For pharmacists and pharmacy assistants, addresing continence issues can be challenging. In this article we cover some common issues that your customers might be experiencing and the best ways to address them.
Who might be at risk of developing continence issues?
Many people may develop continence issues but the key at risk groups include:
- Women who have had a baby
- Elite athletes
- Men who have had prostate surgery
- Older men and women
- Children post toilet training
What are some of the excuses that people might use to avoid discussing their continence issues with you?
New mum: I am too busy with the baby right now
- Older person: They will just tell me it’s because of my age
- Man: I won’t mention it just in case they tell me I need more surgery
- Younger woman: This is just too embarrassing
What is an effective way to ensure I am ready to answer any questions about incontinence with a customer?
Have a small ‘continence pack’ ready for customers. It could include sample products and relevant information leaflets and include contact details for continence support services, local GPS and physiotherapists.
I don’t like talking to customers about incontinence in front of a shop full of people. What should I do?
Have an area set aside that is a little more discrete or away from the main counter-area where you can address the customer’s queries in private. Ensure that you have all resources readily available.
How can we encourage customers to engage in a conversation about their continence issues?
Promote your pharmacy as a continence friendly pharmacy. Have stickers on products that encourage customers to ask questions. Have posters located in key places in the pharmacy and have information leaflets freely available for customers that they can discretely collect.
How should I talk to a customer about incontinence?
Remember that the customer may be slow to reveal their continence situation so provide them with the time to recover from any initial embarrassment. Ensure that the customer has privacy to allow them to discuss their continence issues with you and respect the comfort level of the customer. Use the customer’s language rather than medical terminology to help engage with the person. Some customers may talk about the occasional bladder or bowel ‘accident’ and may not acknowledge this as incontinence.
What are some of the cues that indicate a customer may be at risk of, or have a family member at risk of incontinence?
Be alert to the customer that:
- Talks about frequent constipation or regularly purchases laxatives
- Has multiple prescriptions for the treatment of UTIs
- Is always asking for the bathroom
- Smells of urine or has tell-tale stains on their clothing
- Is a male purchasing feminine hygiene products
What types of incontinence might my customers have?
There are different types of incontinence and each has different symptoms. They include:
- Stress – Involuntary leakage on effort or exertion, sneezing or coughing
- Urge – Involuntary leakage accompanied by or immediately preceded by urgency
- Mixed – Involuntary leakage associated with urgency and also with exertion, sneezing or coughing
- Functional – Untimely urination because of physical disability, external obstacles or problems in thinking or communicating that prevent a person from reaching a toilet
- Incontinence associated with chronic retention – Unexpected leakage of small amounts of urine because of an overfilled bladder
My customer has faecal incontinence and wants to know what might be causing it. What can I tell them?
The reasons why a person may have faecal incontinence include:
- Low fibre and/or fluid intake
- Neurological disease or nerve damage
- Chronic disease
- Inflammatory bowel disease
- Weakness of the anal sphincter
- Disease or injury to the nerves of the bowel
- Constipation faecal impaction
- Bowel disorders
What types of treatment are available for customers with incontinence?
Treatment will depend on the type of incontinence that the customer has but could include:
- Pelvic floor exercises
- Review of the customer’s current medicines in case they are a contributing factor
- Providing specific medicines for the improvement of incontinence
- Encouraging customers to find out more about managing their incontinence
- Discussing possible causes of the condition
A customer would like to know about deferment exercises.
Deferment exercises are designed to help a person improve their bladder capacity by delaying urination. There are five ways in which deferment can be practiced by the person including:
- Thinking about something else
- Contracting the pelvic muscles and not releasing them before reaching the toilet
- Avoid going to the toilet for three to five minutes and then each time extend it a little bit longer
- Concentrate on slow deep breathing
- Applying perineal pressure
What advice should I give regarding maintaining a healthy bladder and bowel?
Remind customers about the importance of:
- Avoiding the development of poor toileting habits i.e.: going to the toilet ‘just in case’
- Ensuring good posture on the toilet to encourage effective evacuation of bladder and bowel
- Maintaining a healthy diet
- Keeping the pelvic floor muscles strong with regular pelvic floor muscle training
How can I help the customer who has tried to manage their incontinence but has not been successful?
Ensue that the customer has a private space to discuss this with you. Ensure that you have as much information as possible from the customer including any medically diagnosed conditions and whether or not they have had a continence assessment. Recommend one if they have not had one yet. You need to understand the type of incontinence that the customer may have including the volume and frequency of leakage. Recognise the lifestyle impacts that this may have on the customer. Provide as much information as you can to the customer about potential aids, appliances and products that may be able to assist the customer and match them to the needs of the individual.
Customers have been asking me about funding support for their continence products. What is available?
The Australian Government Continence Aids Payment Scheme (CAPS) provides financial assistance to eligible people. The funds aim to meet some costs associated with continence products. Details are available from the National Continence Helpline (1800 330066) or www.bladderbowel.gov.au. The Department of Veteran Affairs (DVA) Rehabilitation (RAP) provides both aids and appliances for eligible veterans. Contact the DVA on 133254.
How do I know what products to suggest for the customer?
There are some key questions that you need to consider when looking to suggest the right product for your customers. They include:
- Who is going to use the product?
- Is the person a male or a female?
- Has the customer used any type of continence product in the past?
- What sort of incontinence problem does the customer need to manage?
- Has the customer had a continence assessment? If not…. suggest that they do and provide information as to where they can go for assessment. Provide them with the National Continence Helpline free phone number: 1800 33 00 66
- Does the customer have a heavy or light leakage problem?
- Is the leakage problem bladder or bowel related, or both?
- Are they incontinent at night
- Is poor mobility, cognition or dexterity an issue?
- Is a continence pad the best solution?
My customer has constipation and is wondering if it is their medication causing it. What should I tell them?
Medicines that cause constipation may also result in the person straining which in turn can result in fissures and haemorrhoids. Resolving constipation is critical to prevent faecal impaction and overflow incontinence. Some ingredients in the following medications may contribute to constipation (please check with the Pharmacist for a comprehensive list):
- Mineral supplements
- Cough and cold products
- Complementary products
- Travel sickness products
My customer has faecal incontinence and is asking if any of their medications may be impacting on their management of the condition?
Complementary medicines and over the counter medicines can impact a customer’s management of faecal incontinence either as a side effect or directly; such medications given to treat diarrhoea or constipation. It is important that a Pharmacist is consulted if the customer indicates a wish to use:
- Herbal remedies
- Bulk forming laxatives
- Osmotic laxatives
- Stool softeners
- Stimulant laxatives
To get help for bladder, bowel and pelvic floor health:
- Call the free National Continence Helpline 1800 33 00 66
- Go to continence.org.au to download fact sheets, flyers and brochures
- Or talk to your GP, pelvic physiotherapist or continence specialist