Separating continence promotion from managing incontinence

Professor Jo Booth has developed the model below which separates interventions and activities that promote continence (treatment) from those which manage incontinence (containment).

^{Figure 1.1: Separating treatment from containment.}

^{Key: SNS = sacral nerve stimulation; TTNS = transcutaneous tibial nerve stimulation; IUC = indwelling urethral catheter; SPC = supra-pubic catheter}

Each of the segments in the figure broadly reflect the proportion of each type of treatment or containment intervention commonly found; so for example in the continence promotion model (on the left) the majority of effort is put into supporting the person to make lifestyle changes or use behavioural interventions such as teaching them pelvic floor muscle exercises, supporting dietary changes, or bladder training.

These types of ‘first-line’ activities are offered to all people who seek help for a bladder or bowel dysfunction because they support general bladder and bowel health and there is good evidence that they are effective treatments.

Fewer people will require, or benefit from, the interventions higher up the triangle, which represent second and third line interventions.

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Your task

Reflect on what types of continence interventions you spend most time doing.

Do you most commonly promote continence or manage incontinence?

When you think about your own practice, do you think the balance is right? Should you try to change your practice? Make notes about any changes you feel would benefit your patients. You can revisit these notes when you have completed the course to decide if, and how you will make changes to your practice.

Don’t forget to capture your thinking in your learning log or portfolio.