Depending on the area of the tumour, continence awareness or normal toileting habits can be affected in many ways. If you or the person you are caring for is taking dexamethasone, this medication can increase urination frequency as it can increase blood sugar levels.
Continence depends on:
• Awareness of the need to pass urine/bowels
• Mobility – to be able to get to the toilet
• Being able to ask to go to the toilet, if help is needed
• Being able to remove clothing or appliances if needed
• Being able to adjust clothing or change a pad after toileting
Differences with age
• Younger people have a larger bladder and may need a pad that can absorb more urine.
• Older people might have other medical problems that will affect their bladder volume, how often they need to go, and the need to urinate at night.
• Older men may have a larger prostate, which can cause trouble emptying the bladder
Management of Incontinence
A couple of definitions:
Urinary urgency: this is the need to pass urine suddenly
Urinary frequency: this is the need to pass urine often
Urinary retention: this is when someone needs to pass urine, but is not able to do so
One of the first things a continence nurse will ask you to keep is an ‘intake and output’ chart. This is a record of the person’s fluid intake, the time they are toileted, the amount passed in the toilet (if possible), incontinent episodes, and if their bowels were open.
The following information helps a continence nurse understand where the problem lies and plan a programme:
• A record of fluid intake helps to find out if they are drinking enough. Drinking caffeine products and not drinking enough fluid increases the risk of urinary frequency and urgency, as well as constipation.
• Times they are toileted and the amount passed will help plan a timed toileting regime, and understand what capacity a pad would need to contain.
• Constipation will cause more urinary urgency and the need to pass urine. Constipation can cause urinary retention in men.
• Use clothing that is easy to remove, elastic waistbands, dark pattern or colour to cover up leakage.
• If the person you care for has difficulty moving, arrange furniture to allow free access to the doorway. Protect seating with chair pads and make sure chairs are at a height to make it easier to go from sitting to standing.
Discuss bedroom and toilet changes with an occupational therapist to make it easier for the person you care for to get to the toilet independently. Aids such as grab rails can help getting on/off the toilet, a night light can help people to see where the toilet is. Other aids include a raised toilet seat or a bed side commode at night time. It can also be helpful to move them to a bedroom closer to the toilet, and use pads that can be easy to remove.
Appliances for incontinence
A number of products are available to help with continence problems
Pads
A continence nurse can help guide you on the need for continence pads, and which type is the best to use depending on the needs of the person you care for.
Options include:
- One-piece pull-up pads
- Two-piece systems
- Adult nappy/diaper pads with a high capacity
- Male pads
- ‘Booster’ pads to increase capacity
- Odour absorbing pads
- Washable pads which are not suitable for high volume
Bed and chair protection
- Washable non-slip chair pads.
- Washable bed pads. The person lies directly on top of the sheet, with or without a pad to cope with breakthrough incontinence if they are a large night time wetter.
- Waterproof mattress protectors in various sizes.
- Waterproof Macintosh sheets to use under a washable bed sheet.
- Waterproof doona covers, pillows and doonas.
Penile sheaths or a condom drainage system
Penile sheaths fit over the male penis like a condom. Men must be measured for an accurate size sheath. There are a number of different systems and sizes available and they should be properly fitted. Sheaths are attached to non-sterile leg bags during the day and night bags at night. These bags can be washed and reused for up to one month.
Catheters and catheter drainage bags
Catheters are hollow tubes that are used to drain the urine from the bladder.
There are two types of catheters:
- Intermittent catheters that are put in two to six times a day.
- Indwelling catheters, which stay in permanently. Different catheters may need to be changed with different frequency
Drainage bags for legs
Leg bags are available as either sterile or non-sterile bags, depending on whether they are used with catheters or condom drainage systems. They are available in different sizes and some come with a drainage tube for people in a wheelchair.
Drainage bags for night time
Night drainage bags which hold a greater volume are also available.
Funding schemes
The Federal scheme is called Continence Aids Payment Scheme (CAPS). To be eligible the person must either be on a pension or have a documented neurological condition including brain tumours. This scheme allows for $520 per financial year with the money being put into the person’s bank account for them to purchase their own products. A person must be assessed by a doctor, nurse, physiotherapist or occupational therapist to access the scheme. Phone 1800 239 309.
Department of Veterans’ Affairs (DVA) scheme for Gold card and some white card holders. The person must be assessed by either a Doctor or Continence Nurse every two years. Products are listed by the government and include pads, bed and chair protection, condom drainage systems, catheters, drainage bags and skin care products.
The Continence Aids Payment Scheme (CAPS) provides a payment to help with some of the costs of your continence products.. There are also a range of state based schemes available for funding support:
Queensland: Medical Aids Subsidy Scheme (MASS)
New South Wales: EnableNSW
Victoria: State-wide equipment program (SWEP)
Western Australia: Continence Management and Support Scheme (CMASS)
Northern Territory: Disability Gateway: General equipment schemes and services (click the “NT” link of the map)
Tasmania: TasEquip – NDIS fact sheet
ACT: ACT Equipment Scheme
For further information, contact the Continence Foundation of Australia.
Continence Foundation of Australia
Level 1, 30-32 Sydney Road
BRUNSWICK VIC 3056
National Continence Helpline 1800 33 00 66
www.continence.org.au
This service offers continence information in 20 languages. Fact sheets and videos to watch on line are also available.