Continence Clinic – Five years experience
TKK Yu and CP Wong
Department of Integrated Medical Service, Ruttonjee Hospital and Tang Shiu Kin Hospital
Incontinence, both urinary and faecal, is prevalent but a much hidden and neglected health problem. It causes numerous physical, psychological, social and economic consequences. Continence clinic was first established in April 1996 in Ruttonjee Hospital with the aim to provide comprehensive assessment and management for incontinence problem.
A total of 303 new cases were seen in our Continence clinic since 1996 and 296 records could be retrieved. Of the 296 cases, majority of them had urinary incontinence with only 6 cases of faecal incontinence and 5 cases of double incontinence. The mean age was 72.9 years old (range 36 –95) with female predominance (78.7%). Referrals from other departments (apart from geriatrics department), community and self-referrals were increasing and account for about 40% of all referrals. Urodynamics were performed in 76.6% of all urinary incontinence cases. Unstable detrusor being the most frequent urodynamic diagnosis (40.5%), followed by genuine stress incontinence (18.7%), hypocontractile detrusor (18.3%), outflow tract obstruction (10%), sensory urgency (5.5%) and others (7%). Cases without urodynamics investigation were mostly stress incontinence cases. Of those clients with symptoms of stress incontinence, only 39.3% of them could demonstrate genuine stress incontinence during urodynamics study. 43.4% of all cases had more than one diagnosis and 13.1% had transient causes with urinary tract infection being the most common transient cause. Of the 45 clients with typical symptoms of urinary tract infection only 17 of them were proven to have the infection microbiologically. On the other hand, there were 36 cases of culture positive urinary tract infection and only 16 of them had typical symptoms.
Eighty-three clients were given oxybutynin for the treatment of unstable detrusor and within them 25.2% had got mild dry mouth, 15.5% moderate dry mouth and need dosage reduction and 4.8% required drug withdrawal due to severe dry mouth. Cardiac (7.1%) and gastro-intestinal side-effects (3.6%) of oxybutynin were also encountered. Pelvic floor exercise were taught by our continence nurse in nearly half of our clients and among them about a third were also referred to our physiotherapist. Bladder retraining was taught in about one third of our clients but bladder retraining was seldom used as a sole treatment modality. 43 clients (14.5%) were referred to the surgeons or gynecologists for further management. Overall, more than half (54.8%) of the clients had great or total improvement of their incontinence problem.
In these years of working in the Continence clinic, much knowledge has been gained and experience shared among different disciplines. Continence clinic, with comprehensive assessment and treatment, has been successful in the management of incontinence clients.