Fiona Saunders
Retired Head of Continence Advisory Service, Nottinghamshire Healthcare NHS Foundation Trust and member of ACA Executive Committee.
Activity
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Fiona Saunders replied to Marisa Scarano
Hi Marisa, thanks for you comments. If you are a member of the ACA you may be able to get a few upgrade to this course which would enable you to have access to the resources after the course is closed. Just wondered if you were aware of this and if it would help you. More information is on the ACA website www.aca.uk.com
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Fiona Saunders replied to Sam Densem
Hi Claire, thanks for sharing this with us. It is really good to hear that you are reflecting on your practice and looking at treatment options.
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Fiona Saunders made a comment
Welcome to week 7, the final week of this course. Please complete the feedback survey at the end and tell us what you think about the course.
We really don't have all the answers to bladder and bowel problems which are still often hidden. We need to continue to gain confidence to discuss and challenge, we don't want to loose the treatment versus containment...
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Fiona Saunders made a comment
Welcome to week 6, last week we looked at continence assessment, which is essential and fundamental to continence care. This week we are focusing on promotion and self management. We will be exploring and discussing some of the treatment options. Self management strategies can be very helpful with bladder / bowel problems. Please post your comments, Gill and I...
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Fiona Saunders replied to Trish Oreilly
@TrishOreilly
Hi Trish and Annette, please do what is best for you. Use your learning log or portfolio to assist and support you with your learning and reflection. You can use it as evidence for you continuing professional development. If you upgrade Understanding Continence, you will be able to continue to access this course after it has finished, there are... -
Fiona Saunders replied to Trish Oreilly
Hi Trish, this is the reply I have had from FutureLearn:
I have checked the links in week 1 step 1.4 and they all seem to be working fine. They link out to external portfolio tool options and then ask the learners to sign up or log in. Trish's browser may blocking her from accessing the websites. I do not believe this is anything to do with the FutureLearn... -
Fiona Saunders replied to Trish Oreilly
@TrishOreilly Hi Trish, I have emailed FutureLearn to ask them to look at the links as they advised these portfolios. I hope they will reply soon.
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Fiona Saunders made a comment
Welcome to week 5 were we are going to focus on assessment. Assessment is essential and is the foundation of all continence care.
We need to complete a thorough assessment to identify the underlying cause or causes and then to make a diagnosis, an accurate diagnosis is the key to a successful outcome.
I hope you will enjoy this week and further your...
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I agree with Josca, overactive bladder, especially OAB wet has a massive impact on quality of life and self esteem, it prevents people from wanting to go out as they are terrified they may wet themselves in front of other people.
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Hi Kyoko, with OAB wet the size of the wet patch depends on how full the bladder is that the time of the unstable bladder contraction and how strong the contraction is, so it could be a lot, a bladder full, 400mls. For many people it will be less, as often their bladder's can small volumes, perhaps only 100mls. OAB wet is a very debilitating condition is the...
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Fiona Saunders replied to Trish Oreilly
Hi Trish, sorry to hear you have had problems logging into you portfolio, which portfolio have you been using?
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Fiona Saunders replied to Joe Goodwin
Hi Joe, there is a lot of information, especially in week 3, if you upgrade the course you will be able to continue to have access to this course run after it has had ended
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I agree with you, a clear routine for toileting is will help to prevent problems.
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I don't think Lasix would have helped Jean as she was in retention and the nerve supplying her bladder were not working effectively.
Helping hydrated is definitely very important, often the one of the first things people do when they have a bladder problem is to reduce fluids which is likely to make their problem worse and increase the risk is a UTI as you... -
Fiona Saunders made a comment
If you are enjoying this course you may be interested in joining our E-conference on 24th and 25th May, please see the website for details www.aca.uk.com.
Please take a look at the programme. -
Fiona Saunders made a comment
Welcome to week 4. We would really like to have some feedback from you all, we have added a poll at the beginning of this week, please tell us how the course is for you.
This week the focus is on how our bowels function and what can go wrong. Bowel problems are rarely the subject of general conversation but they are more common than most people imagine. I...
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Fiona Saunders made a comment
Welcome to week 3, last week we focused on who the bladder works and now we will start looking at what happens when things go wrong and how this can affects individuals. As you will see there are many different causes of bladder dysfunction. I hope you enjoy this week. Please keep posting your comments and thoughts and share your learning.
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Fiona Saunders replied to Sam Densem
Hi Sam, I hope you are able to consider making some changes. Perhaps some of you colleagues may be able to join this course also.
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Hi Kyoko, stress incontinence and overactive bladder are different types of incontinence but individuals can and often do suffer from both these problems at the same time.
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Fiona Saunders made a comment
It has been good to meet you in week 1 and I am sure you will enjoy week 2. I find anatomy and physiology fascinating, it is so interesting seeing how systems develop and work. Understanding "the normal" is important, when we are trying to understand and explain symptoms and problems individuals experience, as we will do in later weeks. I am looking forward to...
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Fiona Saunders replied to Sarah Murphy
Hi Sarah, great to have you join this course. We have a new run of this course which actually started on the 12th April, the new run will have new learners just starting, just wanted to let you know in case you would like to move across to the new run.
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Fiona Saunders replied to Mcini Dhlodhlo
Hi Micini, we have a new run of this course which actually started on the 12th April, the new run will have new learners just starting, just wanted to let you know in case you would like to move across to the new run.
Really great to have students joining and look forward to following you through the course. -
Fiona Saunders made a comment
Hello everyone and welcome to "Understanding Continence Promotion" course and thank you for joining. Gill and I am looking forward to the comments and discussions over the next 7 weeks. I am sure we will have an interesting mix of people with a wide range of experiences of continence issues, from both a personnel and professional perspective joining, and I...
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Fiona Saunders replied to Jodi Simpson
Thank you for discussing this, we have an ACA Executive meeting next week and I hope we will have an opportunity to discuss this, other areas are having the same challenge with the present situation. Vaginal examination is key when assessing the pelvic floor power and teaching pelvic floor exercises. I found that feeling my own pelvic floor muscles helped me...
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Fiona Saunders replied to Adrienne Cox
Hi Adrienne, thank you for sharing this us, it is great to here how you knowledge and understanding is developing. The role of the nervous system in bladder and bowel control is complex but like you say an understanding of this can really help when trying to work out what has gone wrong.
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Fiona Saunders replied to Emily Matthews
Hi Emily, thank you for sharing what you have learnt, like you I find the dementia detail fascinating and this knowledge is very valuable when completing assessments.
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Fiona Saunders made a comment
Welcome to week 7, the final week of this course. Please complete the feedback survey at the end and tell us what you think about the course.
We really don't have all the answers to bladder and bowel problems which are still often hidden. We need to continue to gain confidence to discuss and challenge, we don't want to loose the treatment versus containment... -
Fiona Saunders made a comment
Welcome to week 6, last week we looked at continence assessment, which is essential and fundamental to continence care. This week we are focusing on promotion and self management. We will be exploring and discussing some of the treatment options. Self management strategies can be very helpful with bladder / bowel problems. Please post your comments, Gill and I...
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Fiona Saunders replied to Jodi Simpson
Thank you for sharing this with us Jodi, I am sure you will gain confidence with making diagnosis and the skills you develop with vaginal examination will help with this.
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Fiona Saunders made a comment
Welcome to week 5 were we are going to focus on assessment.
Assessment is essential and is the foundation of all continence care.
We need to complete a thorough assessment to get the right diagnosis and identify what we can do to help the person recover bladder/bowel function.
I hope you will enjoy this week and further your learning. We am looking forward... -
Fiona Saunders made a comment
Welcome to week 4. We would really like to have some feedback from you all, we have added a poll at the beginning of this week, please tell us how the course is for you.
This week the focus is on how our bowels function and what can go wrong. Bowel problems are rarely the subject of general conversation but they are more common than most people imagine. I... -
Hi Jodi, yes these symptoms are variable, individuals can experience overactive bladder at different levels of bladder filling, only 50mls or volumes of 250mls, if only small volumes the stream is likely to be poor. When individuals are experience "sudden urgency" and are "desperate" to void but can only pass a small amount, they often get the feeing that...
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Fiona Saunders replied to Gill Kaylor
@GillDavey Thank you Gill and Gill, it is now updated.
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Fiona Saunders made a comment
Welcome to week 3, last week we focused on who the bladder works and now we will start looking at what happens when things go wrong and how this can affects individuals. As you will see there are many different causes of bladder dysfunction. I hope you enjoy this week. Please keep posting your comments and thoughts and share your learning.
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Fiona Saunders made a comment
It has been great to meet you in week 1 and to read your comments, please keep posting them. I am sure you will enjoy week 2. I find anatomy and physiology fascinating, it is so interesting seeing how systems develop and work. Understanding "the normal" is important, when we are trying to understand and explain symptoms and problems individuals experience, as...
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Fiona Saunders replied to Nor Mastura
Hi Nor, thank you for sharing this, it is great to hear that by understanding more about how the bladder and bowel functions you feel more confident as a continence nurse.
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Fiona Saunders made a comment
Hello everyone and welcome to "Understanding Continence Promotion" course and thank you for joining. Gill and I am looking forward to the comments and discussions over the next 7 weeks. I am sure we will have an interesting mix of people with a wide range of experiences of continence issues, from both a personnel and professional perspective joining, and I...
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Fiona Saunders replied to Bridget Hansberry
Hi Bridget, thank you for your feedback, I am pleased you have gained from doing this course. Are you aware that all members of the ACA can apply for a free upgrade which will give you on going unlimited access to the course, more details are on the home page of the Association of Continence Advise.
Also can you help us? any ideas as to how we can advertise... -
Thank you Alison for sharing your thoughts, I also feel that parents should take responsibility for potty training.
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Hi Beate, thanks for telling us that the link in longer works, I hope this link will give you access: https://member.wocn.org/link.asp?ymlink=506943352
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Hi Cristina, I have contacted a colleague in the ACA and she had suggested that the following information my help you:
(athttps://www.ibdpassport.com/travelling-ibd/ibd-and-travel) that might help??Can't wait card for bathroom emergencies
The European federation of Crohn’s and Colitis organisation (EFFCA)4 association website contains useful...
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Fiona Saunders replied to Cristina Gias
Hi Cristina, that is a really interesting question, I have just had a search on Google and the articles I have read are suggesting that if we squat at 35 degrees, this will create the best the anorectal angle (natural bend in the colon where it meets the rectum) to enable relaxation of the muscles and faeces to pass through with ease.
This angle is more... -
Hi Nor, I am pleased you are learning from this course, thank you for sharing this
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Fiona Saunders replied to Keryn Avemarg
Hi Keryn, men can do pelvic floor exercises, this is discussed in the week we look at treatments.
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Hi Cristina, the website Emily refers to is:
https://www.bladderandbowel.org/help-information/just-cant-wait-card/. I hope this helps. -
Fiona Saunders replied to Neda Aghakhani
Hi Neda, medications to help with bladder and bowel problems are discussed in week 6, I am not sure if you have reached that part of the course yet. Within the medication section there is a chart which I hope will provide the information you are looking for.
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Hi Michelle, thank you adding this link, the article was easy to read and informative. I learnt several things from reading it, I was not aware how high the incidence of a stroke was with autonomic dysreflexia.
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Fiona Saunders replied to Fiona Fraser
Hi Fiona, thank you for sharing the above, it is great to hear the news about one of your patient's.
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The ACA is presently having discussions about moving the Conference on-line in view of the present situation with Covid. Please visit the website the keep up to date with this.
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Fiona Saunders replied to Michelle LM
Thank you for your feedback Michelle, I am pleased you found the information useful and relevant.
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Fiona Saunders made a comment
Welcome to week 7, the final week of this course. Please complete the feedback survey at the end and tell us what you think about the course.
We really don't have all the answers to bladder and bowel problems which are still often hidden. We need to continue to gain confidence to discuss and challenge, we don't want to loose the treatment versus containment... -
Fiona Saunders replied to Charlotte Davies
Hi Charlotte, prevalence figures suggests that underactive bladder affects up to 45% of women (depending on the definitions) and the prevalence increases with age, increasing from the age of 70. The incidence men is lower.
Underactive bladder is a common condition but is poorly understood and not well researched. I have attached a reference, i hope the link... -
Hi Tracy, many people are troubled by bladder problems at night. Getting up several times at night needing to pass urine can affect the quality of sleep and cause tiredness in the daytime. Studies have shown that bed wetting in children causes sleep disturbances and can affect concentration in the daytime.
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Fiona Saunders made a comment
Welcome to week 6, last week we looked at continence assessment, which is essential and fundamental to continence care. This week we are focusing on promotion and self management. We will be exploring and discussing some of the treatment options. Self management strategies can be very helpful with bladder / bowel problems. Please post your comments, Gill and I...
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Fiona Saunders made a comment
Hi Charlotte,
A loop diuretic such a furosemide may be prescribed in the daytime (often about 4pm) to help with nocturnal Polyuria – overproduction of urine at night. These work by increasing urine output during the day in order that your body doesn’t produce so much urine at night. I have seen this treatment work very effectively, it can significantly... -
Fiona Saunders made a comment
Hi Katie, thank you for your feedback and for the comments you have shared. I hope look forward to meeting some of you colleagues on the course.
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Fiona Saunders made a comment
Welcome to week 5 were we are going to focus on assessment.
Assessment is essential and is the foundation of all continence care.
We need to complete a thorough assessment to get the right diagnosis and identify what we can do to help the person recover bladder/bowel function.
I hope you will enjoy this week and further your learning. I am looking forward... -
Fiona Saunders replied to Eve Shearer
Hello Eve, thank you for sharing the above, you will find that week 2 and 3 week focus more on bladder problems and causes and in week 4 we are looking at bowel problems and causes.
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Fiona Saunders replied to sheila murray
Hi Sheila, great to hear from you. Hope you have got back into the course.
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Fiona Saunders replied to Clare Smart
Hi Claire, I have had a reply from FutureLearn, they suggest that you try to access week 4 by navigating to the 'To Do' section and click on week 4?
If you are still having problems please post another message and they will investigate further. -
Fiona Saunders replied to Clare Smart
Hi Claire, I am sorry to hear you have not had access to week 4 of the course, I am not sure why. Thanks for your message. I have sent an e mail to FutureLearn requesting them to investigate why. Hopefully this situation can re resolved very soon. Please post another message if you still have problems.
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Fiona Saunders made a comment
Welcome to week 4. We would really like to have some feedback from you all, we have added a poll at the beginning of this week, please give us feedback about how the course is for you.
This week the focus is on how a person's bowels functions and what can go wrong. Bowel problems are rarely the subject of general conversation but they are more common than... -
Fiona Saunders made a comment
Welcome to week 3, last week we focused on who the bladder works and now we will start looking at what happens when things go wrong and how this can affects individuals. As you will see there are many different causes of bladder dysfunction. I hope you enjoy this week. Please keep posting your comments, thoughts and ideas.
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Fiona Saunders made a comment
It has been great to meet you in week 1 and to read your comments, please keep posting them. I am sure you will enjoy week 2. I find anatomy and physiology fascinating, it is so interesting seeing how systems develop and work. Understanding "the normal" is important, when we are trying to understand and explain symptoms and problems individuals experience, as...
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Fiona Saunders made a comment
Hello everyone and welcome to "Understanding Continence Promotion" course and thank you for joining and I am looking forward to following your comments over the next 7 weeks. I am sure we will have an interesting mix of people with a wide range of experiences of continence issues, from both a personnel and professional perspective joining, and I hope we can...
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Fiona Saunders replied to Yvonne Gall
@YvonneGall Thank you Gall
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The urine passed first thing in the morning is a darker yellow colour (concentrated), compared to urine produced in the daytime, which a pale yellow/straw colour ( dilute). This happens because antiduretic hormone is released at night time acts on the kidneys to reduce the production of urine during sleep.
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From my experience, many older people can learn and cope very well doing intermittent catheterisation. The "teaching" of intermittent catheterisation is key, a discussion about the advantages and disadvantages of intermittent catheterisation and step by step guidance and support to learn the procedure by motivated and knowledgable teacher are important.
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Fiona Saunders replied to Yvonne Gall
Dear Yvonne, thank you for your feedback. We would love to use it to promote the course on the FutureLearn website and in our newsletter. May we have your permission to do this?’
If you are in agreement, please can I ask you how you would prefer to have your comment attributed to you, using your profile name, YG, or anonymised, eg Anonymous or A previous... -
Fiona Saunders replied to Wendy M
@WendyM Hi Wendy, thank you for your reply and for your support to promote this course. Please can I ask you how you would prefer to have your comment attributed to you, using your profile name, WendyM, or anonymised, eg Anonymous or A previous learner on this course.
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Fiona Saunders replied to Wendy M
Hi Wendy, thank you for your feedback. We would love to use it to promote the course on the FutureLearn website and in our newsletter. May we have your permission to do this?’
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Hi Winifred, thank you all the comments you have posted throughout this course and I am pleased you enjoyed it. I have been trying to follow up with Future Learn about your mark of 98%, I presume you were expecting 100%. I have been asked to check with you that you marked all steps as completed?
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Fiona Saunders replied to nicola Salisbury
Hi Nicola, thanks for your comment on our course. We would love to use it to promote the course on the FutureLearn website and in our newsletter. May we have your permission to do this?’
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Fiona Saunders replied to Lynne Hemming
Hi Lynne, thanks for your comment on our course. We would love to use it to promote the course on the FutureLearn website and in our newsletter. May we have your permission to do this?’
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Fiona Saunders made a comment
Thank you also, from me, for joining this course, it has been inspiring following and sharing your comments, conversations and hearing about what you have learnt and reflected on. Please share information about this course with friends and colleagues.
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Fiona Saunders made a comment
Are aware that it is "World Continence Week" this week?
I have just been forwarded a link and I thought you might find the activities interesting: https://sneakpeekwcw20.org/
Each day covers a different set of subjects around continence to mark world continence week. You can access the days that have already gone Mon-Thursday as well a preview what is till... -
Agree with you, many people I have taught have amazed me. For ladies identifying and visualising the urethra can often be one of the biggest challenges.
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Firstly I would suggested discussing it with the women's health physiotherapists with your area, they may be able to offer you training or signpost you to some one who can. There are also several course available in the UK, the Pelvic, Obstetric and Gynaecological Physiotherapyhttps://pogp.csp.org.uk/ or Bladder & Bowel UK...
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Fiona Saunders made a comment
If you are a healthcare professional and you are teaching someone how to do pelvic floor exercises, best practice is to do physical examination, which we discuss in 5.9.
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Fiona Saunders replied to ushagowri mavuri
From my clinical practice bladder retraining, was a very effective treatment. I think it is important to take time to explain how the treatment works, using the individuals bladder diary information, and discuss with them the different distraction techniques. It can be very empowering and progress can be seen by repeating bladder diaries.
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Fiona Saunders replied to ushagowri mavuri
My understanding, from a physiological view is that when you contract your pelvic floor muscles, the bladder muscle relaxes, therefore pelvic floor exercises you help reduce bladder spasm. I also agree with you, by "focusing" on doing pelvic floor exercises it can be a diversion technique.
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Fiona Saunders made a comment
Welcome to week 7, the final week of this course. There is a lot to think about and comment on in this week. We really don't have all the answers to bladder and bowel problems which are still often hidden. We need to continue to gain confidence to discuss and challenge, we don't want to loose the treatment versus containment battle.
There is still a lot of... -
Fiona Saunders made a comment
Welcome to week 6, last week we looked at continence assessment, which is essential and fundamental to continence care. This week we are focusing on promotion and self management. We will be exploring and discussing some of the treatment options. Self management strategies can be very helpful with bladder / bowel problems. Please post your comments, Gill and I...
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Fiona Saunders replied to Hannah McKee
With normal bladder control you would not expect any "urgency", if you keep holding you can get an urgent need to go but this is different to actual "urgency", which comes very suddenly and is difficult to control.
From the chart Jane was experiencing urgency with each void, she scored 2 or 3. It is good idea to discuss the urgency score and what urgency... -
Fiona Saunders replied to Alison Illing
Yes. The squatting position is best position for everyone. It is very difficult to defeacate effectively if feet are not well supported and knees are not above hips, this is the same for children and adults.
Individuals whose feet do not touch the floor will greatly benefit for using a stool, box, tin etc. -
Fiona Saunders replied to Alison Illing
https://www.medicalnewstoday.com/articles/325863 This article has research relating to this.
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Fiona Saunders replied to Yasmin Murray
Yes, individuals with reflex incontinence generally do not feel an urge or sensation to urinate which can result in the sudden loss of large amounts of urine.
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Urodymanic investigations are studies to assess the performance of the bladder and urethra when it is stores urine and releasing/voiding urine. They comprise of uroflowmetry , cystometry/ video-cystometry and urethral pressure profile.
Uroflowmetry - measures the rate urine is voided, peak flow rate should be at least 15ml/s for a volume of at least... -
Neurogenic bladder is the name given to urinary bladder problems caused by disease or injury of the central nervous system (the brain and the spinal cord) or peripheral nerves involved in the control of urination.
Nerve damage could cause the bladder to become overactive, as seen with strokes or Parkinson's Disease.
Nerve damage could cause the bladder to... -
Thank you for sharing this with us.
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Fiona Saunders made a comment
Welcome to week 5 were we are going to focus on assessment. Assessment is essential and is the foundation of all continence care. We need to complete a thorough assessment to get the right diagnosis and identify what we can do to help the person recover bladder/bowel function. I hope you will enjoy this week and further your learning. I am looking forward to...
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Fiona Saunders made a comment
Welcome to week 3, last week we focused on who the bladder works and now we will start looking at what happens when things go wrong and how this can affects individuals. As you will see there are many different causes of bladder dysfunction. I hope you enjoy this week and please keep posting your comments.
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Thank you for sharing this reference, it is very interesting to read
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Fiona Saunders replied to Ghazal Kharaji
@GhazalKharaji To get a free upgrade you need to be a member of the ACA. If you are not already a member and you are interested the website address is : https://www.aca.uk.com/
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Fiona Saunders replied to Ghazal Kharaji
@YasminMurray To get a free upgrade you need to be a member of the ACA. If you are not already a member and you are interested the website address is : https://www.aca.uk.com/
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Fiona Saunders replied to Hannah McKee
The key symptoms of an overactive bladder are: urgency and frequency and the urgency can happen with low bladder volumes, the volume could be as small as only 20 mls.
Individuals with normal capacity bladder (300-400 mls), who drink large volumes (well over 2 litres) will need to void more than 8 times and may need to go quickly but this would not be an... -
Fiona Saunders replied to Ghazal Kharaji
Hi Ghazal, at the end of the course you will have the opportunity to upgrade, this will give you on going free access to the course.
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Fiona Saunders made a comment
Welcome to week 3, last week we focused on who the bladder works and now we will start looking at what happens when things go wrong and how this can affects individuals. As you will see there are many different causes of bladder dysfunction. I hope you enjoy this week. Please keep posting your comments, thoughts and ideas.
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Hi Mary, the anatomy and physiology is complex, especially if this is something you have not studied before, please remember at anytime you can go back and look at this information again. The key message from this section is that the bladder fills and empties in cycles which is controlled by the nervous system. I hope this helps you and that you are enjoying...
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Fiona Saunders made a comment
Thanks for your discussion, medical terminology can be confusing.
The pelvic floor has 2 hiatus (openings), the urogenital hiatus and the rectal hiatus.
The term "urogenital" relates to both the urinary and genital organs.
In anatomy the urogenital hiatus is the structure through which the urethra and vagina pass in females and the urethra pass in...
