What does self-management of continence involve?

Self management of bladder and bowel continence is dependent on the person’s self-efficacy for continence - This means ‘their confidence in their own capabilities to be continent’.

Did you know? People with long-term conditions, including bladder and bowel dysfunction, spend less than two hours each year in direct contact with a healthcare professional. The other 8758 hours they have to self-manage their own symptoms and health.

A person living with bladder and bowel dysfunction, may try lots of different ways to cope with their situation. The effects of these ‘trial and error’ approaches will be variable.

Around two thirds people with incontinence will never seek professional advice[1], but over time, they will develop expertise in their own condition.

Effectively supporting a person to self-manage involves different skills, and a different relationship between the person with the bladder or bowel dysfunction and the healthcare professional.

It is a collaboration, with both sharing the responsibility for the outcomes. So it empowers the person to take control of, and live with, their continence situation.

Key elements

The key elements of supporting self-management are:

  • The person identifies the problem to be addressed - not the professional. This helps the person to ‘own’ their bladder or bowel issue.
  • The person acquires evidence-based knowledge about their situation. This will happen via a healthcare professional or other resource and it will help the person to make informed choices about their treatment.

    People with incontinence often try trial and error approaches, which may not help, and may even be harmful, such as severely restricting their fluid intake.

    Knowing about what works from the evidence, will help them to benefit from treatment approaches that are effective.

  • The person decides what they are going to do to improve their incontinence or bladder/bowel dysfunction, (selects a behaviour to change), with support from their healthcare provider.
  • A plan of action is developed by the person and the healthcare professional, which often includes setting specific goals.
  • The action plan is self-monitored by the person, for indicators of effect and adjustments are made to improve the effect where appropriate.

The figure below shows the parts of a self-management approach to incontinence and was developed by Prof Cara Tannenbaum[2], University of Montreal.

Self-management approach to incontinence

Figure 6.1: Self-management approach to incontinence. Available to download in PDF format.

Clinical practice Point. Healthcare professionals support people with bladder and bowel dysfunction to self-manage their condition by working with the person to identify what matters to them and what they want to change.

Also by helping the person to understand what behaviour changes and treatments would work for them.

They support the person to decide exactly what they want to do and then discuss realistic goals and timings for improvements to occur. They then decide, with the person how they will know they are making improvements.

The professional is a partner to the person with the bladder or bowel problem - they do not tell the person what to do. Instead they use their knowledge and expertise to offer the person choices, options and support for the decisions they make.


References

1. Peters TJ, Horrocks S, Stoddart H, Somerset M. Factors associated with variations in older people’s use of community-based continence services. Health and Social Care in the Community. 2004 Jan;12:1;53-62 [Cited 28 Aug 2018] Available from: https://www.ncbi.nlm.nih.gov/pubmed/14675365

2. Wilde MH, Bliss DZ, Booth J, Cheater FM, Tannenbaum C. Self-Management of Urinary and Fecal Incontinence. American Journal of Nursing. 2014 Jan;114:1;38-45 [Cited 28 Aug 2018] Available from: https://www.ncbi.nlm.nih.gov/pubmed/24335594


Further reading

3. Kelly AM, Jordan F. Empowering patients to self-manage in the context of incontinence. British Journal of Nursing, 2015;24:14 [Cited 28 Aug 2018] Available from: https://doi.org/10.12968/bjon.2015.24.14.726

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Understanding Continence Promotion: Effective Management of Bladder and Bowel Dysfunction in Adults

Association for Continence Advice

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