training

skills

COUNTERSKILLS training programme

Incontinence bladder incontinence

13

workbook

bowel incontinence risk factors

skill builder:

diagnostics

advising confidently

treatment

using WWHAM activities & assessment merchandising aid

Supported by:

Incontinence

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Dear pharma

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Alphega Pharmacy team continue to offer comprehensive support and training packages for the whole pharmacy team. For more information please contact: Member Support on [email protected] or speak to your Alliance Healthcare account manager. Content developed by:

2 Counterskills

Incontinence

Market overview Bladder weakness Bladder weakness as a category is worth £106.98m* up 9.9% year on year (YOY). Generally growth has been driven by increased buyers and distribution (particularly on Pants). Total Market: £106.98m + 9.9% YOY

16.2%

YOY % change

0.6%

2.5% 3.0%

65%

TENA

Envive / Profresh

Depend

Bladder weakness

+£9.6m

TENA

+£9.66m

Envive / Profresh

-£0.98m

Depend

-£0.37m

Retail brand

+£1.3m

Other

+£0.02m

Retail brand

Other

Total Market Volume: £526.4m + 8.1% YOY 14.5%

0.4%

1.0% 5.6%

78.5%

TENA

TENA continues its double-digit growth and is growing ahead of the Total Market. Own brand is also enjoying growth while other branded competitors are seeing decline.

Envive / Profresh

Depend

YOY % change

Bladder weakness

+£39.3m

TENA

+£56.75m

Envive / Profresh

-£17.3m

Depend

-£1.54m

Retail brand

+£1.62m

Other

-£0.21

Retail brand

Other

*Source: IRI Total Market 52 w/e 7th September 2013

Counterskills 3

Incontinence

Market overview Category size 62.3m Population in UK 30.6m Men

31.7m Women

4.3m Girls below 12 years of age

18.6 million experience discharges

27.4m Total Target group

15.3 million have periods

6.0 million women experience some kind of bladder weakness

Also consider child and young adult incontinence as an add-on to the main adult incontinence shelf fixture. This is an area where

• 62% of women 18+ experience light bladder weakness • 25% of women 35+ experience bladder weakness • 15% of women 40+ have regular or daily bladder weakness

Source: SCB 2009; Epincont incontinence research 2000

Pharmacy is seen to have advantages vs. Supermarket in offering a more personal service and giving advice. The main advantage for independent pharmacies is in terms of being close to the shoppers’ home. Ensure that you make your customers feel comfortable in talking about their needs, possibly in a consultation room, as this is key to gaining their trust and repeat purchasing.

Around 500,000 men have some kind of bladder weakness

mums find it hard to identify a healthcare professional that can advise on the best products for their children. The Total Bed Wetting category is worth £28.9m* which is up 9.1% on 2012. This is made up of pyjama pants category, which is worth £23.3m, and the bedmat category worth £5.6m. Huggies Drynites is the main brand driver in these categories.   *Source: AC Nielsen MAT 14/9/13

4 Counterskills

Incontinence

Section 1: Introduction Incontinence is the loss of bladder or bowel control. Either type of incontinence can affect both men and women but bladder incontinence is more common in women.

The urinary system

Bladder incontinence which is sometimes referred to as urinary incontinence or bladder weakness, affects between three to six million people in the UK to some degree and becomes more common with age. Bowel incontinence affects around six and a half million people in the UK. a

Many people who suffer with either problem don’t talk about it or seek help as they are embarrassed or think that there is nothing that can help them. There are, however, things which can be done to support these people and to make sure whenever possible that incontinence does not interfere with their everyday life.

b

The urinary system The diagram opposite describes the component parts of the urinary system. The urinary system consists of two kidneys, which act as filters from which urine is carried, via the ureters to the bladder. The kidneys control the amount of blood and the chemicals carried within it, and they remove any toxic waste. The toxic waste then becomes part of urine. The bladder is a muscular reservoir that holds the urine. Once the bladder is full enough for the muscles in the bladder to be stretched, a message is sent to the brain indicating to the person that they need to go to the toilet. This normally occurs when the bladder is half full. The urine is then carried from the base

c d

e

a Kidney

d Sphincter

b Ureter

e Urethra

c Bladder

of the bladder to the outside of the body via the urethra. The urethra is kept closed by two sphincter (circular) muscles. The inner sphincter opens when the bladder is full but

Counterskills 5

Incontinence

Section 1: Introduction the outer sphincter muscle can be voluntarily held shut, controlling when urination takes place. Pelvic floor muscles located beneath the bladder and around the urethra keep these two sphincters working properly.

A normal functioning bladder:

• Empties every three to four hours

• Can hold up to a pint of urine • May need to be emptied once or twice at night

• Empties completely each time urine is passed

• Does not leak urine • Informs the brain when it is full, with sufficient time to find a toilet.

Bladder incontinence Bladder incontinence is when the bladder leaks urine involuntarily. This can be drops of urine, leakage of urine in small amounts through to the loss of the entire bladder contents.

Common types are:

• Stress incontinence • Urge incontinence • Overflow incontinence • Nocturia • Functional incontinence. 6 Counterskills

Stress incontinence Stress incontinence does not refer to the emotional state of a person but is to do with the physical stress caused to the pelvic floor muscles when a person coughs, sneezes, laughs hard, exercises or when lifting. Small amounts of urine leakage happen during any of these activities and if the bladder is very full, larger amounts are sometimes passed. This is one of the most common forms of urinary incontinence and can affect women who have had a baby as their pelvic floor muscles are stretched and weakened during childbirth. It can also affect women who have been through the menopause as the body stops producing the hormones which help to keep the vagina and bladder healthy. Men can develop stress incontinence after a prostate (a gland which gets bigger from the age of 40 and can restrict the flow of urine) operation. Being overweight can also cause stress incontinence or suffering from long-term constipation can also cause stress incontinence, as both of which put additional stress on the pelvic floor muscles.

Urge incontinence Urge incontinence is when urine leaks out just when the person feels an intense urge to pass urine. It can be quite sudden, leading to the person not being able to get to the toilet in time. It may be accompanied by an urge to pass urine frequently, which may be every half an hour (this is known as ‘frequency’) and may wake a person up several times during the night.

Incontinence

An overactive bladder or a urine infection can also cause urge incontinence. Many people find that with age they will need to go to the toilet more often and experience more urgency as less warning is given before needing to pass urine.

Overflow incontinence This is when the bladder does not fully empty and so a build up of urine occurs, leading to leakage. It can be difficult to start to pass urine and after passing urine, there is a feeling that the bladder is still not empty. There may be a number of reasons for the bladder not emptying fully: An obstruction such as an enlarged prostate gland in men, known as Benign Prostatic Hyperplasia (BPH)

•

edical conditions such as diabetes, • M multiple sclerosis, stroke or Parkinson’s disease can make the bladder less efficient at emptying.

Nocturia Nocturia is when a person is woken up several times during the night to pass urine. This will lead to them feeling constantly tired and so limiting what they can do during the day. It is more common in the over 60’s.

Functional incontinence Functional incontinence can be due to having practical difficulties reaching a toilet in time. This can be walking difficulties or problems removing clothes.

evere constipation, as the bowel can • Spress on the bladder

Counterskills 7

Incontinence

Section 1: Introduction The bowel The diagram below describes the component parts of the digestive system.

The bowel

The digestive system consists of the stomach, the small bowel, the large bowel (or colon), the rectum and the anus. Food passes from the stomach into the small bowel, then through the large bowel where fluid is absorbed and the remains of undigested food form the basis of a bowel motion or the faeces. When a bowel motion reaches the rectum it creates a feeling of needing to pass a motion and when a person is ready to do this, the muscles around the anus (anal sphincter) relax allowing the motion to be passed.

a

A normal functioning bowel:

b

• P roduces bowel motions which are easy to pass either a couple of times a day or every few days (this varies from person to person) • Should not cause a person

c

d e

to strain.

Bowel incontinence Bowel incontinence is when the bowel leaks faeces involuntarily. It is not a condition in itself but usually a symptom of an underlying condition such as irritable bowel syndrome (IBS), constipation, diarrhoea, or a neurological condition such as multiple sclerosis. It can also occur following an operation in the bowel area. It affects around 1% of adults to the point of impacting on their quality of life.

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a Stomach b Small bowel c Colon (large bowel)

d Rectum (large bowel)

e Anus

Incontinence

Section 2: Risk factors There are some risk factors that increase the chances of a person developing bladder incontinence. They are different for men and women.

Risk factors in women

Risk factors in men

• Age. The risk of developing

Risk factors for men developing bladder incontinence include one or more of the following:

• Age. The risk of developing

bladder incontinence becomes higher, the older they get

• Family history. There maybe a genetic link to bladder incontinence, particularly stress incontinence

• Disability. People who suffer

with conditions that affect the brain or spinal cord such as multiple sclerosis and dementia

• Removal of the prostate gland • Problems with the lower urinary track (the bladder and urethra), such as problems storing urine, passing urine (having to strain to pass urine or having a slow stream or stopping and starting during passing urine), or feeling that they have not completely emptied the bladder.

Risk factors for women developing bladder incontinence include one or more of the following:

bladder incontinence becomes higher, the older they get and is most common in women over 70 years old

• Family history. There may

be a genetic link to bladder incontinence, particularly stress incontinence

• Disability. People who suffer

with conditions that affect the brain or spinal cord such as multiple sclerosis and dementia

• Pregnancy. If they have

developed stress incontinence during pregnancy or in the six weeks following the birth they are likely to have stress incontinence five years after the birth

• Vaginal birth. Giving birth

vaginally, rather than via a caesarean, increases the risk and if it was a forceps birth, the risk is increased further

Counterskills 9

Incontinence

Section 2: Risk factors • Obesity. Women with a Body Mass index (BMI) of 30 or more are at greater risk

• Problems with the lower

urinary track (the bladder and urethra), such as problems storing urine, passing urine

10 Counterskills

(having to strain to pass urine or having a slow stream or stopping and starting during passing urine), or feeling that they have not completely emptied the bladder.

Incontinence

Product recommendations

Drynites – Pyjama Pants Key attributes

• Absorbent – a thin super absorbent pad draws

wetness away from the skin, while leak guards and a moisture proof outer cover offer added security • Discreet – designed to be worn under nightwear they look and feel like normal underwear and can be taken on and off like normal underwear • Soft – softer feel material with stretchable sides ensure a snug for a comfortable fit throughout the night • Quiet – quiet materials for less rustle.

OTHER ADVICE

Why recommend

• DryNites

® Pyjama pants help children to manage the bedwetting phase by providing unbeatable overnight protection; meaning a better night's sleep for your child and for you too. And because they're discreet and underwear-like, children can feel more confident and independent at bedtime, either at home or on nights away (e.g. meaning a better night’s sleep for both child and parent alike).

Available in three sizes – 3 to 5 years, 4 to 7 years and 8 to 15 years with designs suitable for both boys and girls

Counterskills 11

Incontinence

Section 3: Diagnosis Both types of incontinence are a symptom of an underlying problem. It is important to diagnose the cause so that, if possible, appropriate treatment can be provided. Bowel incontinence is fairly straight forward in its diagnosis. Bladder incontinence is slightly more complex due to the number of different types. In the first instance, customers who are concerned they may be suffering with incontinence, and have not had a diagnosis, should be referred to their GP. If customers are not able to get to their GP, then their surgery can arrange for a district nurse to visit them at home. Alternatively, customers can contact their local NHS continence service for an assessment. Their surgery will have contact details for this service. Those experiencing problems passing urine will be asked the following type of information:

• When did the problem start? • When the incontinence

occurs? Is it when they cough, sneeze or laugh?

For a few days (at least three days) before visiting their GP, you should advise your customer to keep a ‘bladder diary’. This is so they can record the following information that will help their GP with their diagnosis:

• How much fluid and what it was that they drank

• How often they needed to pass urine

• The amount that was passed • How many times incontinence was experienced and the severity of each episode

• How many times they

experienced an urgent need to pass urine.

They may also need to be physically examined by their GP. For women this may involve a pelvic examination to check the health of their bladder and for men a rectal examination to check the health of their prostate.

• Whether they need to pass

Customers may also need to provide a urine sample so their GP can rule out whether their problems are being caused by an infection.

• How much fluid in general,

If these tests do not provide sufficient information for their GP to provide treatment then further tests may be needed.

urine during the day or the night alcohol and caffeinated drinks they consume every day

• Whether they can feel when their bladder is full.

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Incontinence

Section 4: Treatment In most cases treatment is to try and reduce the symptoms and support customers with suitable products and advice to make them feel more confident to carry on with their everyday activities without worrying. There are a number of ways to do this:

• Pelvic floor exercises • Bladder retraining • Lifestyle changes • Incontinence products. For customers who are suffering with urge incontinence that is caused by an infection, a short course of antibiotics from their GP should clear the infection and the symptoms.

your customer to their GP. It may be that they haven’t been doing them correctly, in which case their GP may refer them to a specialist to start a programme of pelvic floor exercises with a specialist nurse. Women who complete pelvic floor exercises correctly have fewer leaking episodes and improve stress incontinence by two thirds. In men, studies have shown that pelvic floor exercises can reduce urinary incontinence, particularly after surgery to remove the prostate gland. The diagram below shows where the pelvic floor is situated in both men and women.

The Pelvic floor

In some cases, it may be that the symptoms need to be treated differently:

• Tamsulosin can be sold

b

over the counter for men suffering with Benign Prostatic Hyperplasia (BPH)

Pelvic floor muscles are a layer of muscles that span the bottom of the pelvis. They support the bladder and bowel in men and the bladder, bowel and uterus in women. Although these muscles cannot be seen, they can be consciously controlled and trained to strengthen them and therefore help control stress incontinence and bowel leakage. The exercises should be tried for a few weeks, but if no benefit has been gained, then refer

d

a

c

a

c

• Surgery may be required. Pelvic floor exercises

b

Men

Women

a Pelvic muscles

a Pelvic muscles

b Bladder

b Bladder

Bowel c 

Bowel c 

d Uterus

Counterskills 13

Incontinence

Section 4: Treatment How to perform pelvic floor exercises In order to perform the exercises, the person needs to identify the correct muscles. One way to identify these muscles is to try to stop or slow the flow of urine midway through emptying the bladder. Stopping the flow of urine repeatedly on the toilet is not an exercise in itself, but a way of identifying your pelvic floor muscles. This should only be done to identify which muscles are needed for bladder control. The exercises should be completed as follows:

• The person should imagine

they were trying to stop themselves passing wind and urine at the same time

• They should then squeeze

in and hold the muscles inside the pelvis. They may notice some tightening and flattening of the lower part of the tummy as the muscles in the tummy and pelvis work together but they shouldn’t pull in their stomach

14 Counterskills

• They should make sure not to squeeze their legs together, tighten their buttocks or hold their breath

• They should then relax the

muscles, and complete the process again.

There are two exercises they should do; one is slow and one is quick. For the slow exercises they should tighten the pelvic floor as above for as long and as hard as they can, building up to a maximum of 10 seconds. If you tell them to think of the muscles tightening, as if going up in a lift, so they are consciously trying to pull and lift them up throughout the 10 seconds. They should then relax and rest for four seconds before repeating, up to a maximum of 10 times. The quick exercises help to strengthen the muscles so they can react quickly to stress such as sneezing, coughing and laughing. They should squeeze in and hold the muscles tight for one second before relaxing and repeat this up to 10 times.

Incontinence

To get the most benefit you should recommend that customers do one set of slow exercises then one set of quick exercises six times a day. They can be done in any position (lying down, sitting or standing) and other people shouldn’t be able to tell they are being done. In order to get into a habit of completing them it is best to recommend that they think of everyday tasks during which they can complete them such as while washing up, waiting for a bus, while travelling, while feeding a baby. This will help to ensure they complete the exercises without it becoming a chore. They need to be completed every day throughout the person’s life and should not be stopped when they start to benefit from the results or these benefits will soon disappear.

Biofeedback Biofeedback is a way to monitor how well pelvic floor exercises are being performed as feedback is given while they are being performed. This can be done one of two ways: A small probe is inserted, either into the vagina in women or the anus in men. It senses when the muscles are squeezed and feeds the information to a computer. Sticky electrical patches are attached to the skin on the abdomen or around the anus. They sense when the muscles are squeezed and feed the information to a computer. Both methods help the person to learn which muscles to use to perform pelvic floor exercise.

Electrical stimulation If your customer is unable to contract their pelvic floor muscles, electrical stimulation may be of use. A pelvic floor stimulator is used which helps to strengthen the pelvic floor by passing mild electrical pulses, via an internal vaginal probe for women or anal probe for men. This contracts and relaxes the pelvic floor muscles. It cannot be used during pregnancy.

Bladder retraining

Bladder retraining helps with urge incontinence. It can be combined with pelvic floor exercises if a person is suffering with a combination of both urge and stress incontinence. The purpose is to learn techniques to increase the length of time between feeling the need to pass urine and actually passing urine. Customers should be advised to:

• Keep a record, for three days, of how often they pass urine and when they get wet

• Review the record to see if

there is a pattern, then try to hold off passing urine and so gradually extend the time intervals between visits to the Counterskills 15

Incontinence

Section 4: Treatment toilet. So, if they are passing urine every two hours, they should aim to extend this to two and a half hours initially, then longer, once this feels comfortable. This in turn will also reduce the number of visits to the toilet every day

• When they feel the urge to

go, they should wait for a few minutes, tightening their pelvic floor muscles to extend the time between visits.

This will help customers regain confidence when they go out for the day or have a long journey to make. It can take six or more weeks to overcome the urge to pass urine, but gets easier with time and perseverance. The aim is to pass urine every three to five hours, which equates to around five to seven visits to the toilet a day. Customers should keep a record every so often so that they can see progress.

Lifestyle changes

There may be some simple changes customers can make which can make a big difference to the severity of their symptoms in all forms of incontinence.

Customers should be advised:

o reduce their caffeine intake as • Tcaffeine acts as a mild diuretic (a product which promotes the production of urine). They should limit their intake to around two to three cups of tea/coffee or cola

16 Counterskills

o make sure they are drinking enough • Tfluids. Reducing their intake of fluid within a 24 hour period will not reduce the symptoms. They may in fact make them worse, leading to constipation or a urine infection. If fluid intake has been reduced for a length of time, the bladder can get used to holding smaller amounts. They should aim to drink between six to eight cups of liquid a day (around two litres) and try to drink the majority during the day and not too close to bedtime. This will help to avoid being woken up several times in the night to go to the toilet

o reduce or cut out alcohol. Alcohol • Talso has a mild diuretic affect, which can irritate the bladder. Customers should be advised to stay within the recommended daily limits for alcohol consumption which is three to four units a day for men and two to three units a day for women. If they find that their symptoms are worse when they have consumed alcohol, they should try to avoid it

o keep active and mobile wherever • Tpossible. A brisk walk, five days a week,

for around 30 minutes is enough to keep the body healthy and the bowels moving

o avoid becoming constipated. • TCustomers should be advised to eat a

well-balanced diet with plenty of fibre rich foods such as brown rice, pasta and bread, include five portions of fruit and vegetables every day, and try to eat lean meats and keep their fat intake low

Incontinence

o maintain a healthy weight. Being • Tobese increases the risk of developing incontinence and losing weight if obese will help reduce the symptoms.

Absorbent products

There are a variety of absorbent products available for customers to buy. Choosing from this wide range of products can be daunting and of course they may be too embarrassed to ask questions. If you see a customer looking a bit lost, looking at a range of products, then approach them sensitively, asking them if they are OK or if they need any help. Products available include:

• Liners • Pads • Pants • Bedding protectors Liners

Incontinence products There are a number of incontinence products that your customers may find useful in managing their symptoms and helping them to feel confident to go about their everyday life. Products include:

• Absorbent products • Hand held urinals • Catheters • Penile sheath • Infection control products

Liners are designed to be discreet, whilst providing security against leakage. They are for light urinary incontinence such as those customers suffering with stress incontinence, who need protection from small leakages. These liners are much more absorbent than ordinary sanitary towels. Customers can choose from standard liners, extra length liners and those with wings to hold the liner in place better.

Pads Pads are similar to liners but are more absorbent and so can be used for light to moderate urinary incontinence. They tend to come in a number of absorbencies for customers who want a little more protection. Pads are more absorbent than liners. Customers can choose from standard male or female pads, (the male pads are cup shaped to follow the male anatomy), extra length liners and those with wings to hold the pad in place

Counterskills 17

Incontinence

Section 4: Treatment better. There are also night time pads available which are a different shape, to provide added protection when lying down. Some pads have the additional feature of an odour control system.

Bedding protectors There are a number of bedding protectors available; waterproof mattress covers, absorbent sheets, which can be washable or disposable and pillow and duvet protectors.

Pants Disposable pants can be used for moderate to heavy urinary incontinence. They are available for both men and women, designed to be worn like normal underwear and come in a variety of sizes and absorbencies. They have a highly absorbent pad integrated within the fabric and have odour control systems. Customers can also choose to use a reusable pants system. This consists of two parts; a disposable pad and a pair of stretch reusable pants or a disposable pad held in place with a reusable belt. These offer high absorbency and are an alternative for those customers who wish to carry on using pads.

Hand held urinals Hand held urinals are portable devices that are useful when access to a toilet is not possible or convenient. They can be used for both urge and functional incontinence, particularly if your customer is going on a long journey or for those who are dependent on a helper to use the toilet. They are available in different shapes and sizes.

18 Counterskills

Incontinence

Catheters

A catheter is a long thin tube, inserted up the urethra, or through a hole in the abdominal wall, into the bladder, to drain urine. Bladder catheterisation may be a temporary or a permanent solution for urinary incontinence and will be initiated by your customer’s GP or nurse.

help with infection control. These are wipes, wash creams, wash gloves (these offer the benefits of a wipe with the ease of use of a glove), barrier creams to protect the skin (such as zinc and castor oil) and the use of disposable gloves. Antibacterial alcohol hand gels are useful when out and about and hand washing is not always easy. Disinfectant should be used in the home to clean up any leakages. Good hand hygiene is the best way to prevent infection. This should be carried out in the following manner: Hands should be washed thoroughly for 10-15 seconds with soap and water and dried

•

n alcohol hand gel should then be used • Aafter washing, or if there are no hand washing facilities available

Penile sheath A penile sheath is sometimes used by men and is available on prescription. It fits over the penis and collects urine into a bag that is strapped to the leg. Again your customer’s GP or nurse would initiate this.

Infection control products Urine and faeces sometimes contain infections that can be transmitted to other parts of the body or between people. Exposure to bowel incontinence is more likely to lead to infection, especially if the person has diarrhoea. 60% of faecal matter is made of bacteria which destroy the skin’s cellular defence and can lead to skin breakdown and infection. These bacteria can also infect the urethra causing urinary tract infections. Proper infection control methods and hygiene products for bladder and bowel incontinence should therefore be used. There are a number of products available to

isposable gloves should be worn if • Dthere is exposure to any body fluids

n emollient hand cream should then be • Aapplied regularly to the hands to protect the skin from becoming dry and sore. When cleaning the genital area, customers should be advised to: Use wipes, as they are more hygienic than a flannel and towel as they can be thrown away after use

•

ently cleanse the skin with the wipe • Gafter every episode, making sure that the area is clean and dry

pply a barrier cream to protect the skin • Afrom damage.

Counterskills 19

Incontinence

Section 4: Treatment If urine smells offensive, customers should be advised to see their GP as they may have an infection. Similarly if their skin becomes red or sore, they need to make sure any products they are using are fitting properly and not rubbing. If the skin becomes broken or they are concerned that a product they are using is not fitting correctly, they should be advised to see their GP.

Benign Prostatic Hyperplasia (BPH) Benign Prostatic Hyperplasia (BPH) is the enlargement of the prostate gland in men. From around the age of 40, the male prostate gland gets bigger, which can restrict the flow of urine, causing overflow incontinence. This can lead to Lower Urinary Tract Symptoms (LUTS) such as:

• Incomplete emptying of the bladder

• The urine stream stopping and starting

• Dribbling • The urge to go to the toilet

more often, particularly during the night and with more urgency than before.

The bladder wall muscles may also thicken. This causes a loss in elasticity and so reduces the amount of urine the bladder can hold and the bladder having to work harder. The customer will need to go to the toilet more often, with more urgency than before and can experience dribbling.

20 Counterskills

There is an over the counter treatment available for those men who are suffering with Benign Prostatic Hyperplasia (BPH) called tamsulosin.

If you suspect the When symptoms to refer being described to you by a male, over the age of 40, are associated with BPH, refer the customer to your pharmacist, so they can make a decision whether they are suitable for this treatment. If a customer has been using this treatment and requests a further supply from you, you must also refer them to your Pharmacist.

Surgery Surgery may be required in some cases. The type of surgery depends on which type of incontinence the person is suffering with. A sling or tape procedure is used to treat stress incontinence as these both reduce the pressure on the bladder. For urge incontinence, surgery is performed to enlarge the bladder or an implant can be inserted which stimulates the nerves controlling the muscles.

Incontinence

T

MEMBE R RE

N

n TO ho is it for?

W

hat are the symptoms?

io at

W

Inform

WWHAM!

•

PORTA IM

Refer to the Pharmacist if: Your customer is male Treatment is being requested for a child under 12 years old

Refer to the Pharmacist if: Blood is present in the urine Pain is present in the lower abdomen and/or back They have a raised temperature, as this may indicate an infection

H

ow long have they had the symptoms?

Refer to the Pharmacist if: You suspect they have an infection

A

ctions taken so far:

Refer to the Pharmacist if: They are requesting a supply of tamsulosin

M

edication, if any, taken at the moment?

Refer to the Pharmacist if: The answer is yes

Counterskills 21

Incontinence

Section 4: Treatment

ACTIVITY A man of about 60 comes into your pharmacy. He says that he has to rush to the toilet for a wee otherwise he is afraid that he won’t make it in time. He is also having to get up three or four times a night to go for a wee and he is now tired all the time. What questions would you ask this customer and what actions would you take?

my r we ans

Ask your Pharmacist to review your answer and discuss it with you if required. 22 Counterskills

Incontinence

Product recommendations

Envive Key attributes

• New Envive by Always has a special shape that widens at the front* • Hundreds of ultra-absorbent micro-channels absorb wetness and odour and lock them discreetly away • Absorbs twice as much as typically needed.

OTHER ADVICE

Why recommend

• One out of four women have a sensitive bladder • But the best thing is, new Envive by Always offers you the protection of a specialty product and is as thin as an Ultra pad!

Check out our website at http://www.always.ie/NewEnviveUK/en_UK/products_liner.php

* Liner Plus, Regular and Regular Plus sizes

Counterskills 23

Incontinence

Section 5: Practical advice It can be embarrassing for customers to talk about incontinence with friends and family and even with healthcare professionals. It may stop them from doing the activities they would like to do so any help you can provide them with will be invaluable. Try to reassure them that they are not alone with this problem. The incidence of people suffering with incontinence at some stage in their life is one in four for women and one in eight for men. For women, that makes it as common as hay fever and it can happen in the young as well as in the old. The following are some tips you could provide your customers with to help them cope with their symptoms: They should not reduce their fluid intake to try and control symptoms as this will increase the possibility of infections and constipation

•

24 Counterskills

eight loss, if overweight, may reduce • W the pressure on the pelvic muscles and alleviate the symptoms

hey should try to avoid alcohol • Tand caffeine as these are likely to increase the urgency of needing to go to the toilet

ustomers should also try to avoid fizzy • Cdrinks as these can irritate the bladder should make sure that their route • Ttohey the toilet is not obstructed so they can get there quickly

f they have limited mobility, they could • Iconsider installing grab rails next to the toilet or a raised toilet seat to help them get on and off the toilet

Incontinence

• The use of a commode may be beneficial he Bladder and Bowel Foundation • Toffers a free ‘Just Can’t Wait’ toilet card. This states that the holder has a medical condition that requires the urgent use of a toilet, so when they are out, they can show this and then they will not have to queue for a public toilet

should be easy to remove if this • Cislothing a problem lidded bin in the bathroom to • Adispose of used products is useful and minimises infection

hey should always make sure they • Thave some spare pads/pants with them when out

disposable bags are helpful • Stocented place soiled pads/pants in to help disguise odours

customers to tell friends/family • Aifdvise they are going on a long journey so plenty of toilet stops can be planned in

should make sure they follow • Tahey strict hygiene routine to prevent any infection.

Preventing urinary incontinence You may also be asked how customers can prevent urinary incontinence. This is not always possible, but there are some steps you can advise your customers to take, to reduce the chance of the condition developing. This includes:

• Controlling their weight • Reducing or stopping alcohol consumption

• Keeping fit • Doing pelvic floor exercises,

especially if they are female and are trying for, are expecting a baby or have just had a baby. This is not exclusive to females as men also benefit from doing these exercises as it helps with erectile dysfunction (difficulty getting or keeping an erection).

Counterskills 25

Incontinence

Section 5: Practical advice

ACTIVITY

A lady of about 30 comes into your pharmacy. She says that she has just had a baby and ever since then, whenever she sneezes or coughs, she has a little ‘accident’. It is starting to concern her and wondered if you could help her. What products would you recommend and what practical advice would you give her? Write your answers in the box below.

my r we ans

Ask your Pharmacist to review your answer and discuss it with you if required. 26 Counterskills

Incontinence

Product recommendations

Alvita Incontinence Range Key attributes

Why recommend

skin, for comfort and dryness • Absorbent layers to rapidly trap fluids and prevent leakages • Alvita Air System, which makes products breathable, to minimise the risk of skin irritation • Odour neutraliser, to control urine odours • Wide adhesive strip, to hold pads firmly in place • Elasticated leg cuffs, to prevent leakage • Soft re-sealable tapes, for a comfortable fit.

of quality assured personal hygiene products for the symptoms of moderate to heavy incontinence • The products are highly effective and discreet, providing patients with comfort, security and confidence.

• Ultra-soft cover, which keeps moisture away from the

OTHER ADVICE

• The Alvita incontinence range offers patients a choice

Women are twice as likely as men to suffer from incontinence, due to their anatomical characteristics, pregnancy, and menopause

Counterskills 27

Incontinence

Section 6: Check your understanding Complete the following multiple choice questions on Incontinence health. Ask your Pharmacist to check your answers. Question 1 Bladder incontinence affects between:

A) Three to four million people in the UK B) Two to three million people in the UK C) Three to six million people in the UK

Question 2 Stress incontinence is to do with:

A) Emotional stress B) Psychological stress C) Physical stress

Question 3 Overflow incontinence is:

A) When urine permanently leaks from the bladder B) When the bladder does not fully empty and so a build-up of urine occurs C) When urine overflows back into the kidneys

28 Counterskills



Incontinence

Question 4 A risk factor for men developing bladder incontinence is:

A) Smoking B) Age C) Eating too much red meat

Question 5 A risk factor for women developing bladder incontinence is:

A) Drinking too much caffeine B) Smoking C) Pregnancy

Question 6 Customers who are concerned they may be suffering with incontinence should be:

A) Referred to their GP B) Referred to the hospital C) Told that it will probably clear up after a few days

Question 7 A ‘bladder diary’ will include (tick any that are true):

A) How often they needed to pass urine B) How often they had sexual intercourse C) How many times incontinence was experienced

Counterskills 29

Incontinence

Section 6: Check your understanding Question 8 Bladder retraining involves learning techniques to train your bladder to:

A) Increase the length of time between feeling the need to pass urine and actually passing urine B) Only go to toilet once a day C) Only go to the toilet when there is a toilet nearby

Question 9 Products to help with infection control include (tick any that are true):

A) Antibacterial alcohol hand gels B) Disposable gloves C) Cold water

Question 10 A tip, to give your customer, to cope with their symptoms is to:

A) Get plenty of sleep B) Avoid alcohol and caffeine C) Drink less fluid throughout the day

30 Counterskills

Incontinence

Look out for the next Counterskills workbook from Alliance Healthcare covering Baby

Coming soon

training

skills

COUNTERSKILLS training programme

Baby keeping healthy during pregnancy common complaints in pregnancy the first few weeks weaning

14

workbook

skill builder: advising confidently using WWHAM activities & assessment merchandising aid

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Queries relating to Counterskills should be directed to [email protected] or 0203 044 8681 Content developed by: ©2011 Scientia Skills Limited Copyright in the whole and every part of the workbook belongs to Scientia Skills Limited (“the Owner”) and may not be used, sold, transferred, copied, adapted or reproduced in the whole or in part in any manner or form or in any media to any person without prior written consent of the Owner.

Counterskills 31

Planogram This planogram has been provided as a guide to help you optimise the sales opportunity on the incontinence category. For a full listing see the ‘Star Ratings’ document included with this workbook which contains essential, additional and supplementary brands within pharmacy.