1. Current practice of continence advisors in the UK:
results from an online survey
CA Leo¹ ², Y Maeda¹, B Collins¹, J Hodgkinson¹ ², J Murphy², CJ Vaizey¹
1. Sir Alan Parks Physiology Unit, St Mark’s Hospital, Harrow, Middlesex, United Kingdom
2. Academic Surgical Unit, St. Mary’s Hospital, Imperial College London, United Kingdom
Introduction
Faecal incontinence is a common symptom, that occurs predominantly in the elderly population. Between 1 and 18% of people have reported experiencing this condition (1,2)
Specialist teams provide support and medical advice for patients with bowel or bladder incontinence
There are over 400 continence advisors in UK
Aims
To investigate the current practice and the services offered by continence advisors in the UK
Methods
An online survey was constructed as a platform to deliver the questionnaire
All UK-based continence advisors were contacted by , phone calls and letters to be invited to participate in the study
A voucher of £50 was used as an incentive to participate
Results (continued)
159 (*87.3%) continence advisors recommend Coloplast® Anal Plug and 78 (*47.%) recommend Renew™ Anal Insert (Figure 1 & 3)
167 (*75.5%) perform a digital rectal examination, 159 (*94%) feel confident to do this; 131 (*61.2%) can diagnose rectal prolapse and of these, 114 (*80.8%) feel confident making this diagnosis (Figure 2)
207 (*93%) instruct patients to perform pelvic floor / anal sphincter exercises
188 (*84%) teach urge resistance techniques
29 (*19%) prescribe Shreddies© pants (Figure 4)
Up to 70% offer patients dietary advice
125 (*57%) felt that they have not been adequately trained to provide a bowel continence service.
* expressed as percentage of responders to each question
Conclusion
Majority of the continence advisors in the UK treat both urinary and faecal incontinence
They provide comprehensive management of faecal incontinence
43% of the continence advisors feel that they require further training and greater support is necessary
References
Perry S et al. Leicester MRC Incontinence Study Team. Prevalence of faecal incontinence in adults aged 40 years or more living in the community. Gut. 2002 Apr;50(4):480-4.
Madoff RD et al. Faecal incontinece in adults. Lancet Aug 14-20;364(9434):
Association for Continence Advice: driving excellence in bladder and bowel care. Accessed in October 2015 and in August 2016.
Figure 1: continence advisors prescribe Coloplast© and Renew™ Anal Insert 2B
Figure 2: do continence advisors feel confident to do a digital rectal examination or diagnose a rectal prolapse?
Results
448 UK-based continence advisors were contacted and invited to complete the questionnaire; 228 (50.8%) advisors responded
150 (76.9%) advisors reported treat both faecal and urinary incontinence
Figure 3: Renew™ Anal Insert
Figure 4: Shreddies© panties are prescribed by 10% of the continence advisors interviewed
The Pouch Disease Activty Index {Sandborn W.J., 1994}
A total score of <7 = remission
A total score of >7 = active disease