Contained incontinence management
In contained management of urinary incontinence (leakage of urine), the leaked urine is collected for disposal at a convenient time, and the cause is not treated.
Remember
Containment collects the leaked urine but does not treat the cause, so it is used while awaiting treatment, alongside treatment, or as the long-term plan when other treatments have failed.
Memory aid
A bucket under a leaking roof
The bucket catches the water but does not mend the roof, just as containment collects the leaked urine but does not treat the cause.
Containment is offered only while assessment or treatment is awaited, alongside ongoing treatment, or as the long-term plan when other treatments have failed. Contained incontinence management deals with the urine that has leaked instead of the cause. The urine is collected so that it can be disposed of at a convenient time, and the gain is comfort and quality of life rather than a cure.
It is generally used for patients who are unsuitable for surgery or who have failed conservative management (lifestyle change, pelvic floor training and bladder training) or medical management (drug treatment). The pelvic floor muscles surround the bladder and urethra and help control the flow of urine. Bladder training teaches a patient to lengthen the time between needing to pass urine and doing so.
The urine is collected with an indwelling catheter (a tube left in the bladder for a long time to drain urine into a bag), a sheath device (an adhesive condom-like sheath attached to tubing and a bag) or incontinence pads. A catheter is usually passed through the urethra, the tube from the bladder to the outside. If that is too difficult, it can be placed through the skin above the pubic bone, and it is then called a suprapubic catheter.
Pelvic floor training, bladder training, drugs and surgery all try to cure or improve the leak itself, which is the opposite of containment.
Containment has its own risks: pads must be changed often to avoid skin irritation and infection, and a suprapubic catheter carries a small risk of bowel injury.
Key facts
- Purpose
- to collect the leaked urine so that it can be disposed of at a convenient time.
- Limit
- it manages the leak but does not treat the cause.
- Used for
- generally patients who are unsuitable for surgery or have failed conservative or medical management.
- Devices
- an indwelling catheter, a sheath device or incontinence pads.
- Catheter caution
- the NHS describes a catheter as a last-resort treatment for urinary incontinence when other treatments have been unsuccessful, and long-term catheters carry a risk of infection.
- Pad care
- pads must be changed often to avoid skin irritation and infection.
Exam traps
- Duloxetine, an antidepressant medicine, keeps the urethra closed more firmly, so it treats the cause of the leak rather than collecting the urine, even when surgery is unsuitable.
- Mirabegron relaxes the bladder muscle so that the bladder can store urine, so it is a treatment aimed at the cause and not a way of containing leakage.
- Bladder training lengthens the time between feeling the need to pass urine and doing so, so it aims to change how the bladder behaves and does not collect leaked urine.
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