Continence

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Continence Mental Health

• Charmaine Bryant
• Clinical Nurse Consultant
• Prince of Wales Community Health

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People with mental illness

• The bladder / bowel dysfunction may not be
  related to mental illness

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Incontinence facts

• 1 - 3 females and 1 - 10 males
• 46 pregnant women
• 1 mil Australians incontinent on regular basis
• 3.5 mil Australian women wet themselves last
  month
• lt47 seek treatment
• gt100,000 Australian children wet the bed last
  night
• 12 NH admissions gt50 NH residents
• childhood bed wetters 5 fold risk bladder
  dysfunction later in life

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Whats Normal?

• Bladder
• X 4-6 day
• 350 500 ml each time
• nil _at_ night
• no pain, burning, straining or leakage
• Bowel
• x 3 day to every 3 days
• no strain
• Consistency

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Types of incontinence

• Overactive bladder urge incontinence
• Stress incontinence
• Overflow incontinence
• Reflex incontinence
• Functional incontinence
• Causes poor pelvic floor muscles, child birth,
  prostate disease, medication, neurological
  conditions

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Mental illness

• Increases risk of poor bladder/bowel control
• May interfere with ability to get to toilet on
  time due to disorganised thinking, confusion or
  inattention
• Medications can directly affect bladder or
  decrease awareness of bladder sensation, cause
  bedwetting (Clozapine) (Lithium may cause
  polydipsia)
• Poor physical health from long term self neglect
  
• Other chronic health conditions diabetes,
  respiratory may be a factor
• Lack of insight

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Mental illness

• Increases risk of poor bladder/bowel control
• Lifestyle factors
• poor diet
• high caffeine
• high fluid intake
• nicotine

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Bladder symptoms

• Rushing to get to toilet urgency
• Passing urine frequently - gt 7 day
• Leaking urine before getting to toilet
• Leakage with cough, sneeze or exercise
• Getting up more than once at night to pass urine
  
• Difficulty starting or straining to pass urine
• Repeated urinary tract infections
• Afterdribble
• Poor stream
• Wetting bed

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Bowel symptoms

• Unable to control wind
• Frequency and urgency to open bowel
• Constipation and straining
• Leakage with urge to open bowel
• Leakage without urge to open bowel
• Leakage with passing wind

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Dont ignore the symptoms

• Can make mental illness worse as it may
• Increase anxiety
• Contribute to feelings of shame and embarrassment
• Lead to isolation and loss of opportunity eg
  educational, social, recreational, vocational
• Lead to housing issues

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Prevention and management Lifestyle changes

• Drink well
• 2 litre fluid each day (more in hot weather)
• Increase water best fluid
• Decrease caffeine - gradually
• Decrease alcohol

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Prevention and management Lifestyle changes

• Eat well
• Healthy diet
• High in fibre, fruit, vegetables, wholegrain
  bread, legumes
• Healthy snacks instead of cakes or biscuits
• Reduce take-away food high fat food

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Prevention and management Lifestyle changes

• Stop smoking
• Call the quitline
  for
  assistance
• Exercise regularly
• Aim for at least 30min day walking is great

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Prevention and management

• Where to go for help
• Continence Foundation Australia
• Freecall 1800 330066 or www.contfound.org.au
• General Practitioner
• Local Nurse Continence Adviser for comprehensive
  continence assessment

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