The politics of continence

A simple incontinence matter caught today could prevent a lifetime of misery and cost in both personal and financial terms to the patient and the NHS as a whole.

It has taken many years to relax over the word incontinence. Firstly it became the 'butt-end' of many comedians’ jokes, living in the same realm as sexual innuendo. Then society became ultra politically correct and to simply mention the word was taboo, particularly anything to do with the bowel. Today in the media, we hear or see advertisements for condoms, sanitary wear, and even incontinence pads. Adverts tell us: not to accept bleeding from our teeth and gums, that a persistent cough can be lung cancer and that blood in ‘pee’ or ‘poo’ is cause for concern. This can be so but just as easily, the latter can be merely an indication of a urinary tract infection or haemorrhoids. Red urine is not always blood, it can be beetroot eaten yesterday. Black tarry stools may not be bleeding high in the intestinal tract but the by-product of iron tables, diarrhoea may not be caused by cancer but by antibiotics. Whether it is a simple remedy to a simple matter or something more serious, you the Primary Care Nurse, are likely to be involved in that persons care before, during or after the diagnosis is made.

In the main we know that incontinence can be completely cured or successfully managed. Let’s consider what I believe are a few of the basic things that we don’t always see or think about. Primary Care nurses have a busy workload and your patients will have only a short time with you.

Listening - remember you were taught to talk to the patient and not over them, talk to them and not about them? I would add ‘listen’ to what they say. All too often what they say simply passes over us as a non-descript off the cuff chat, yet within that there lies many a clue to what the person want to say.

Time – general practitioners are busy people; patients get a few minutes of their time and the conveyor belt runs on. Nurses (some may think) are not busy! Yes, I know the steam is blowing out of your ears now. Yes, I know that you are every bit as busy if not in some cases more busy than everyone else but this is not about reality it is about perception. The nurse is perceived to have more time, can be more approachable, can have a better bed-side manner, and can listen.

Deciphering - people have a habit of visiting the doctor or nurse with a headache when really they have major problems; by listening you will sometimes hear that nugget of information about impending ill health or incontinence that they can’t/won't come out directly to tell you. Why, well it’s really quite obvious isn’t it, they are embarrassed. Would you not be? I would.

Being there - when dealing with incontinence you need to be approachable; when you hear something you have to open that door gently and compassionately without judgement.

There are times when we are prescribed medications; I know that all too well. They do a great job for the ill-health matter but can have quite devastating effects on bladder and bowel. Let me give you two simple examples that you should already be aware of. I have heart failure, so am prescribed the equivalent 12 diuretics per day - yes 12. While in most people, that would require a permanent lavatory visit, I don’t pee as constantly as my neighbour. Why? I also take Co-codamol; great tablet, it does what it says on the packet, but leaves in its wake a most unpleasant constipation. So what I ask of the nurse is an understanding of the common side-effects of medication upon my continence, but also the ability to deal with these, and any uncommon effects.

Incontinence is not something that is easily spoken about by patients or staff, but it is your job to be willing and knowledgeable enough to hear what is said and know the potential meaning and get something done. Record it, file it away but don’t let it get away. A simple incontinence matter caught today could prevent a lifetime of misery and cost in both personal and financial terms to the patient and the NHS as a whole.