Information 1-5

  • Undertaken to identify and address the varied conditions associated with incontinence to improve a persons social-emotional wellbeing and quality of life

Health check recommendations

  • All women > 25 years annually or earlier for those who have birthed
  • All men > 55 years annually

1. Procedure

  • Ask the questions and explore further if required. See Table 1.
  • Provide brief intervention
  • Determine if the person requires a referral and place on a follow-up and recall register

Table 1. Continence questions for adults

Questions

Explore

Does the person have any urine or bowel leakage?

  • When sneezing, coughing or lifting?
  • When jogging, exercising or bending down
  • Any sense of urgency or won’t make it?

Does the person pass urine frequently?

  • More than twice at night?
  • More than 6 times during the day?

Does the person have any difficulty passing urine?

  • Getting urine out?
  • Difficulty starting to urinate?
  • Stream that starts or stops
  • Sensation of incomplete emptying

Does the person have any problems with constipation or faecal loss?

  • Loose bowels or diarrhoea
  • Hard faeces or constipation

2. Results

  • If the person answers ‘yes’ to any question, explore further. See Table 2.
  • Use screening tools to help gain clarity:
    • the Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders
    • the Bristol Stool Chart
    • see Resource 1.
  • Provide brief intervention and make a referral

Table 2. Further exploration of incontinence

Pain or discomfort in lower pelvic region? Any straining/grunting when passing faeces?

Recent unexplained weight loss? Without trying and without reason?

Recent sudden change in bowel habit? Going to the toilet more or less? Hard, runny, soft or watery? Size, time, colour and amount? Passing more wind?

Pelvic mass? Lump in the stomach, pelvis or groin? Scrotal swelling in men?

Rectal bleeding? Blood in the stool or in the toilet bowl?

Persistent diarrhoea? Runny, soft, watery stool that does not go away? For how long? Smelly?

Haematuria? Urinalysis positive for blood in the urine. Red or pink urine

Urinary tract or other urogenital infections? Stinging or burning sensation? Frequency? Smelly or cloudy urine? Pain in lower back or stomach area? Feeling unwell with or without a fever? Any vaginal discharge in women or urethral discharge in men?

History of pelvic surgery or irradiation? Past operation to genitalia?

Major pelvic organ prolapse? Vagina or bowel protruding?

3. Brief intervention 1–5

  • The involuntary loss of urine or faeces due to a failure of functional control over elimination is embarrassing, affecting social-emotional wellbeing, often requiring high-care needs
  • Incontinence occurs in 1.5% of Australian population. 70% of those improve with conservative treatment
  • Causes of incontinence are varied and include:
    • age and gender
    • childbirth
    • prostate problems
    • hysterectomy
    • urinary tract infections
    • Diabetes
    • neurological disorders
    • Dementia
    • menopause
  • Begin a bowel or bladder diary to provide the continence advisor. See Resource 2.
  • Provide Resources 3–5. to assist with the prevention and management of bladder and bowel problems, including the National Continence Helpline (1800 33 00 66)

4. Referral

  • Refer to the Primary Clinical Care Manualto exclude urinary tract infections
  • Refer to your local continence advisor or women’s health nurse to support:
    • with continence assessment issues
    • advise on the use of aids, appliances or support services. See Resource 6:
      • Medical Aids Subsidy Scheme (MASS) for continence aids
      • Continence Aids Payment Scheme (CAPS) to assist with continence aid costs
  • Refer to the MO/NP to manage a prolapse or continence issues. See Resource 7.

5. Follow-up

  • Place the person on a recall register if required
  • Ensure all referrals are actioned
  • Provide the person with details of the next scheduled follow-up appointment

6. References

7. Resources

  1. The Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders and the Bristol Stool Chart
  2. Bladder or bowel diary
  3. The Continence Foundation of Australia
  4. Information to assist with the prevention and management of bladder and bowel problems
  5. Prostate Cancer Foundation of Australia or free call 1800 220 099 or email enquiries@prostate.org.au
  6. Medical Aids Subsidy Scheme (MASS) and Continence Aids Payment Scheme (CAPS)
  7. Resources for clinicians to manage incontinence issues

Last updated: September 2024

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