Detailed assessments should be offered to people who have neurological conditions like stroke, multiple sclerosis and head and spinal cord injuries, and who experience incontinence or other urinary problems. A new NICE guideline out today (8 August) 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 from NICE 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.

Professor 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 don't 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.”

Noreen Barker, a nurse who specialises in multiple sclerosis and who helped develop the guideline for NICE, said: “While incontinence can have a great effect on the sufferer, unfortunately sometimes carers can be overlooked. Caring for someone with a neurological impairment who develops urine problems can be physically demanding and can add to psychological, relationship and social pressures. Also, they may feel anxious about their ability to support their partner or relative in management, particularly if this involves the use of containment products or collecting devices.

“The NICE guideline promotes the active participation of family and carers by highlighting the need for them to be offered information, training and support that is specific to their particular requirements and concerns. In particular, they should be offered this if their management plan involves the use of catheters, appliances and pads.”

Ends

Notes to Editors

About the clinical guideline

1. Visit the NICE website for further information about NICE clinical guideline 148 on the management of lower urinary tract dysfunction in neurological disease.

2. Neurological disease refers to any condition which involves damage to the brain, spinal cord or other parts of the nervous system. It can include conditions such as, cerebral palsy, dementia, multiple sclerosis, Parkinson's disease, stroke, head injury, peripheral neuropathy and spinal cord injury.

3. Incontinence can be caused by various diseases and events affecting nervous systems controlling the lower urinary tract. It is believed to be very common in neurological disease; however exact figures are unavailable and will vary according to the underlying neurological condition.

4. This guideline specifically covers the assessment and management of lower urinary tract dysfunction in neurological disease. If the initial assessment shows that the incontinence does not have a neurological cause, NICE advises healthcare professionals to refer to its previously published guidelines, e.g.:

• Urinary incontinence in women (2006)
• Lower urinary tract symptoms in men (2010)

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

2. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

3. NICE produces standards for patient care:

• quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services.
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients.

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.