Principles of assessment

Continence assessment is an essential intervention presenting a detailed history, objective identification of incontinence symptoms and ascertaining what previous treatment programmes were successful or unsuccessful^[1].

In order to provide the best treatment for anyone with symptoms of bladder or bowel dysfunction it is essential to carry out a comprehensive and holistic assessment of the individual.

Never accept incontinence as ‘just one of those things’, you must investigate, find the cause and establish a treatment plan that will cure or improve symptoms where possible, or at the very least help the individual to find ways to cope and improve their quality of life.

Remember that incontinence of bladder and/or bowel is a symptom that may be caused by numerous factors:

• Reversible conditions, such as urinary tract infection or faecal impaction
• The effect of other medical conditions
• Medication
• The environment
• Bladder and/or bowel pathology

Bladder and bowel dysfunction should never be looked at in isolation and must always be seen as a part of a whole person. They are important aspects of our human functioning and central to our individual identity.

Without treatment they can lead to physical, emotional, psychological and financial difficulties, as well as self-imposed life-style restrictions and social isolation, to avoid embarrassment.

Why do we assess?

Our purpose in undertaking a bladder and bowel assessment is:

• to identify the cause of the bladder and/or bowel dysfunction
• to make an accurate diagnosis
• to develop effective, realistic treatment plans
• to empower people with bladder and/or bowel dysfunction
• to enable people to be discharged with an effective self-management plan

Clinical practice point
A comprehensive continence assessment is the foundation for person-centred care planning, based on accurate identification of the cause of the bladder and/or bowel dysfunction and the individual’s needs for treatment and support.

Skills of the assessor

What skills does an assessor need?

• Excellent communication skills including listening and questioning skills
• Positive attitude, honest communication reduces person’s embarrassment
• Empathetic approach – it’s a sensitive subject
• Ability to encourage
• Motivator – success of treatments depends on person’s degree of determination
• Knowledge of the subject – gives the person confidence in assessor’s ability to help
• Use of range of terminology – what words is the person comfortable to use? use their language
• Confidentiality
• Trust and rapport – the person may talk to you, the assessor, about symptoms or situations they have not previously told anyone, including sexual problems or abuse

References

_{1. Dowling-Castronovo AM, Specht JK. Assessment of transient urinary incontinence in older adults. Am J Nurs 2009 Feb;109(2):62-71. [Cited 1 Aug 2018] Available from: https://www.ncbi.nlm.nih.gov/pubmed/19300009}