UK’s NICE releases guideline to support people with incontinence who have neurological conditions

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On 8 August, UK’s National Institute of Health and Clinical Excellence (NICE) released a guideline to encourage detailed assessments to people who have neurological conditions like stroke, multiple sclerosis and head and spinal cord injuries, and who experience incontinence or other urinary problems. 

 

The guidance hopes to minimise the distressing effects that lower urinary tract dysfunction can have on people with neurological conditions and their families, and promote active participation in their care.

This new clinical guideline advises healthcare professionals across England and Wales to undertake thorough assessments of their patients who have a neurological condition and experience incontinence. This should include obtaining information about their urinary tract and neurological symptoms, other health problems (e.g. bowel or sexual problems), and their use of medications and therapies.

Also, healthcare professionals should assess factors such as mobility, hand function, cognitive function, social support and lifestyle in order to inform how their patient’s urinary problem should eventually be managed.

These assessments should take place at intervals dictated by the person’s individual circumstances (e.g. age, diagnosis and type of management) but should happen at least every three years.

Mark Baker, director of the Centre for Clinical Practice at NICE, said: “Incontinence is common in people who have conditions caused by damage to their brain, spinal cord or other parts of their nervous system. It can be particularly problematic when there is an underlying neurological condition because these people may have mobility, hand function, and sight impairments and so may need extra support to manage the effects. Incontinence can have a huge impact on a person’s daily activities, and can increase demands on carers, such as partners and family members.

“It is extremely important for healthcare professionals to undertake thorough examinations. We recommend these be carried out, both when symptoms change and periodically, to ensure patients receive the best care. These assessments will allow healthcare professionals to establish the type of urinary dysfunction, what this means in relation to the person’s neurological condition and those who care for them, and will inform how their incontinence should subsequently be managed.

“There are lots of management options available depending on the type of urinary problem, from bladder and pelvic floor training, to medicines, catheters, and surgical procedures. This guideline will help to ensure that people with neurological disease get the care they need.”

In addition, NICE’s clinical guideline advises that healthcare professionals should:

  • Be aware that unexplained changes in neurological symptoms could be caused by a urinary tract disease
  • Refer patients for specialist investigation if their urinary function changes (e.g. needing to urinate urgently and/or frequently, stress incontinence and having a delay between trying and starting to urinate) as this may be due to new or progressing neurological disease
  • Consider how incontinence may affect the patient’s family members, as they often act as immediate carers

Simon Harrison, a consultant urological surgeon from Mid-Yorkshire Hospitals NHS Trust who chaired the guideline development group for NICE, said: “As with people who do not have a neurological impairment, incontinence can be an extremely distressing condition. It can cause feelings of social isolation and embarrassment, and can affect daily activities. Lower urinary tract dysfunction is especially important for people with a neurological condition as the symptoms can be an indicator of additional problems. It is vital for healthcare professionals and patients to know that effective treatments for urinary symptoms caused by neurological disease are available, and so they should not accept incontinence and other symptoms as a being inevitable and untreatable.

“The guideline from NICE encourages healthcare professionals to refer patients for specialist investigation where necessary in order to ascertain how their problem might be managed and to ensure they continue to receive the most appropriate care.”

 

Click here for further information on this guideline.