The Promotion of Continence in Adult Nursing

Part 1 Defining the problem: the role of the nurse in continence promotion; the role of the continence advisor; defining incontinence; the prevalence and cost of incontinence; attitudes of incontinence. Part 2 Urine production and the physiology of micturition: anatomy and physiology of the urinary tract; the physiology of urine production; factors affecting urine production; the physiology of micturition; the effects of ageing on the bladder and micturition. Part 3 Assessment of the individual: the importance of assessment; multidisciplinary involvement; the assessment process; initial assessment of physical aspects; psychological assessment; assessment chacklists; invasive procedures and urodynamic investigations. Part 4 Frequency and urgency: common causes of frequency and urgency and related physiology; causes of irritation to the bladder and urethra; bladder training. Part 5 Leakage on exertion: causes of leakage; anatomy and physiology related to leakage on exertion; retraining of the pelvic floor muscles; starting an exercise programme; aids to pelvic floor training; aids for the management of stress incontinence; leakage during sexual intercourse. Part 6 Dribbling and difficulty in voiding: outflow obstruction; urinary problems associated with prostatic enlargement; physiology of atonic bladder; intermittent self-catherization; non-invasive voiding techniques; surgical interventions for outflow obstruction; management of outflow obstruction by long-term indwelling catheter. Part 7 Lack of awareness of the need to void: reflex bladder emptying; inability to recognize the appropriate time and/or place to void; unable to express the need to void; behavioural incontinence; drug induced incontinence; nocturnal enursesis. Part 8 Faecal incontinence: anatomy and physiology of the lower gastro-intestinal tract; assessment in faecal incontinence; constipation; faecal incontinence related to constipation; diarrhoea; diarrhoea and incontinence; nursing interventions for faecal incontinence; medical management of faecal incontinence. Part 9 Other considerations: environmental and social factors; clothing; sex and incontinence; aids for the management of incontinence; types of aid available; re-useable products. Part 10 Starting a programme: factors affecting motivation; education; budgetary implications. Appendices: abnormalities of urine; useful addresses.