A consensus statement on when to start clean intermittent self-catheterization: An untapped resource?

BACKGROUND: Clean intermittent self-catheterisation (CISC or ISC) is used by patients/carers to empty the bladder if needed. Sometimes the urethral lumen leading out of the bladder is blocked; sometimes, the bladder (detrusor) muscle itself or the autonomic motor nerves innervating the bladder are damaged, resulting in a failure of the detrusor muscle to work, leading to a failure of the bladder being able to empty adequately. Prior consensus as to the indications and timing of CISC has yet to be provided. This article aims to provide a multidisciplinary consensus view on this subject. CONCLUSION: It is evident that every patient needs to be considered individually, bearing in mind the symptoms and investigations to be considered. We emphasise the importance of considering the term Bladder Voiding Efficiency (BVE). One group of patients who might find CISC helpful are those with a neurological disorder; these include spinal injury patients, multiple sclerosis, Parkinson's, and a condition called cauda equina. Sometimes bladder problems are treated with anticholinergics, and others may be treated with Botox. These may cause the bladder not to empty at all, which is good for leaks but needs self-catheterisation to empty the bladder. In the past, hospitals used a permanent catheter called an 'indwelling' or a 'suprapubic' catheter. These can have side effects, including infections, stones, and pain. For CISC, disposable catheters are the best option for patients as they come in different sizes and styles to provide individualised care. In conclusion, we would like hospitals to consider each patient separately and not use a general 'one-size-fits-all' bladder function for these patients.

Intermittent self-catheterisation: the gold standard for individuals with bladder dysfunction.

Intermittent self-catheterisation (ISC) has long been identified as the 'gold standard' for drainage of the bladder for individuals with bladder dysfunction. This article will outline identification of appropriate individuals, the types of intermittent self-catheters available, outline how it can improve quality of life for sufferers of bladder dysfunction, outline the complications that may occur and finally, suggest why it should be recommended as the 'gold standard' if it is taught and done correctly.

Addressing the gender gap in urinary continence care.

Urinary incontinence is a common condition that affects both men and women, and with profoundly negative effects. Prevalence figures do show that it is more common in younger women than men, but as people age the difference decreases, with research identifying that one-in-three older men have continence issues. However, even with this increase, there is little direct best practice guidance on addressing male urinary incontinence compared to that for women. Professionals seem to be unaware that men have known existing barriers to accessing health care and this would be especially true for incontinence care. There seems to be a lack of education in identifying and assessing symptoms, and little thought to appropriate management if required. This can also be true of manufacturers that provide continence management equipment. This article will look at some of these themes and highlight the gender gaps and give guidance on how professionals may address these.

Identification, assessment and treatment of urinary incontinence and bowel control issues.

Urinary incontinence and bowel control issues are prevalent within the general population and have significant adverse effects on peoples' daily lives and quality of life. This article examines the prevalence of urinary incontinence and bowel control issues and describes some of the more common types of issues. The author explains how to undertake a basic urinary and bowel continence assessment and outlines some of the treatment options, including lifestyle interventions and medicines.

Midwives speaking out on COVID-19: The international confederation of midwives global survey.

BACKGROUND: Maternity services around the world have been disrupted since the outbreak of the COVID-19 pandemic. The International Confederation of Midwives (ICM) representing one hundred and forty-three professional midwifery associations across the world sought to understand the impact of the pandemic on women and midwives. AIM: The aim of this study was to understand the global impact of COVID-19 from the point of view of midwives' associations. METHODS: A descriptive cross-sectional survey using an on-line questionnaire was sent via email to every midwives' association member of ICM. SURVEY INSTRUMENT: The survey was developed and tested by a small global team of midwife researchers and clinicians. It consisted of 106 questions divided into seven discreet sections. Each member association was invited to make one response in either English, French or Spanish. RESULTS: Data were collected between July 2020 and April 2021. All respondents fulfilling the inclusion criteria irrespective of whether they completed all questions in the survey were eligible for analysis. All data collected was anonymous. There were 101 surveys returned from the 143 member associations across the world. Many countries reported being caught unaware of the severity of the infection and in some places, midwives were forced to make their own PPE, or reuse single use PPE. Disruption to maternity services meant women had to change their plans for place of birth; and in many countries maternity facilities were closed to become COVID-19 centres. Half of all respondents stated that women were afraid to give birth in hospitals during the pandemic resulting in increased demand for home birth and community midwifery. Midwifery students were denied access to practical or clinical placements and their registration as midwives has been delayed in many countries. More than 50% of the associations reported that governments did not consult them, and they have little or no say in policy at government levels. These poor outcomes were not exclusive to high-, middle- or low-income countries. CONCLUSIONS: Strong recommendations that stem from this research include the need to include midwifery representation on key government committees and a need to increase the support for planned out of hospital birth. Both these recommendations stand to enhance the effectiveness of midwives in a world that continues to face and may face future catastrophic pandemics.

The neurogenic bladder: developing a consensus bladder and bowel management pathway for people with MS.

This article outlines how the bladder can be affected in neurological conditions such as multiple sclerosis (MS) and the impact this has on patient quality of life and NHS resources. A group of MS and bladder and bowel nurse specialists has developed consensus bladder pathways in the hope that all nurses in contact with patients who are likely to have neurogenic bladder symptoms become 'bladder aware'.

RSV: perspectives to strengthen the need for protection in all infants.

Respiratory syncytial virus (RSV)-the most common viral cause of bronchiolitis-is a significant cause of serious illness among young children between the ages of 0-5 years and is especially concerning in the first year of life. Globally, RSV is a common cause of childhood acute lower respiratory illness (ALRI) and a major cause of hospital admissions in young children and infants and represents a substantial burden for health-care systems. This burden is strongly felt as there are currently no effective preventative options that are available for all infants. However, a renaissance in RSV prevention strategies is unfolding, with several new prophylactic options such as monoclonal antibodies and maternal vaccinations that are soon to be available. A key concern is that health decision makers and systems may not be ready to take full advantage of forthcoming technological innovations. A multi-stakeholder approach is necessary to bridge data gaps to fully utilise upcoming options. Knowledge must be made available at multiple levels to ensure that parents and doctors are aware of preventative options, but also to ensure that stakeholders and policymakers are given the necessary information to best advise implementation strategies.

Addressing the gender gap in urinary continence care.

Urinary incontinence is a common condition that affects both men and women, and with profoundly negative effects. Prevalence figures do show that it is more common in younger women than men, but as people age the difference decreases, with research identifying that one in three older men have continence issues. However, even with this increase, there is little direct best practice guidance on addressing male urinary incontinence compared to that for women. Professionals seem to be unaware that men have known existing barriers to accessing health care and this would be especially true of such an embarrassing condition. There seems to be a lack of education in identifying symptoms and assessing and little thought to appropriate management if required. This can also be true of manufacturers that provide continence management equipment. This article will look at some of these themes and highlight the gender gaps and give guidance on how professionals may address these.

Transanal irrigation: is it the magic intervention for bowel management in individuals with bowel dysfunction?

Historically, the use of colonic irrigation or transanal irrigation (TAI) has been viewed as an alternative therapy for the treatment of a wide variety of conditions not relating to bowel dysfunction, including nausea, fatigue, depression, headache, anxiety and rheumatism. However, these days it is viewed as an effective treatment in individuals who may present with bowel dysfunction and related symptoms of constipation and faecal incontinence. Such individuals would include people with neuropathic bowel disorders, conditions that affect sphincter control or bowel motility disorders. injury to the rectum, sphincter or bowel, slow transit times, evacuation difficulties or prolapse due to a weak/damaged pelvic floor, and chronic faecal incontinence. TAI may be performed by the person with bowel dysfunction, or by a carer or health professional. An individual's ability to use a device to undertake the procedure will be influenced by a range of factors, which are explored in this article.

Promoting and Protecting Human Milk and Breastfeeding in a COVID-19 World.

The global COVID-19 pandemic has put enormous stress on healthcare systems and hospital staffing. However, through all this, families will continue to become pregnant, give birth, and breastfeed. Unfortunately, care of the childbearing family has been de-prioritized during the pandemic. Additionally, many healthcare practices during the pandemic have not been positive for the childbearing family or breastfeeding. Despite recommendations from the World Health Organization to promote early, direct breastfeeding and skin to skin contact, these and other recommendations are not being followed in the clinical setting. For example, some mothers have been forced to go through labor and birth alone in some institutions whilst some hospitals have limited or no parental visitation to infants in the NICU. Furthermore, hospitals are discharging mothers and their newborns early, limiting the amount of time that families receive expert lactation care, education, and technical assistance. In addition, some hospitals have furloughed staff or transferred them to COVID-19 wards, further negatively impacting direct care for families and their newborns. We are concerned that these massive changes in the care of childbearing families will be permanently adopted. Instead, we must use the pandemic to underscore the importance of human milk and breastfeeding as lifesaving medical interventions. We challenge healthcare professionals to change the current prenatal and post-birth practice paradigms to protect lactation physiology and to ensure that all families in need receive equal access to evidence-based lactation education, care and technical assistance.

Catheter securing and fixation devices: their role in preventing complications.

Ann Yates, Director of Continence Services, Cardiff and Vale University Health Board, discusses the technology available to minimise urinary catheter-related complications, Ann.yates@wales.nhs.uk.