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Blog: 'Incontinence remains the last taboo subject'

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Our new continence expert blogger Frank Booth shares his experience of 30 years working with people with incontinence.

The research has been done into continence care would seem to suggest that we can resolve many of the problems that are faced both by patients and professionals alike.

Continence was rarely discussed 20 or more years ago, in fact 25 years ago the number of Continence Advisors were few and although they were very professional most health organisations didn’t have one and those who did really were pioneers of their time.

20 years later we find Continence firmly set on the map but has anything really changed? Only you can answer this question in your own organisation.

The use of incontinence pads has risen rather alarmingly over the years and finance departments have probably been grumbling at you for years as with the higher volumes comes higher costs.

Today we know a lot more and our understanding of incontinence and we can now say with confidence that for between 50 – 70% of incontinent can either be cured completely or at least significantly improved. So what comes to mind then is that if this is so, why don’t we do it?

What evidence do I have that shows that we don’t? You really don’t have to look too hard to hear complaints, you can see them on most patient organisations websites where patients ask for help. Here we find the public saying how unhelpful we are, how we don’t seem to care, how our attitude to continence/incontinence is at best poor and if we were at school we would have a note on our work ‘could do better’.

Incontinence remains the last taboo subject, faecal incontinence more so than urinary incontinence. We are seeing and hearing more and more from organisations like NICE, SIGN, The Royal College of Physicians and the RCN and ACA and all have issued either members or national guidance on what and how we should deal with incontinence but despite this either we or our Trusts don’t seem to be playing the game.

Best practice is so clear now for both urinary and faecal incontinence affects both adults and children.

We are instructed how we should commission continence services. The only evidence that we actually do any of these things is the 2005 and 2006 Royal College of Physicians continence audit which we conduct ourselves, we fill in the forms and we could just say what we want the RCP to hear. Surely independent evidence supported by real physical examples of change, such as care pathways, policies and procedures and of course the numbers of service complaints would help.

Who is holding up proceedings, is it you, is it your Trust. When I was employed of course I was protective towards my trust and service but only to the point of making my concerns truly felt and ensuring that what was missing we endeavoured to put into practice as soon as possible.

No continence service should be ashamed of not achieving the highest of standards, what we should be worried about is knowing things are not right and doing nothing about them. What have you done to put things right? Can you tell us?

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Readers' comments (1)

  • With so many incontinent people about has anyone read this, I seem to be the first to respond. It's worrying isn't it, do nurses not have an opinion, good or bad about continence? Is this why continence has been ignored for years?

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