Skip to 0 minutes and 2 secondsIn my current role, which I've been doing for nearly three years I support other health care professionals and advise them. I also deliver a lot of training and the message about bowels that I always try and get across is that it's really important to sit on the toilet at regular intervals, after breakfast, after other meals if after breakfast doesn't work and try and get into the routine of doing this, because it works.
Skip to 0 minutes and 37 secondsThe other important thing is to make sure the person is sitting in a good position to have their bowels open, so knees higher than hips, leaning forward, feet flat on a stool or a cushion or something so that the body is in the most natural position to have the bowels open and the bowel will empty as opposed to emptying a bit and then having some leakage later on in the day. So those two things are so important. Establishing a bowel routine and making sure the person is in the right position.
Skip to 1 minute and 8 secondsIf somebody is needing support to get to the toilet then that is always going to be a problem, especially if the person that is helping them doesn't get them at the toilet at the right time. You don't want to be faecally incontinent sitting with faeces in a continence pad, it's very uncomfortable and it's very bad for the skin. The best treatment always is to start trying to get someone into a routine.
Skip to 1 minute and 34 secondsThere are lots of other ways to treat it, but if you can get somebody into a routine where they're going to the toilet soon after meals, when they're most likely to have their bowels open it can make a huge difference to that and help to perhaps not completely cure them but it can certainly help to improve their symptoms.
Toileting Assistance Programmes (TAPs)
Toileting assistance programmes (TAPs) are provided by carers, to help the person to avoid or reduce episodes of incontinence.
In this video, clinician Kate Boyce describes how she supports other health care professionals in thinking about establishing bowel routines and sitting people in the correct posture on the toilet to have their bowels open.
Toileting Assistance Programmes include:
Prompted voiding - the person is verbally prompted to use the toilet by carers, and positive reinforcement is provided by praising them when they successfully use the toilet, or are ‘dry’ when a pad check is done. Prompted voiding is a useful TAP for people who have dementia or other forms of cognitive impairment.
Habit training - the person’s usual pattern of voiding is recorded using a 3 to 7 day bladder and/or bowel diary. This allows the timing of their likely need to void, or empty their bowel, to be predicted. In the half hour before their usual ‘time’ to void or defaecate the person is offered the use of the toilet, and in this way episodes of incontinence are avoided.
Scheduled voiding - a regular schedule of taking the person to the toilet is followed, such as 2-hourly toileting, so that the person has the opportunity to void before their bladder is full. Another example is sitting the person on the toilet immediately after breakfast to stimulate the gastro-colic reflex to encourage bowel emptying. Sitting on a toilet seat acts as a stimulus to empty both their bladder and their bowel and can be a very useful approach to maintaining continence in people who have dementia.
TAPs are different from the behavioural techniques of pelvic floor muscle exercises or bladder training, because they do not aim to change function eg by strengthening the pelvic floor muscles (pelvic floor muscle exercises) or increasing bladder capacity and reducing frequency of voiding (bladder training). But TAPs are still a type of continence promotion, although the person with incontinence needs the carer to lead it.
TAPs are focused on helping the person to use the toilet before they have an incontinence episode. TAPs rely on the carer being able to accurately predict and preempt any bladder leakage.
Consider where TAPS should be placed in the continence paradigm. Share your thoughts on why with fellow learners.
Thinking about the three types of TAPs outlined above, what type do you commonly use in your practice and why? Add your views to the discussion.
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