included promotional posters and 'loo stickers' promoting the Helpline, a draft press release announcing the leaflet, an abridged version of our DIY Guide to Success with Local Publicity, back-up reference material and a re-order form for additional literature. The pack offered Continence Services a range of options according to the effort they could invest in the campaign. Those unable to devote much time to the initiative could simply add their own letterhead to the press release and send it to local papers. Others could use our DIY Guide to develop newsworthy events, such as setting up stalls in local shopping centres, or conducting 'mini surveys', and use these as the basis for a publicity drive. At the London event, Claire Rayner, a patron of the Continence Foundation, took the chair. It focused on the personal stories of six women, aged from 35 to 65, who spoke about their experiences of post-natal incontinence. Also present was an eight-and-a-half-months pregnant mother-to-be, who provided a 'benchmark' of how well the NHS is currently delivering best advice about pregnancy and continence. To represent the healthcare professions several experts were on hand - a senior continence nurse, a consultant gynaecologist, a consultant coloproctologist, a physiotherapist and a midwifery manager. After the moving - and sometimes harrowing - testimony of the mothers, questions were taken from the journalists present. A lively debate ensued between the mothers and the medical professionals. The consensus at the end of the event was that while great strides had been made in the last thirty years or so, much more needed to be done to educate the public and non-specialist primary care professionals in this area. The event generated considerable media interest in our campaign. The Daily Telegraph carried a news item in its health section, ITV's Teletext devoted a page to the leaflet, and the e-magazine babyworld.co.uk reproduced it in full. Other magazines that carried articles about pregnancy and continence arising from our campaign included Woman; Woman's Weekly; Best; Pregnancy; Baby Magazine; Pregnancy & Birth; Bella; Parents; Having a Baby and You and Your Baby. Several other publications did not cover our specific theme, but did run short pieces on various aspects of incontinence. These included Essentials; Woman's Realm; and the trade publication This Caring Business. Local media coverage was also extensive and the success of the Awareness Week can be judged by the fact that the Foundation sent out more than 40,000 copies of Expecting a Baby within a few weeks of its launch. The campaign had the support of several organisations in addition to the members of the steering group (above), including: The Organisation of Chartered Physiotherapists in Private Practice Chartered Physiotherapists Promoting Continence The Association of Chartered Physiotherapists in Women's Health The National Association for Colitis & Crohn's Disease The Association of Community Health Councils for England and Wales Women's Health The Enuresis Resource & Information Centre The International Continence Society (UK) Coping with Incontinence The foundation's latest campaign was in September 2001 which was based on a leaflet offering suggestions how to cope with incontinence in the psychological sense, maintaining one's sense of dignity and self-worth. Bibliography Dobson, P. & Weaver, A. (2006); Nocturnal Enuresis: Systems for Assessment; Nursing Times, 102, 1, p49 Mangnall J, Watterson L (2006) Principles of Aseptic techniques in Urinary Catheterisation. Nursing Standard.21, 8, 49-56. Getliffe, K. & Dolman .M. (2nd Ed) (2003) Promoting continence: A clinical research resource. Continence foundation, (2002), good, better and best practice. The Continence Foundation-Indepth. Retrieved on April 11, 2007. From http://continence-foundation.org.uk/in-depth/ Incontinence and Water Restrictions. Retrieved on April 11, 2007. from http://www.continencevictoria.org.au/ Continence Care (2001). Retrieved on April 11, 2007. From http://www.whcassoc.com/continence.htm Continence Foundation of Canada. Retrieved on April 11, 2007 From http://www.continence-fdn.ca/about/index.html Continence Worldwide. Retrieved on April 11, 2007 From http://www.continenceworldwide.org/ Products for Continence. Retrieved on April 11, 2007. 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