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INCONTINENCE


that up to 60-80% of sufferers have never sought medical advice for their condition and 35% view it simply as part of the ageing process. In most cases, these conditions can be easily treated or signifi cantly improved via straightforward interventions.


WHAT CAUSES INCONTINENCE? The urinary tract is a particularly complex system, made up of a number of parts, including the bladder, kidneys, ureters, urethra and other connective thoroughfares which are all involved in the production, storage and ejection of waste in the form of urine. Depending on the type of UI that the patient is suffering from, various components of the system can be affected, leading the unwanted and uncontrolled passing of urine. The most commonly encountered types of UI include2


:


• Stress incontinence – the leaking of urine on application of pressure to the bladder, during actions such as coughing or laughing. This is due to the pressure within the bladder being greater than the bladder sphincters can withstand.


• Urge incontinence – the feeling of an intense need to pass urine, followed by the leakage of urine. This condition is also known as unstable or overactive bladder, and is due to the early contraction of the muscles surrounding the bladder, leading to unwanted urination.


• Mixed incontinence – a combination of stress and urge incontinence, which can lead to an even greater uncontrolled passing of urine.


Less common types of UI include overfl ow incontinence (where the urine outfl ow is hindered by a blockage or malformation, leading to increased bladder pressure, and subsequent leakage of small amounts of urine), functional incontinence (UI which can be brought about due to other issues, such as the patient’s reduced mobility), and other types caused by congenital issues.


Many conditions fall under the umbrella of UI, but it’s important to understand what causes these conditions on a physiological level. In most cases, UI is brought about when the various muscle systems of the urinary tract are unable to withstand the pressure exerted on them, after being weakened by other processes,


such as pregnancy and childbirth, via increased pressure as a result of obesity or chronic constipation, and also via complex genetic causes, linked to a family history of UI3


. Fatigue


and the reduction in muscle elasticity which occurs with age can also lead to reduced bladder control in the elderly. As a result, UI can be seen to be a complicated medical condition, and one which pharmacists need to be knowledgeable about.


MANAGING UI – ASKING THE RIGHT QUESTIONS As always, the appropriate and effective management of a condition like UI involves an in-depth


BOX 1. SOME QUESTIONS WHICH MAY BE ASKED DURING A UI CONSULTATION3


• When did you notice a change in your bladder habits?


• How often does the problem occur?


• How much urine is passed?


• How are you dealing with the problem at the moment? Is this helping?


• How much are you drinking? • What are you drinking? • When are you drinking?


• Can you feel when your bladder is full?


• How often to do you use the toilet?


conversation with the patient, to draw out important information about their condition. Useful questions to ask are provided in Box 1. By asking these questions, specifi c aspects about the nature of the patient’s condition should become more apparent, and allow you to make the correct decision on treatment options, and whether referral to a GP or urologist is needed.


.


Of course, having a conversation like this with a patient is much easier said than done, when many patients are too embarrassed to acknowledge they might have an UI problem and ask for help. Demonstrating an awareness of incontinence will go a long way to easing customers’ minds, and help them to seek advice. Useful techniques to make your customer more comfortable include:


• Moving the conversation to the consultation room or a quiet part of the pharmacy, to remove the patient’s fear of being overheard by others.


• Putting them at ease by telling them how common UI conditions are (see the statistics above).


• Letting them know why you’re asking particular questions and advising them that in most cases the problem can be easily managed via a combination of medical products and self-help.


Showing empathy with the patient,


and carefully choosing the language you use to talk to the customer, will also put them at ease. During these conversations, pharmacists should use their skills to assess the severity and nature of the condition, possible management and treatment options and make sure they refer the patient on to an appropriate healthcare professional when appropriate.


MANAGEMENT OF UI IN THE PHARMACY


Management of UI conditions within the pharmacy setting includes:


• Referral on to another healthcare professional for further assessment, testing and pharmacological intervention, or


• Supplying the patient with products from the pharmacy to assist them with their condition.


Pharmacists should use their best judgment with regard to these approaches, and should also be aware of the products which are available to them, should they wish to recommend products from the pharmacy shelves.


The main types of products which can be recommended are absorbent preparations and garments. According to NICE, these products should be used only as:


SCOTTISH PHARMACIST - 19


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