Hi-R-Ed Online

Patient/Caregiver Strategies and Tips

There are a number of tips and strategies to pass on that may help in your interactions with your patients who may be suffering from incontinence.

Preparing for health care appointments

Answering questions about incontinence

Asking questions about incontinence

Planning for assessment and path for treatment options

To get the most value and success from health care team interactions, it is helpful to prepare for appointments related to fecal incontinence. Patients can be advised to keep a record of symptoms and potential triggers for incontinence, key personal information that may include major life stressors, all medications, vitamin/mineral and other supplements, and a list of questions to ask. It is helpful to bring a friend or family member to help in remembering information received during an appointment. Asking for a printed or emailed copy of information provided during the appointment can also be helpful.

Patients should also be prepared to answer some questions from the health care team member to evaluate fecal incontinence for treatment. These may include questions about when symptoms first started, whether they are intermittent or continuous, severity, what improves and worsens symptoms, if there are other conditions, such as diarrhea, diabetes, multiple sclerosis, chronic constipation, ulcerative colitis or Crohn’s disease, radiation therapy to the pelvic area, urinary incontinence, and others. The patient may be asked about whether they avoid any activities, have any limitations, or are experiencing depression and social isolation.

Some questions to ask the health care team members may including the following:

What are likely causes for my symptoms?

Is my condition likely temporary or chronic?

What tests do I need?

What approach to treatment do you suggest and are there alternatives?

Are there any restrictions I should be following?

If any other health conditions: Will treatment cause any problems with my care for the other conditions?

Should I see a specialist?

What resources can you provide, such as printed materials, websites you recommend, and other patient and caregiver support resources?

Communication Strategies and Tips

Patients may be hesitant to bring up issues related to incontinence, and incontinence may be inadequately screened by health care professionals. For female patients it may be typical to wait from the time of first experiencing symptoms to getting a diagnosis for six years! It is important for clinicians to bring up the issue of incontinence with patients, especially because many may think that incontinence is just a normal part of aging. Patients may not bring up the topic even though it is already interrupting their lives through avoiding some activities, limiting their social interactions, and maybe even losing sleep.

Initiating the discussion

Matter-of-fact approach: treatment and management options exist

Communicate with respect and preserve dignity

Screening

Coping with urinary and fecal incontinence can be difficult for patients. When communicating with patients and caregivers, they should be reminded that:

Incontinence isn’t necessarily a part of normal aging

It can often be treated and there are a wide range of successful treatments and management strategies available

It generally doesn’t just go away on its own and most people will need treatment

It isn’t something to be ashamed of because it is simply a medical problem

How a clinician enquires about incontinence may lead to differing responses. For instance, asking if the patient has had daily accidents may miss the problem completely. Asking whether the patient has ever had leakage or had leakage at any time in the last month or may help to identify the problem, as leakage at any time should be considered abnormal. If a patient notes that they have diarrhea, a clinician may be able to determine incontinence through a follow-up question about whether the diarrhea is overwhelming--and if the patient does not make it to the toilet in time.

It may be easier to identify incontinence problems in institutional settings with routine nursing and medical assistant care. Nurses and medical assistants can screen for incontinences, pharmacists can help to reconcile medications, and primary care and specialists can be included to provide the necessary care.

Finding ways preserve dignity while communicating with patients about incontinence can be tricky. Consider patient background, their perception about incontinence, and how they might prefer to engage in a discussion about incontinence. Suggestions for health care providers and caregivers include respecting the need for privacy, not scolding or otherwise making the patient feel guilty, and being matter-of-fact in discussions to help patients see incontinence as a medical condition and not as a reason to feel ashamed. Patients should be made aware that they do not need to simply accept the condition, but that there are management and treatment options and that some causes may be fully reversible.

Once a patient becomes open for discussion of the condition, a screening tool can be implemented to start the assessment process.