Clinical Advice

The Bladder and how it works

The bladder is positioned low in the abdomen, to the front of and slightly lower than the uterus (womb). Urine is produced by the kidneys, stored in the bladder and passed by way of a short channel which is called the urethra. The female urethra is about 4cm or 1½" in length.

The bladder wall is muscular, relaxing as it fills with urine and contracting to expel urine. Supporting the organs in the lower abdomen are the pelvic floor muscles, shaped like a small basin and attached to the base of the pelvis. There are three openings in the pelvic floor to allow for emptying the bladder, opening the bowels, and for childbirth. The pelvic floor muscles can be relaxed at will, as happens when urine is passed, and also tightened voluntarily.

The feeling of needing to pass urine is described as an urge or desire. This can often be delayed until a more convenient time, by tightening the pelvic floor muscles.
 

Stress urinary incontinence

Exertion such as jogging, lifting a bag or small child, a sudden cough, laugh or sneeze increases the pressure inside the abdomen. The rise in pressure happens instantly and, as the bladder is within the abdomen, it also experiences the increased pressure. Strong pelvic floor muscles contract and tighten to prevent urine leakage but if these muscles are weak, urine leakage may occur. This is called stress urinary incontinence. The leak is usually slight and may be described as a ‘spurt’, but can be heavier in some people. Stress urinary incontinence mainly affects women but can occur in men.

Why does stress incontinence happen?

• A weakness of the pelvic floor muscles is the cause of stress urinary incontinence
• Risk factors include pregnancy; childbirth; the lowering of oestrogen levels at and following the menopause; constipation; being overweight; a chronic cough; trauma and some illnesses

What can be done to help?

• Assessment and advice from a GP or Specialist Bladder Service
• A urine test to screen for abnormalities
• Pelvic floor muscle exercises to strengthen the supporting muscles (see promoting contincence tab for advice)
• Prevent constipation (see promoting contincence tab for advice)
• Weight reduction if indicated
• Smoking cessation if applicable
• Oestrogen replacement if appropriate

Urge urinary incontinence

Urgency describes a sudden, compelling desire to pass urine which is difficult to delay. Leakage from the bladder associated with urgency is called urge urinary incontinence. The leakage may be described as a ‘gush’ and may be difficult to stop until a considerable volume of urine has been passed. Other symptoms which may occur include thinking that you pass urine too often during the day (frequency) and waking more than once in the night to pass urine (nocturia).

Why does urge incontinence happen?

• May be due to the bladder muscle suddenly squeezing while it is storing urine. This is called Overactive Bladder
• Some of the symptoms may be due to a bladder infection (Cystitis)
• Often, we don’t know why it occurs

What can be done to help?

• Assessment and advice from a GP or Specialist Bladder Service
• A urine test to screen for abnormalities
• A review of fluid intake and caffeine (see promoting continence tab for more information)
• Reduce anxiety - the nature of sudden urgency may cause anxiety
• Pelvic floor muscle exercises to help reduce urgency when it occurs (see promoting continence tab for more information)
• Bladder training (see promoting continence tab for more information)
• Tablets may be prescribed but may not be first option
 

Urge and stress urinary incontinence can occur together, and may be referred to as mixed urinary incontinence.

IMPORTANT: IF YOU SEE BLOOD IN THE URINE, REPORT THIS TO YOUR DOCTOR.

Download PDF Versions

• Stress Urinary Incontinence in Women
• Urge Urinary Incontinence in Women

Clinical Advice by
Wendy Colley OBE
Clinical Resource Manager

The Bladder and how it works

The bladder is positioned low in the abdomen. Urine is produced by the kidneys, stored in the bladder and passed through the penis by way of a channel which is called the urethra. The male urethra is about 20cm or 8" in length. Around the urethra, where it leaves the bladder is the prostate gland.

The bladder wall is muscular, relaxing as it fills with urine and contracting to expel urine. Supporting the organs in the lower abdomen are the pelvic floor muscles, shaped like a small basin and attached to the base of the pelvis. There are two openings in the pelvic floor to allow for emptying the bladder and opening the bowels. The pelvic floor muscles can be relaxed at will, as happens when urine is passed, and also tightened voluntarily.

The feeling of needing to pass urine is described as an urge or desire. This can often be delayed until a more convenient time, by tightening the pelvic floor muscles.

Stress urinary incontinence

Exertion such as jogging, lifting a heavy weight, a sudden cough, laugh or sneeze increases the pressure inside the abdomen. The rise in pressure happens instantly and, as the bladder is within the abdomen, it equally experiences the increased pressure. Strong pelvic floor muscles contract and tighten around the urethra to prevent urine leakage but if these muscles are weak, urine leakage may occur. This is called stress urinary incontinence. The leak is usually slight and may be described as a ‘spurt’, but can be heavier in some people. Stress urinary incontinence can occur in men but is more common in women.

Why does stress incontinence happen?

• A weakness of the pelvic floor muscles is the cause of stress urinary incontinence
• Risk factors include: constipation; being overweight; a chronic cough; trauma and some illnesses
• An operation on the prostate gland may result in temporary pelvic floor muscle weakness

What can be done to help?

• Assessment and advice from a GP or Specialist Bladder Service
• A urine test to screen for abnormalities
• Pelvic floor muscle exercises to strengthen the supporting muscles (see the promoting continence tab for more information)
• Prevent constipation (see the promoting continence tab for more information)
• Weight reduction if indicated
• Smoking cessation if applicable

Urge urinary incontinence

Urgency describes a sudden, compelling desire to pass urine which is difficult to delay. Leakage from the bladder associated with urgency is called urge urinary incontinence. The leakage may be described as a ‘gush’ and may be difficult to stop until a considerable volume of urine has been passed. Other symptoms which may occur include thinking that you pass urine too often during the day (frequency) and waking more than once in the night to pass urine (nocturia).

Why does urge incontinence happen?

• May be due to the bladder muscle suddenly squeezing while it is storing urine. This is called Overactive Bladder
• Some of the symptoms may be due to a bladder infection (Cystitis)
• May occur when the prostate gland is enlarged
• Often, we don’t know why it occurs

What can be done to help?

• Assessment and advice from a GP or Specialist Bladder Service
• A urine test to screen for abnormalities
• A review of fluid intake and caffeine (see promoting continence tab for more information)
• Reduce anxiety - the nature of sudden urgency may cause anxiety
• Pelvic floor muscle exercises to help reduce urgency when it occurs (see promoting continence tab for more information)
• Bladder training (see promoting continence tab for more information)
• Tablets may be prescribed but may not be first option
 

Urge and stress urinary incontinence can occur together, and may be referred to as mixed urinary incontinence.

IMPORTANT: IF YOU SEE BLOOD IN THE URINE, REPORT THIS TO YOUR DOCTOR.

Download PDF Versions

• Stress Urinary Incontinence in Men
• Urge Urinary Incontinence in Men

Clinical Advice by
Wendy Colley OBE
Clinical Resource Manager

Normal bowel function / habit

The digestive system is a series of hollow organs, joined in a continuous, twisting tube from the mouth to the anus. The upper gut digests the food that is eaten and extracts and absorbs nutrients.

The large bowel or colon receives a soft, semi-liquid mixture from the small intestine and gradually re-absorbs fluid, resulting in a formed stool.

The rectum is where faeces are stored until they leave the digestive system through the anus, as a bowel movement.

Faeces, motion and stool are all names which may be used to describe the body waste which is passed from the large bowel, and consists of 60-70% water, roughage or food that could not be digested, dead cells and dead bacteria. In fact all the solids the body doesn’t want any more. Normal faeces are brown in colour however, variation in the colour of faeces can occur as a result of eating certain foods. For example, beetroot can colour the faeces.

Opening the bowels each day is perceived as ’normal’ however only 4 out of 10 people have a daily bowel movement. The normal frequency of bowel movements varies between individuals and between three times a day and three times a week can be considered normal. Faeces continues to be produced even if no diet is taken.

The urge to open the bowel is usually at it’s strongest following a meal, especially so, after breakfast, when contractions of the bowel wall results in a mass movement of waste products towards the rectum.

Common conditions

Some common conditions which can affect the bowel include:

• Constipation, which is the infrequent passage of hard stools and has many possible causes. A few examples of the causes might be: a diet low in fibre, reduced fluid intake, the side-effects of some medicines, a painful condition at the anus, illnesses affecting the nervous system, poor mobility, diverticulitis, irritable bowel syndrome or even simply a fear of using public toilets.
   
• Haemorrhoids or ‘piles’, which are swollen veins which bleed easily and can protrude from the anus.
   
• Pruritus ani (itching and irritation of the skin around the anus) is a common symptom usually due to slight soiling or a dermatological (skin) condition.

The National Key Scheme from RADAR offers independent access by disabled people to around 7,000 locked public toilets around the country.

Faecal incontinence

Faecal incontinence is the involuntary loss of solid or liquid stool and affects over half a million adults in the UK.

Leakage can occur for many reasons. A few examples are: as a result of damage to muscles following childbirth or trauma, confusion, illnesses or other damage affecting the nervous system, mobility and environmental problems, loose stools and constipation.

This problem affects all ages, but the risk increases sharply with age when men and women are equally affected.

An assessment to find the cause will, in many cases, result in an improvement or cure of this embarrassing problem.

Download PDF Versions

• Promoting a Healthy Bowel

Clinical Advice by
Wendy Colley OBE
Clinical Resource Manager

Pelvic Floor Exercises for Men

How to strengthen your pelvic floor muscles

You need to learn, and regularly carry out, your pelvic floor muscle exercises. To begin, choose a quiet time and place, so you can concentrate on learning the exercises correctly.

Sit, stand or lie down, with your feet comfortably apart. You can do the exercises in any of these positions. Relax and breathe normally.

You are going to learn to carry out both slow and fast pelvic floor muscle exercises. You should aim to do the same number of each, every time.

• Concentrate, then squeeze and lift the muscles around the back passage, as if trying not to pass wind. At the same time, pretend you want to pass water but there is no toilet nearby. Squeeze and lift the muscles in your water pipe (urethra). As you tighten the muscles, you will feel your scrotum and base of your penis move slightly upwards.
  
  Keeping the muscles tightly squeezed, count slowly and hold for as long as you feel comfortable. Then relax for the same count. Repeat the slow squeeze exercise until the muscles are tired. Try to gradually increase the duration to ten seconds if possible. Aim to repeat the ten-second holds as many times as you can, aiming for ten times.
• After a short rest, repeat the above exercise but this time quickly twitching the penis upwards, as if to the beat of a drum; Tighten, Relax, Tighten, Relax. For maximum effect, the slow and fast exercises should be repeated several times a day.

 

Pelvic Floor Exercises for Women

How to strengthen your pelvic floor muscles

You need to learn, and regularly carry out, your pelvic floor muscle exercises. To begin, choose a quiet time and place, so you can concentrate on learning the exercises correctly.

Sit, stand or lie down, with your feet comfortably apart. You can do the exercises in any of these positions. Relax and breathe normally.

You are going to learn to carry out both slow and fast pelvic floor muscle exercises.

• Concentrate, then squeeze and lift the pelvic floor muscles as if you are trying to stop yourself from passing urine. Then tighten the muscles around the back passage, as if you are trying not to pass wind. By doing these two together, you should be exercising your pelvic floor muscles.
  
  Keeping the muscles tightly squeezed, count slowly and hold for as long as you feel comfortable. Then relax for the same count. Try to gradually increase the duration up to 10 seconds if possible. Aim to repeat the 10-second holds as many times as you can, aiming for 10 times.
  
  To check you are using the correct muscles, hold a small mirror so you can see the area between your legs. Tighten the muscles. The skin between the anus and vagina should move away from the mirror.
   
• After a short rest, repeat the above exercise but this time tighten and relax the muscles quickly, as if to the beat of a drum; Tighten, Relax, Tighten, Relax. Make sure that you properly relax between each fast contraction and do as many as you can, up to 10.
  
  For maximum effect, the slow and fast exercises should be repeated about 4 times a day.
   

Bowel management and prevention of faecal incontinence in adults

Healthy bowel function and the prevention of faecal incontinence should be the aim of individuals and carers. Some basic tips for maintaining a healthy bowel are given below. These are not a substitute for seeing a doctor or nurse, if undue bowel problems are present.

• Fruit and vegetables contain fibre which helps to keep the bowel healthy. Eating a healthy diet makes conditions such as constipation and diverticulitis less likely to develop. A healthy diet should include 5 portions a day of fruit and vegetables. To get the best health benefits, 5 a day portions should include a combination of a variety of fruit and vegetables. That’s 5 portions altogether, not 5 portions of fruit and 5 portions of vegetables. Examples of a portion are:

• Apple - 1 medium
• Banana - 1 medium
• Clementines - 2
• Fruit juice - 1 medium glass
• Grapefruit - half
• Grapes - 1 handful
• Orange - 1 medium
• Broccoli - 2 spears
• Carrots - 3 heaped tablespoons
• Cauliflower - 8 florets
• Sweetcorn (canned) - 3 heaped tablespoons
• Tomato (fresh) - 1 medium or 7 cherry

More 5 a day from www.5aday.nhs.uk

• If the stools are hard, the aim should be to drink at least 1 1/2 litres (about 3 pints) of fluid in 24 hours, unless there is a medical reason not to do this. Plain water should be included in the fluid intake.
• Many individuals will be aware of a ’trigger’ food which stimulates the bowel. Examples include: onions, prunes, oranges and hot drinks such as coffee or even hot water.
• Contractions in the bowel wall can be stimulated by regular exercise. Exercise within an individual’s capabilities, will promote regular bowel movement.
• Mass movement of waste products in the colon is at it’s strongest about 30 minutes after a meal. This is often the time when an urge to empty the bowel is felt, and should not be ignored.
• Exercising the muscle around the anus (back passage) can help to prevent involuntary leakage from the back passage. (see the HARTMANN leaflet about pelvic floor muscle exercises)
• Toilet facilities should be private, comfortable and easily accessible.
• The best posture for bowel opening is safely seated on the toilet with the feet supported (e.g., on a foot-rest), so the knees are higher than the hips.
• Following a bowel movement, the skin should be gently cleansed to remove any soiling.
• Some medicines have side-effects which can cause constipation or diarrhoea. Read the leaflet supplied with your medicine for further information.

Download PDF Versions

• Pelvic Floor Exercises for Men
• Pelvic Floor Exercises for Women
• Promoting a Health Bowel

Clinical Advice by
Wendy Colley OBE
Clinical Resource Manager

Molimed

MoliMed for men protect

Please look through the following fitting guides:

• Molicare soft fitting guide
• Moliform soft fitting guide

Clinical Advice by
Wendy Colley OBE
Clinical Resource Manager

"Healthcare professionals often use complex medical terms to explain types of and treatments for incontinence. The glossary below provides an overview of key medical words and aims to provide a simple explanation in layman's terms. We hope this glossary is of benefit to you".

• A
• B
• C
• D
• E
• F
• G
• H
• I
• J
• K
• L
• M
• N
• O
• P
• Q
• R
• S
• T
• U
• V
• W
• References

A

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Abdominal massage
A technique which involves massaging up the ascending colon of the large bowel, across the transverse section from left to right, then down the descending colon to aid defaecation

ACE
See antegrade continence enema

Acute urinary retention (AUR)
A painful, palpable or percussable bladder, when the patient is unable to pass any urine, which often develops from benign prostatic hyperplasia. Also called acute retention of urine

ADH
See antidiuretic hormone

Adnexae
Accessory or adjoining anatomical parts

AHP
See allied health professional

All Party Parliamentary Group
All-Party Groups (APGs) are informal cross-party groups that have no official status within Parliament. They are essentially run by and for Members of the Commons and Lords, although many groups involve individuals and organisations from outside Parliament in their administration and activities.

All Party Parliamentary Group for Continence Care
An All Party Group chaired by Baroness Sally Greengross, founded in 2009. The aims of this group include: to break the taboo by raising awareness of continence issues, and raise the profile of the importance of continence services for all age groups

Allied health professional (AHP)
A health professional other than a doctor or nurse. See Occupational Therapist and Physiotherapist

Alpha reductase inhibitors
Classification of drugs, which inhibits the metabolism of testosterone. This leads to a reduction in prostate size, with improvement of urinary flow rate and other symptoms associated with obstruction

Alpha-adrenocepter blocking drugs (Alpha-blockers)
A classification of drugs used to relax smooth muscle in benign prostatic hyperplasia, producing an increase in urinary flow rate and an improvement in obstructive symptoms. (Also used in men and women to reduce high blood pressure)

Anal fissure
Fissure-in-ano is a painful, tear or cut in the lining of the anal canal caused by excessive stretching of the anal mucosa

Anal fistula
An anal fistula is a tract or cavity which communicates with the ano-rectum and usually, an external opening

Anal plug
The Peristeen® Anal Plug is a soft, foam plug which expands when inserted through the anus into the rectum, to prevent faecal leakage

Anal sphincter - external
See external anal sphincter

Anal sphincter - internal
See internal anal sphincter

Anal warts
Anal warts or condylomata present as small, painless lumps that develop on the anus and genitals. They are caused by a virus passed on during sex

Anismus
A malfunction of the external anal sphincter and puborectalis muscle during defaecation, in which these muscles fail to relax or paradoxically contract. Anismus is a form of obstructed defaecation and can cause constipation. Also known as spastic pelvic floor syndrome, anal sphincter dyssynergia, pelvic floor dyssynergia and dyssynergic defaecation

Anorectal angle
The angle between the rectum and anus

Antegrade continence enema (ACE)
The surgical procedure to create a small, right-sided colonic stoma, through which, irrigation is performed to enable predictable colonic emptying, and prevent leakage

Anterior colporrhaphy
Vaginal surgery to repair the anterior vaginal wall, in the treatment of anterior vaginal wall prolapse

Anterior vaginal wall
The front side of the vaginal wall on which the bladder rests

Anterior vaginal wall prolapse
Descent of the front wall of the vagina. See cystocele

Anterior vaginal wall repair
Another term for vaginal surgery to repair the anterior vaginal wall, as is ‘anterior repair’

Anti-androgens
A classification of drugs used to suppress the production of male hormones. See 5-alpha reductase inhibitors

Antibacterials
A large and diverse group of drugs which combat infections by suppressing the growth and reproduction of bacteria

Antibiotics
See antibacterials

Anticholinergic drugs
See antimuscarinic drugs

Antidiuretic hormone (ADH)
The hormone vasopressin, which suppresses the excretion of urine. It is stored and released by the posterior lobe of the pituitary gland. See also Desmopressin

Antimuscarinic drugs
Medication, which reduces bladder spasm. A class of pharmaceutical agents acting on neuromuscular junctions in the autonomic nervous system, used for overactive bladder syndrome

Anuria
Production of an abnormally small volume of urine

Anus
The posterior opening of the alimentary canal, through which the excrements are expelled

Aperients
A mild laxative medicine. See also laxatives

APPG
See All Party Parliamentary Group

Artificial urinary sphincter
A surgically implanted device placed around the urethra, consisting of an inflatable cuff, a reservoir of fluid to inflate the cuff and a control box. There are many considerations for the patient to discuss with their specialist before this surgery is undertaken

Atrophic vaginitis
Vaginitis occurring in post-menopausal women and associated with oestrogen deficiency. There may be intense irritation around the vagina, almost complete lack of vaginal secretions and evidence of tissue atrophy

Atrophoderma
Atrophy of the skin

Atrophy
Gradual decrease in size of a normally developed organ or tissue, along with a reduction in its’ functional ability

AUR
See acute urinary retention

Autonomic dysreflexia
Autonomic dysreflexia is a potentially life-threatening condition for people with spinal cord injury (SCI) above T6. Noxious stimulation including catheterisation or manual evacuation of the bowel, to intact sensory nerves below the injury leads to mass over-activity of the sympathetic nervous system and dangerous blood pressure elevations with associated symptoms

Avoidant paruresis
The inability or extreme reluctance to use toilets other than one particular toilet, usually at home

B

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Bacteriuria
The presence of bacteria in the urine

Barrier creams / preparations
Preparations which often contain water-repellent substances such as dimethicone or other silicones

Bedsore
See decubitus ulcer

Bedwetting
See nocturnal enuresis

Benign prostatic hyperplasia (BPH)
Enlargement of the prostate gland in men, with an increase in normal cells, through age-associated changes. Due to the position of the prostate gland, this can result in an obstruction to the outflow of urine

Biofeedback
The technique by which information about a normally unconscious physical process, is presented to the patient and / or the therapist as a visual, auditory or tactile signal (ICS, 2002)

Biofilm
In this instance, related to the Foley catheter, when micro-organisms form a living surface layer, or biofilm, which develops as the micro-organisms colonise on the surface of the catheter. Can lead to recurrent infection and encrustation, leading to catheter blockage

Bladder
The urinary bladder is a hollow, muscular organ, lined with a mucous membrane, which acts as a storage receptacle for urine, which it receives from the kidneys via the ureters

Bladder calculi
Stones, which form in the bladder, or may travel to the bladder from the upper urinary tract. They are usually composed of mineral salts and are more common in those with a long-term, indwelling catheter

Bladder cancer
Cancer that forms in the tissues of the bladder. Most are transitional cell carcinoma. Bladder cancer occurs more commonly in people between 50 and 70 years of age and is twice as common in men as in women. Among those classed as ‘superficial’, the majority can be controlled by resection and intravesical agents

Bladder capacity
The maximum volume of urine the bladder hold without leakage

Bladder diary
A bladder diary records voiding times and voided volumes, leakage episodes, degree of leakage, pad usage and other information such as fluid intake. See also frequency / volume charts

Bladder expression
Bladder expression comprises various manoeuvres aimed at increasing intravesical pressure (the pressure within the bladder), in order to facilitate bladder emptying. See Valsalva manoeuvre and Credé manoeuvre (ICS, 2002)

Bladder extrophy
Bladder extrophy is a congenital birth defect resulting in the malformation of the bladder and urethra, in which the bladder is turned ‘inside-out’ and exposed outside the body

Bladder lining
The inner lining of the urinary bladder is a mucous membrane of transitional epithelium that is continuous with that in the ureters. When the bladder is empty, the mucosa has numerous ridges or folds called rugae. The rugae and transitional epithelium allow the bladder to expand as it fills

Bladder muscle
For bladder muscle, see detrusor

Bladder outlet obstruction
Bladder outlet obstruction is the term for obstruction during voiding and is characterised by increased detrusor pressure and reduced urine flow rate

Bladder overactive
See overactive bladder

Bladder pressure
See intravesical pressure

Bladder reflex triggering
Bladder reflex triggering comprises various manoeuvres performed by the patient or the therapist, in order to elicit a reflex detrusor contraction. These include suprapubic tapping and thigh scratching

Bladder retraining
Bladder retraining is a form of self-help for people with urinary frequency, urgency and urge urinary incontinence

Bladder Ultrasound
Bladder ultrasound is a noninvasive method of assessing bladder volume and other bladder conditions using ultrasonography to determine the amount of urine retention or post-void residual urine.

BladderScan
A portable 3D ultrasound instrument used to measure bladder volume

BMI
See body mass index

Body mass index (BMI)
A method used to measure a persons height in metres and weight in kilograms, to calculate their BMI. This will determine whether an individual is of acceptable weight for their height

Bowel
The intestine

BPH
See benign prostatic hyperplasia

Bristol Stool Form Scale
A visual resource to assist patients to describe their stool type during assessment. Type 3 or 4 on this seven-point scale is considered the norm

C

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Caecum
The shortest part of the large bowel, where the small intestine joins at the ileocaecal junction. It has a blind end where the veriform appendix is attached

Caesarian section
Delivery of a foetus by incision through the abdominal wall and uterus after 28 weeks of pregnancy

Caffeine
A stimulant present in drinks such as coffee and tea, food, ‘over the counter’ drugs and medication

Care Home
A nursing home, convalescent home, care home or rest home providing a level of care for residents

Care pathway
An integrated care pathway (ICP) is a multidisciplinary outline of anticipated care, placed in an appropriate timeframe, to help a patient with a specific condition or set of symptoms move progressively through a clinical experience to positive outcomes

Carer
A person giving care to another. A carer may be a family member or employed by a Care Agency

Caruncle
A fleshy outgrowth of tissue. See urethral caruncle

Catheter
A hollow tube inserted into a body cavity or organ to instil fluid into, or drain fluid from the cavity or organ

Catheter drainage bags
A urine collection device, usually made from polyethylene, which connects with a catheter or urinary drainage sheath

Catheter encrustation
Deposits on the surface of the catheter within the bladder, which can cause blockage. The main components of catheter encrustations are magnesium and calcium phosphates which precipitate from the urine under alkaline conditions

Catheter valve
A device which is inserted into the end of the catheter which allows bladder filling and intermittent drainage, allowing the user to dispense with urine drainage bags for all or part of the day / night

Catheterisation
A technique for bladder emptying, using a catheter to drain the bladder or a urinary reservoir See also, intermittent (in / out) catheterisation, intermittent self-catheterisation, suprapubic catheterisation and urethral catheterisation

Central nervous system (CNS)
The part of the nervous system consisting of the brain and spinal cord

Cerebrovascular accident (CVA)
See stroke

Charrière (Ch)
Catheter size is measured by the external diameter of the catheter shaft and defined as Charrière units (Ch) or French gauge (Fg). One unit = 1/3 rd of a millimetre

Chronic retention of urine
A non-painful bladder, which remains palpable or percussable after the patient has passed urine. Such patients may be incontinent (ICS, 2002)

Circumcision
The surgical procedure to remove the skin covering the end of the penis, called the foreskin

CNS
See central nervous system

Co-morbidity
Associated with an underlying disease

Coccyx
The coccyx is triangular in shape representing the vestige of a tail. The musculature of the pelvic floor is attached to the coccyx

Collagen
A fibrous, structural protein, that provides strength and elasticity to skin and other connective tissues

Colon
The colon or large bowel, is the part of the large intestine extending from the caecum to the rectum

Colporrhaphy
A term used for a surgical procedure that repairs a defect in the wall of the vagina

Colposuspension
Lower abdominal surgery for stress urinary incontinence in women, where the bladder and bladder neck are raised and supported via a transverse suprapubic incision

Commode
A piece of furniture containing a removable chamber pot. Useful for those who are unable to walk to the toilet

Condylomata
Wart-like growths around the anus, vulva, or glans penis caused by viral infection or syphilis and transmissible by contact. See Anal warts

Constipation
Infrequent or difficult bowel evacuation

Continence
The ability to voluntarily control emptying of the bladder and bowel

Cranberry juice
Cranberries are small, red, sour-tasting berries, which are crushed with added sugar to make a palatable drink. Research suggests 200mls of cranberry juice drunk twice a day, may reduce the risk of cystitis

Credé manoeuvre
The Credé manoeuvre, or manual bladder emptying, involves applying considerable pressure, usually with the ball of the hand or a fist, suprapubically over the bladder

Crohn's disease
A chronic form of inflammatory bowel disease that usually affects the lower small intestine (ileum) or the colon, but it can affect the entire gastrointestinal tract

CVA
See stroke

Cystitis
See urinary tract infection (UTI)

Cystocele
Protrusion of the urinary bladder through the front wall of the vagina. See also anterior vaginal wall prolapse

Cystometry
Cystometry is the method by which the pressure / volume relationship of the bladder is measured

Cystoscopy
Visual examination of the bladder by means of an endoscope, a narrow, telescopic instrument, introduced into the urethra and passed into the bladder

D

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DDAVP (desmopressin acetate)
Desmopressin acetate is a synthetic antidiuretic hormone, which causes less urine to be excreted by the kidneys. Can be used for nocturnal enuresis and to control nocturia in those under 65 years of age

Decubitus ulcer
An ulcer due to interference with the local circulation from prolonged or severe pressure on the surface body tissue, resulting in lack of oxygen to the tissue, and cell death. Also called bedsore and pressure sore

Defaecation
Passing stool

Dementia
A global and progressive deterioration of mental functioning which is irreversible and affects memory, intellect, judgement, personality and emotional control

Dermatitis
Inflammation of the skin

Dermis
The fibrous, inner layer of skin just beneath the epidermis, varying in thickness from 0.5mm to 3mm in thickness. It is well supplied with nerves and blood vessels and contains hair roots and sebaceous and sweat glands

Desmopressin
See DDAVP

Detrusor
The bladder muscle

Detrusor sphincter dyssynergia (DSD)
Detrusor sphincter dyssynergia is uncoordinated external sphincter contractions during bladder contraction giving rise to obstructed voiding seen in neurological bladder dysfunction

Diabetes mellitus
A disease where the body does not produce enough of the hormone insulin and is therefore unable to metabolise sugar and starch. Long-term effects of diabetes can involve damage to the peripheral nerves causing, among others, sight problems and bladder and

Diarrhoea
A condition in which a person has frequent, liquid, bowel movements

Dietary fibre
The part of food, which is eaten, that cannot be broken down by intestinal digestive processes, and therefore passes through the colon, undigested. Vegetables, cereals and fruits are the main sources of dietary fibre

Digital rectal examination (DRE)
Digital rectal examination (DRE) is examination of the rectum, though the anus, using the gloved index finger. In the male, the prostate gland is palpated rectally by the examiner (usually a doctor or specialist nurse), to determine enlargement and / or p

Digital removal of faeces (DRF)
Also called manual removal of faeces (MRF), a procedure which may be required to help empty the rectum of faeces. This is only performed following assessment, when no other way of emptying the rectum is appropriate and only by those trained and competent

Diuretic
Medication which increases urine production

Diverticular disease (Diverticulosis)
Diverticular disease is the presence of diverticulae in the large intestine. These small blind pouches which form in the lining and wall of the colon may become inflamed due to bacteria and other irritating agents trapped there

Diverticulitis
Inflammation of a diverticulum in the colon, causing pain and disturbance of bowel function

Diverticulosis
A condition in which diverticula are present in the intestine without signs of inflammation

DRE
See digital rectal examination

DRF
See digital removal of faeces

DSD
See detrusor sphincter dyssynergia

Dyschezia
Difficulty with rectal evacuation

Dysuria
Pain on passing urine

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EAS
See external anal sphincter

Ectopic
Displaced or situated in an unusual location, e.g.,ectopic ureter, when a ureter opens into the vagina A skin condition primarily affecting the epidermis, marked by redness, itching, minute papules and vesicles, weeping, oozing and crusting. May be due to

Eczema
A skin condition primarily affecting the epidermis,

Electrical stimulation
The application of electrical current to stimulate the pelvic organs

Encopresis
The passage of normal stools in socially unacceptable places

Encrustation
See catheter encrustation

Enema
A solution introduced into the rectum to promote evacuation of faeces

Enterocele
Herniation of the small intestine through the apex of the vagina

Enuresis
Any involuntary loss of urine. When this occurs during sleep, it is called nocturnal enuresis

Enuresis alarm
A device, which activates a visual or audible signal when moisture (urine) comes into contact with the sensor in the device. This alarm may be place on the bed or attached to the individuals clothing

Enzyme
Any protein that acts as a catalyst, increasing the rate at which a chemical reaction occurs. The human body contains in excess of 10,000 different enzymes

Epidemiology
The study of the distribution of factors determining health and disease in human populations

Epidermis
The outermost layer of the skin, varying in thickness from 0.07mm to 1.4mm. It does not contain blood vessels

Episiotomy
A surgical procedure in which an incision is made in the tissue between the vagina and anus to prevent tearing of this tissue during childbirth

Epispadias
Epispadias is a congenital abnormality where the urethral opening is on the upper surface of the penis. This condition is treated surgically. See also hypospadias

Evacuation
An emptying or removal. Material discharged from the body, especially from the bowel

Evidence based
Statements and recommendations based on a level of research-based evidence

Excoriation
An erosion of the skin by a scratch or abrasion, It is commonly seen in skin disorders causing itching / pruritis, or by exposure to an irritant agent, such as urine, which can cause incontinence dermatitis

External anal sphincter (EAS)
The external anal sphincter is a circular, striated muscle, and therefore under voluntary control. It surrounds the internal anal sphincter

External urinary sphincter
The external urinary sphincter (striated muscle) is under voluntary control and is partly responsible for urinary continence

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Faecal impaction
Impaction of faeces in the rectum and colon. This may be as a result of chronic constipation, which leads to impaction when the fluid content of the faeces is progressively absorbed by the colon, leaving hard rounded rocks, or scybala, in the bowel. This

Faecal incontinence
Anal incontinence is the involuntary loss of flatus, liquid or solid stool that is a social or hygienic problem (Norton et al., 2001)

Faecal softeners
Compounds which are taken orally or rectally in an attempt to soften the faeces

Faeces
Body waste discharged from the intestine, also called stool

Fast-twitch muscle fibres
The pubococcygeus muscle of the pelvic floor, comprises of about 30% of fast-twitch muscle fibres. The fast-twitch fibres, which tire easily, are responsible for the fast reflex response associated with coughing or other sudden increases in intraabdominal

Female genital mutilation
Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the female external genitalia and/or injury to the female genital organs for cultural, religious or any other non-therapeutic reasons (WHO, 1997). Also know

Fg
French gauge. See Charrière

FGM
See female genital mutilation

Fibre
See dietary fibre

Fistula
An abnormal connection, usually between two organs, or leading from an internal organ to the surface of the body. See also vesico-vaginal fistula and recto-vaginal fistula

Flatus
Gas or air in the intestinal tract which may be expelled through the anus

Flow rate
See voiding flow rate

Fluid intake
The volume of fluid an individual ingests usually measured over a 24 hour period

Foley catheter
A catheter with a balloon which, when inflated will retain the catheter in the bladder. Invented by Dr Frederick Foley of St Paul, Minnesota, in 1934

Forceps delivery
The delivery of a foetus with the assistance of a two-bladed instrument

Foreskin
The retractable roll of skin covering the end of the penis. See also circumcision

French gauge
See Charrière

Frequency (of micturition)
The number of times an individual passes urine over a given time

Frequency / volume chart (FVC)
A frequency / volume chart records the volumes voided as well as the time of each micturition, day and night, for at least 24 hours (ICS, 2002)

Functional incontinence
Incontinence, which occurs as a result of illness, severe learning or physical disability, or behavioural problems. There may or may not be an underlying bladder or bowel dysfunction

FVC
See frequency / volume chart

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Gastrocolic reflex
A significant increase in peristalsis after food enters the empty stomach

Genitalia
The reproductive organs, also called the genitals

Genitourinary
Pertaining to the genitalia and urinary tract

Genitourinary medicine
Genitourinary medicine (GUM) is the medical specialty concerned with the diagnosis and treatment of sexually transmitted diseases (STDs)

Genitourinary system
The organs of reproduction, together with the organs concerned with the production and excretion of urine (also called urogenital system)

Genuine stress incontinence
See urodynamic stress incontinence, and stress urinary incontinence

Giggle incontinence
Urine leakage, which occurs when laughing and continues until the bladder is empty. Suffered by some girls, it is thought to be a combination of stress urinary incontinence and overactive bladder

Glycosuria
The presence of glucose in the urine

Gut transit times
The length of time taken for foods to pass through the digestive system. This can be measured by use of radio-opaque markers and X-rays

Gynaecology
A branch of medicine which specialises in the female reproductive system

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Habit retraining
Habit retraining attempts to match voiding intervals to an individuals' own natural voiding pattern, usually in a long-term care setting

Haematuria
The presence of blood or blood cells in the urine

Haemorrhoids
A swelling caused by the haemorrhoidal veins within the anal canal. The haemorrhoids may prolapse into the anal lumen as they enlarge. Also called 'piles'

Haustrations
The sacculations of the colon, caused by the teniae, or longitudinal bands, which are slightly shorter than the gut so that the latter is thrown into tucks or pouches, giving the appearance of segmentation

Hesitancy
Hesitancy is the term used when the individual describes difficulty in initiating micturition, resulting in a delay in the onset of voiding after the individual is ready to pass urine (ICS, 2002)

Hirschsprung's disease
Congenital absence of nerve cells in part of the lower bowel, resulting in the absence of peristalsis in the affected portion of the colon, resulting in a massive enlargement of the colon, constipation and obstruction. Also called Megacolon

Hormone replacement therapy (HRT)
Hormone replacement therapy is appropriate for alleviating menopausal symptoms such as vaginal atrophy and 'hot flushes'. HRT contains a low dose of oestrogen and, for women with an intact uterus will be combined with progestogen. See also topical oestrog

HRT
See hormone replacement therapy

Hydronephrosis
Dilation of the kidney with uninfected urine due to an obstruction to the ureter or beyond. If left untreated, the functioning units of the kidney will be destroyed

Hypospadias
Hypospadias is a congenital abnormality affecting 1 in 600 boys. The urethral opening is on the undersurface of the penis. This condition is treated surgically. See also epispadias

Hysterectomy
Surgical removal of the uterus

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I-PSS
See international prostate symptom score

IAS
See internal anal sphincter

Iatrogenic
Resulting from the activity of a doctor. Said of any adverse condition in a patient resulting from treatment by a doctor or surgeon

IBS
See irritable bowel syndrome

ICP
See care pathway

ICS
See International Continence Society

Idiopathic
Of unknown cause

Ileum
The third and longest portion of the small intestine, about 12 feet in length extending from the jejunum to the ileocaecal opening

Imperforate anus
Having no opening. A congenital defect of the anus, where there is partial or complete obstruction of the anal opening

Incidence
The incidence of a disease is the rate at which new cases occur in a population during a specific period (Farmer, in Norton and Chelvanayagam, 2004 )

Incontinence
Involuntary leakage of urine and/or faeces

Incontinence dermatitis
Dermatitis due to the effects of urine and / or faeces on the skin. Also called ‘nappy rash’ or ‘diaper rash’. See also moisture lesion

Inhibitory reflex
A reflex within the parasympathetic fibres in pelvic nerves, which inhibits detrusor contraction during the bladder storage phase

Intermittent (in / out) catheterisation
Drainage or aspiration of the bladder or a urinary reservoir with subsequent removal of the catheter (ICS, 2002)

Intermittent selfcatheterisation (ISC)
Intermittent self-catheterisation (ISC) is performed by the patient himself / herself

Internal anal sphincter (IAS)
The internal layer of rectal smooth muscle. Weakness or disruption of the IAS results in the passive leakage of faeces, and incontinence of flatus

Internal urinary sphincter
The smooth muscle present at the bladder neck

International Continence Society (ICS)
The International Continence Society (ICS) is an international society of medical professionals interested in the study of the lower urinary tract. Its membership is multi-disciplinary, some of the fields covered being urology, urogynaecology, neurology, physiotherapy and nursing

International Prostate Symptom Score (I-PSS)
A symptom index for bladder symptoms, especially related to benign prostatic hyperplasia, and including a 'Quality of Life' question

Intravesical
Within the bladder

Intravesical pressure
The pressure within the bladder, measured in centimetres of water (cmH20). The normal bladder accommodates to changes in volume, from empty to full with little rise in pressure

Involuntary
Not under voluntary control, for example, smooth muscle is not under voluntary control

Irritable bowel syndrome (IBS)
Irritable bowel syndrome (IBS) is a condition which causes the intestines (or bowels, or gut) to be over sensitive. This can cause a variety of abdominal and bowel symptoms. There is no cure, but most people can, with the help of their doctor, learn to co

ISC
See intermittent self-catheterisation

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Jejunum
The part of the small intestine between the duodenum and ileum

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Kegel exercises
See pelvic floor muscle exercise

Kegel, Arnold
An American gynaecologist, Arnold Kegel (1948), was the first to report on an uncontrolled study of 500 women doing pelvic floor muscle exercises. Consequently, in America they are referred to as 'Kegel exercises' (Getliffe and Dolman, 2003)

Ketamine
A synthetic compound used as an anaesthetic and analgesic drug and also (illicitly) as a hallucinogen. Effects of its’ use as a recreational drug include urinary tract symptoms which have been collectively referred as ketamine-induced ulcerative cystitis and they include urge incontinence, decreased bladder compliance, decreased bladder volume, overactive bladder, and painful haematuria

Ketonuria
An excess of ketone bodies in the urine. Excessive production of ketones can occur in diabetes mellitus

Kidney
Either of two bean-shaped organs in the lumbar region that filter the blood, excreting the end products of body metabolism in the form of urine

Knack
'The Knack' is a term given to a voluntary contraction of the pelvic floor muscles prior to any event which increases intra-abdominal pressure. Useful for patients to use prior to any activity which usually results in leakage. Examples may be a cough or s

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Laxatives
A laxative is an agent which facilitates evacuation of the bowel

Levator ani
Main muscle group supporting the pelvic floor

Lower urinary tract
The lower urinary tract is made up of the bladder and bladder neck, the urethra and urethral sphincter mechanism, and the pelvic floor

Lower urinary tract symptoms (LUTS)
Symptoms relating to the lower urinary tract

LUTS
See lower urinary tract symptoms

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Manual evacuation
The digital removal of faeces from the rectum

Medication
Medicinal agent

Medicine
1. Any drug or remedy 2. The science of the diagnosis and treatment of disease and maintenance of health

MEF
Manual evacuation of faeces. See Digital removal of faeces

Megacolon
See Hirschsprung's disease

Menopause
A natural physiological process that results from the normal ageing of the ovaries. The levels of female hormones gradually decrease, which can result in symptoms of vaginal dryness and hot flushes. See also hormone replacement therapy and topical oestrog

Microbiology
The study of micro-organisms, including bacteria

Miction protocol
See bladder diary

Micturition
The passing of urine from the bladder

Midstream specimen of urine (MSU)
The collection of a urine specimen whereby the first part of the stream is passed into the toilet, to ensure any bacteria in the urethra do not contaminate the sample, and the midstream is collected for laboratory testing

Mitrofanoff
A continent tube for catheterisation, leading from the bladder to the outside abdominal wall. A Mitrofanoff is created surgically often using the appendix, but may be constructed with a portion of small bowel.

Mixed urinary incontinence
Mixed urinary incontinence is the complaint of involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing (ICS, 2002)

Mobility
Free movement

Moisture lesion
Moisture related skin lesion caused by contact from incontinence or perspiration. May be called incontinence dermatitis. It is important to define between this type of lesion and a superficial pressure ulcer

Motor nerve (motoneurone)
Pertaining to movement. A neuron having a motor function

MRF
Manual removal of faeces. See Digital removal of faeces

MS
See multiple sclerosis

MSU
See midstream specimen of urine

Multiple sclerosis (MS)
Multiple sclerosis is a chronic disease of the central nervous system. MS is the result of damage to myelin - a protective sheath surrounding nerve fibres of the CNS. When myelin is damaged, this interferes with messages between the brain and other parts

Muscle fibres, slow-twitch and fast-twitch
See slow-twitch muscle fibres and fast-twitch muscle fibres

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National Key Scheme
The National Key Scheme (NKS) offers disabled people independent access to locked public toilets around the country. Toilets fitted with NKS locks can be found in shopping centres, pubs, cafés, department stores, bus and train stations and many other locations in most parts of the country

Necrosis
Changes indicative of cell or tissue death

Necrotic tissue
Tissue which had undergone necrosis

Nelaton catheter
Plastic catheter with a solid tip and single eye, used for the collection of urine samples and by patients' practising intermittent self-catheterisation

Nelaton, Auguste
Auguste Nelaton of Paris, was a physician to Napoleon III. He used a method of forming and shaping rubber, known as vulcanisation, to produce a flexible rubber catheter, with a solid tip and a single eye (Getliffe and Dolman, 2003)

Neurogenic bladder
Neurological disease or injury affecting bladder function

Neurogenic bowel
Neurological disease or injury affecting bowel function. This may give symptoms of constipation and faecal incontinence

Neurogenic incontinence
Incontinence secondary to local nerve damage, for example, damage to the pudendal nerve during childbirth, major neurological injury, or chronic pathological process affecting the nervous system

Neurological disease
Disease affecting the nervous system

Neurological injury
In injury to the nervous system, for example, spinal cord injury

Neuropathy
A general term denoting functional disturbances and pathological changes in the peripheral nervous system See peripheral nervous system

Neutrophil
Neutrophil granulocytes, generally referred to as neutrophils, are the most abundant type of white blood cells and form an integral part of the immune system

Nitrites (urinary)
Most species of bacteria (but not all), that colonize in the urine cause nitrates, which are derived from dietary metabolites, to be converted to nitrites. Urine testing to detect nitrites has become part of a routine urinalysis. A positive result may ind

NKS
See National Key Scheme

Nocturia
Nocturia is the complaint that the individual has to wake at night one or more times to void. (ICS, 2002)

Nocturnal enuresis
Incontinence of urine during sleep See also primary nocturnal enuresis and secondary nocturnal enuresis

Nursing home
An independent, registered unit which offers nursing care to those with complex health care needs who cannot be cared for in their own home

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OAB
See Overactive bladder

Obstetric history
As part of a continence assessment, information regarding the number of children a woman has had, weight of baby, method and history of delivery

Occlusive continence devices
Devices, which cause pressure to prevent leakage from the bladder or bowel, such as anal plugs. For urinary incontinence, penile clamps are now rarely used due to the risk of tissue damage

Occupational therapist (OT)
An Allied Health Professional (AHP) working in occupational therapy

Occupational therapy
Occupational Therapy is the assessment and treatment of physical and psychiatric conditions using specific, purposeful activity to prevent disability and promote independent function in all aspects of daily life

Oestrogen
A female hormone produced by the ovary, oestrogen controls female sexual development. Locally, the effects of oestrogen maintain the vaginal and urethral mucosa. Menopause is associated with a decrease in circulating oestrogen levels and therefore a 'dryi

Oliguria
Oliguria is the production of a lower than normal volume of urine (less than or equal to 0.5ml/kg/hr)

OT
See Occupational Therapist

Outlet obstruction
See bladder outlet obstruction

Overactive bladder
A condition characterized by involuntary detrusor (bladder) contractions during the time the bladder is filling, which may be spontaneous or provoked and which the patient cannot suppress. Symptoms include urinary urgency, frequency, and nocturia and may include urge incontinence

Overflow faecal incontinence
A condition secondary to constipation and stool impaction. Incontinence occurs of solid stool or of liquid stool, referred to a 'spurious' (false) diarrhoea, however the rectum and often a large part of the colon remains impacted with faeces

Oxford grading scale
A graded scale used by clinicians, when carrying out a digital assessment of the pelvic floor muscle

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Pad
A cushion-like mass of soft material. A continence pad or product may be disposable or reusable (washable) and is designed to maintain the social acceptability of the user

Pad weighing test
An objective measure of urinary leakage, by recording the weight of a dry pad, then weighing after wearing and deducting the dry weight from the wet weight to determine actual urine loss.

Paruresis
See avoidant paruresis

Pathogen
Any disease-producing agent or micro-organism

Pelvic floor
The muscles, ligaments and fascia which form the slinglike support for the organs of the lower pelvis

Pelvic floor muscle exercise
Regular, repetitive, voluntary tightening of the pelvic floor muscle, aimed at increasing muscle bulk

Pelvic floor muscles
The muscles of the pelvic floor concerned with maintaining continence, are the levator ani and the pubococcygeus

Pelvic organ prolapse (POP)
Pelvic organ prolapse (POP) occurs when one or more pelvic organs (uterus, vagina, urethra, bladder or rectum) moves downward and bulges into or even out of the vaginal canal

Penile sheath
See urinary drainage sheath

Penis
The external male organ of urination and coitus

PERFECT mnemonic
In the assessment of the pelvic floor muscle contraction, PERFECT relates to: P=power, E=endurance, R=repetitions, F=fast, and ECT=every contraction timed (Laycock, 1994)

Perineum
The region of the body between the anus and genitals

Peripheral nervous system
The portion of the nervous system consisting of the nerves and ganglia outside the brain and spinal cord

Peristalsis
Wavelike contractions, produced by the contraction of smooth muscle, that pass along tubular organs, such as the intestines

Peristeen®
Peristeen anal irrigation is a system that can be used in the management of both constipation and faecal incontinence. The system works by introducing warm tap water into the rectum using a catheter whilst the person sits on the toilet. This encourages the muscles in the bowel to contract. The system is only available after assessment by a qualified health professional, who will also teach the method of administration

Pessary
A device worn in the vagina to support or correct the position of the uterus, rectum, or bladder; or for administering drugs locally, such as a contraceptive, antibiotic, antifungal agent, or oestrogen. See also ring pessary

PH (urinary)
This represents the acidity / alkaline balance. In urine, the normal range varies between 4.5 and 8.0

Physiotherapist
An Allied Health Professional (AHP) working in physiotherapy

Physiotherapy
The use of physical means for the treatment and prevention of injury and disease and for the restoration of function

Piles
See haemorrhoids

Polypharmacy
'Any drug regime with at least one unnecessary medication' (Hogan, 1997). In older people, the absorption, metabolism and elimination of drugs depend on processes which are affected by ageing

Polyuria
The excessive production of urine; can be a symptom of various diseases, most notably diabetes mellitus

POP
See pelvic organ prolapse

Post micturition symptoms
Urinary symptoms which are experienced immediately after micturition

Post-void residual urine (PVR)
The volume of urine left in the bladder at the end of micturition

Posterior colporrhaphy
Vaginal surgery to repair the posterior vaginal wall, in the treatment of posterior vaginal wall prolapse

Posterior tibial nerve stimulation
Percutaneous tibial nerve stimulation (PTNS), also referred to as posterior tibial nerve stimulation, is the least invasive form of electrical stimulation to the peripheral nerves used to treat overactive bladder and the associated symptoms of urinary urgency, urinary frequency and urge incontinence

Posterior vaginal wall
The posterior (back) wall of the vagina on which the rectum rests

Posterior vaginal wall prolapse
Descent of the back wall of the vagina. See rectocele

Posterior vaginal wall repair
Another term for vaginal surgery to repair the posterior vaginal wall, as is ‘posterior repair’

Pressure sore
See decubitus ulcer

Prevalence
The total number of cases of a specific condition or disease in existence in a given population at a given time

Primary nocturnal enuresis
Incontinence of urine during sleep, when the child has never been dry for a significant period of time. See also secondary nocturnal enuresis

Procidentia
Third degree uterine prolapse, or procidentia. The uterus lies entirely outside the introitus (vaginal opening) and denotes complete failure of all the genital supports

Prolapse
Downward displacement of an organ or part. See also cystocele, enterocele, procidentia, rectal prolapse and rectocele

Prostate gland
A chestnut-shaped body that surrounds the neck of the bladder and urethra in the male. It controls the flow of urine from the bladder and also secretes a milky fluid, which is added to semen during ejaculation

Prostate specific antigen (PSA)
Prostate specific antigen (PSA), is a protein produced by the prostate and released in very small amounts into the bloodstream. When there's a problem with the prostate, such as when prostate cancer develops and grows, more and more PSA is released, until

Prostatectomy
Surgical removal of the prostate gland. This may be done retropubically (through an incision over the lower abdomen) or transurethrally (through the urethra). See also trans-urethral resection of the prostate (TURP)

Proteinuria
Proteinuria is protein in the urine. The loss of up to 150 mg of protein per day is normal; this may be expressed as normal is less than 4 mg per hour per square metre of body surface area. Proteinuria may be increased by a factor of 2-3 times by strenuou

PSA
See prostate specific antigen

PSS
See International Prostate Symptom Score

PTNS
See post-tibial nerve stimulation

Pubococcygeus
The pubococcygeus muscle is a hammock-like muscle, found in both sexes, that stretches from the pubic bone to the coccyx (tail bone) forming the floor of the pelvic cavity and supporting the pelvic organs. It controls urine flow and contracts during orgas

Puborectalis muscle
The puborectalis muscle of the pelvic floor, forms a sling around the anorectal junction. When this muscle contracts, it maintains the anorectal angle and prevents faeces passing into the anal canal.

Pudendal nerve
Main nerve supplying the pelvic floor, bladder and urethra. Damage to this nerve can cause incontinence

PVR
See post-void residual urine

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Quality of life (QoL)
Quality of Life includes physical, mental and social wellbeing, and not just the absence of disease or illness. There are many QoL questionnaires relating to health care and some specific to continence problems

Queens Square Bladder Stimulator
A vibrating bladder emptying device used over the lower abdomen before and during voiding. Useful for some patients with bladder emptying problems due to neurological illness

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Receptors
A sensory nerve ending that responds to various stimuli

Rectal examination
See digital rectal examination

Rectal irrigation
Also known as trans-anal irrigation. A rectal irrigation is done to remove stool and gas from the colon. It involves instilling water into the colon which is then passed with faeces from the bowel, onto a commode or into the toilet See also Peristeen®

Rectal prolapse
A condition in which the rectum slips out of its normal position within the body through the anus. It may be put back in place (reduced) by insertion of the finger. If this is not possible, surgery may be required

Recto-vaginal fistula
A recto-vaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina. If the opening between the rectum and vagina is wide it will allow both flatulence and faeces to escape through the vagina. T

Rectocele
Protrusion or herniation of the rectum into the vagina. This can occur if pelvic muscles are weakened by childbirth. See also posterior vaginal wall prolapse

Rectum
The last several inches of the large intestine that ends at the anus and stores faeces before it is eliminated

Residual urine
See post-void residual urine

Retention of urine
See Acute retention of urine and chronic retention of urine

Ring pessary
Rubber or plastic device that is inserted through the vagina to help hold the uterus in place in women who have prolapse of the uterus

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SCI
See spinal cord injury

Scybala
Hard faecal matter, discharged in round lumps

Secondary nocturnal enuresis
Incontinence of urine during sleep, after a significant period of being dry. The 'significant period' is generally accepted as being 12 months or more beyond the age of 3 years (Getliffe and Dolman, 2003)

Sensory nerves
A peripheral nerve that conducts impulses from a sense organ to the spinal cord or brain. Also called afferent nerve. See also peripheral nervous system

Shearing
A tearing or stretching of tissue resulting from movement which puts strain on delicate nerve fibres and blood vessels causing them to stretch to the point of breaking, and is one cause of skin damage

Sheaths
See urinary drainage sheaths

Shewee
A portable urine director for females which enables urination to take place standing. Originally designed for use at festivals, marathons and other activities where conventional toilets are in short supply. Now also available on prescription or to buy from walking / outdoor retailers. Useful for women who are unable to sit down to void due to poor mobility

Sigmoid colon
The sigmoid colon is the s-shaped curve between the descending colon and the rectum

Signs
Signs are observed by the physician, to confirm and quantify symptoms

Skin
The outer covering of the body and the largest organ of the body

Slow stream
Slow stream is reported by the individual as his or her perception of reduced urine flow, usually compared to previous performance or in comparison to others (ICS 2002)

Slow-twitch muscle fibres
The pubococcygeus muscle of the pelvic floor, comprises of about 70% of slow-twitch muscle fibres. The slow-twitch fibres, maintain the pelvic floor strength during normal intra-abdominal pressure. See also fasttwitch muscle fibres

Smooth muscle
Muscle which is not under voluntary control

Sphincter
A circular muscle that constricts a passage or closes a natural orifice. When relaxed, a sphincter allows materials to pass through the opening.

Spina bifida
A developmental anomaly characterised by defective closure of the bony covering of the spinal cord

Spinal cord
That part of the central nervous lodged in the spinal column

Spinal cord injury (SCI)
A traumatic lesion of nerve elements in the spinal cord, resulting in any degree of sensory and / or motor deficit, autonomic dysfunction, and bladder / bowel dysfunction

Star charts
A chart used to record positive gains, as part of an intervention programme

Stoma
An artificial orifice, either temporary or permanent, from the gastrointestinal or urinary tract

Stool
Faecal discharge from the bowel

Straining
An overstretching or overexertion of some part of the musculature which involves excessive effort

Stress urinary incontinence (SUI)
Stress urinary incontinence is the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing (ICS 2002)

Stricture
An abnormal narrowing of a passage. See urethral stricture

Stroke (CVA)
A disorder of the blood vessels serving the cerebrum. The main causes of stroke are cerebral haemorrhage, cerebral embolism, or cerebral thrombosis, resulting in an impaired blood supply to a part of the brain. The result can be major disability with para

Subcutis
The subcutis is the layer of tissue directly underlying the cutis. It is mainly composed of adipose tissue. Its physiological function includes insulation and storage of nutrients

SUI
See stress urinary incontinence

Suppository
A type of medication designed to encourage bowel movements. They are in a solid form and are inserted up the anus into the rectum

Suprapubic catheterisation
A catheter inserted into the bladder, by passing it through a surgically made incision in the lower abdomen. Suprapubic catheterisation, or percutaneous suprapubic cystotomy, offers an alternative method to urethral catheterisation

Sympathetic nervous system
A part of the nervous system that causes relaxation of the bladder and contraction of the internal sphincter. Urine storage in the bladder is primarily the result of a functional sympathetic system. Not under voluntary control

Symptoms
Any indication of disease perceived by the patient

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Tension-free vaginal tape (TVT)
A newer treatment for stress urinary incontinence in women, using a mesh-like tape that is surgically inserted through the vagina to support the urethra

Testosterone
The male hormone, made primarily in the testes. It stimulates blood flow, growth in certain tissues, and the secondary sexual characteristics. In men with prostate cancer, it can also encourage growth of the tumour

Therapeutic
Having to do with treating disease and helping healing take place

Toilet training
The process of teaching a child to control urination and bowel movements

Toileting programme
An individual programme for a client, planned to meet the clients toileting needs and prevent incontinence. There is considerable evidence that individualised management plans can restore continence or greatly improve the quality of life for patients livi

Topical oestrogens
Topical oestrogens are those applied locally to the vagina in the treatment of atrophic vaginitis and may help women who have urinary incontinence resulting from menopause. It can be beneficial in women who have mild stress urinary incontinence

TOT
See transobturator tape procedure

Transobturator tape procedure (TOT)
A procedure used to surgically treat stress urinary incontinence in women. A synthetic mesh (tape) is inserted vaginally to support the mid-urethra. Using the transobturator approach is considered safer than previous techniques used

Transurethral resection of the prostrate (TURP)
Surgical procedure to remove tissue from the prostate using an instrument inserted through the urethra

Trial without catheter (TWOC)
A trial without catheter is when a urinary catheter is removed from the bladder for a trial period to determine whether the patient is able to pass urine spontaneously

Trigone
The triangular area at the base of the bladder where urine enters the bladder via the ureters and leaves the bladder via the urethra

Trigonitis
Inflammation of the trigone

TURP
See transurethral resection of the prostate

TVT
See tension-free vaginal tape

TWOC
See trial without catheter

U

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UKCS
See United Kingdom Continence Society

Ultrasound
A diagnostic technique, which uses high-frequency sound waves to create an image of the internal organs

United Kingdom Continence Society (UKCS)
The society seeks to promote research in the field of continence promotion in new researchers and to this end has a system of grant and bursaries. The activities of the society revolve round the annual scientific meeting

Urea
The main nitrogen-containing waste product in urine, arising from protein metabolism. Its concentration in blood can be used as a measure of kidney function

Urease
An enzyme that breaks down urea

Ureter
The muscular tubes about 8-12 inches long, one on either side, that carry urine down to the urinary bladder

Urethra (female)
The tube 3 to 5 cm in length, through which urine leaves the bladder. The female urethra extends from the bladder to the urinary opening at the vulva

Urethra (male)
The tube approximately 20cm in length, through which urine leaves the bladder. The male urethra extends along the length of the penis. It also conveys the seminal fluid

Urethral caruncle
A urethral caruncle is a soft, red fleshy protrusion of the urethral lining from the urethral opening. It is believed to be due to the prolapse of the posterior wall of the urethra. A caruncle generally does not cause symptoms and occurs in postmenopausal

Urethral caruncle
A urethral caruncle is a soft, red fleshy protrusion of the urethral lining from the urethral opening. It is believed to be due to the prolapse of the posterior wall of the urethra. A caruncle generally does not cause symptoms and occurs in postmenopausal women

Urethral catheterisation
The process of inserting a catheter into the urinary bladder via the urethra

Urethral meatus
Exterior opening of the urethra. The urinary meatus is located at the tip of the penis in men and in front of the vaginal opening in women

Urethral sphincter
A ring-like muscle that is normally tight, and when relaxed allows urine to flow from the bladder

Urethral stricture
A urethral stricture is a narrowing of the urethra caused by injury or disease

Urethrocele
Prolapse of the urethra into the vagina

Urge urinary incontinence
Urge urinary incontinence is the complaint of involuntary leakage accompanied by or immediately preceded by urgency (ICS, 2002)

Urgency
Urgency is the complaint of a sudden compelling desire to pass urine, which is difficult to defer

Urinalysis
Analysis of the urine as an aid in the diagnosis of disease

Urinary catheter
A flexible tube for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for inserting into the bladder through the urethra to remove urine

Urinary drainage sheath
A sheath for the penis, similar to a condom. It is attached to a tube and bag which collects urine as it drains away. Also called penile sheath, external male catheter or condom catheter

Urinary frequency
Increased daytime frequency is the complaint by the patient who considers that he / she voids too often by day. This term is equivalent to pollakisuria used in many countries (ICS, 2002)

Urinary incontinence
Urinary incontinence is the complaint of any involuntary leakage of urine (ICS, 2002)

Urinary retention
See acute retention of urine and chronic retention of urine

Urinary tract infection (UTI)
An infection in the urinary tract caused by the invasion of disease-causing micro-organisms, which proceed to establish themselves, multiply, and produce various symptoms in their host. Infection of the bladder, better known as cystitis, is particularly c

Urinary urgency
Urgency is the complaint of a sudden compelling desire to pass urine, which is difficult to defer (ICS, 2002)

Urination
See voiding

Urine
Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra

Urine flow rate
Urinary flow rate is the volume of urine passed in a certain time, measured in mls per second. It is usually measured electronically, for which, several types of equipment are available

Urodynamic stress incontinence
Urodynamic stress incontinence is noted during filling cystometry, and is defined as the involuntary leakage of urine during increased abdominal pressure, in the absence of a detrusor contraction Urodynamic stress incontinence is now the preferred term to

Urodynamic studies
Tests in which the bladder is filled with fluid, and pressures in the bladder and urethra are measured during filling and emptying. It is an important means of finding out why a person is incontinent

Uroflowmetry
A urodynamic test that measures urine flow either visually, electronically, or with the use of a disposable flowmeter unit

Urogenital system
See Genitourinary system

Urogynaecologist
A surgeon who has been trained in the full range of investigations and treatments required for the management of pelvic floor disorders

Urogynaecology
Urogynaecology is a surgical sub-specialty of urology and gynaecology, treating women with urinary incontinence and prolapse of the bladder, vagina and/or uterus

Urologist
A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system

Urology
A medical specialty that deals with disturbances of the urinary (male and female) and reproductive (male) organs

Urostomy
Urostomy is an operation that is carried out to divert the normal flow of urine from the kidneys. Urine is diverted away from the bladder and into a specially created stoma. The individual will then drain urine through the stoma, completely bypassing the

Uterine prolapse
Uterine prolapse is falling or sliding of the uterus (womb) from its normal position into the vaginal area

Uterus
The womb. The pear-shaped organ in women that holds and nourishes the growing embryo and foetus

UTI
See urinary tract infection

V

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Vagina
The canal in the female which leads from the uterine cervix to the external genitalia

Vaginal dryness
See atrophic vaginitis

Vaginal tape See tension-free vaginal tape (TVT)
tape See tension-free vaginal tape (TVT)

Vaginal vault prolapse
Vaginal vault prolapse occurs when the upper portion of the vagina loses its normal shape and sags or drops down into the vaginal canal or outside of the vagina. Vaginal vault prolapse is a common complication following vaginal hysterectomy

Vaginbal weighted cones
Vaginal weighted cones are small weights which. can be used by women as an adjunct to pelvic floor muscle exercises

Vaginitis
Inflammation of the vagina, often characterized by redness, irritation, itching and / or discharge. Vaginitis may be caused by a variety of factors for example, bacteria, candida, and hormonal changes

Valsalva manoeuvre
A manoeuvre used to greatly increase intra-abdominal pressure and attempt to enable bladder emptying by straining, which involves inhaling deeply and then exhaling forcefully against a closed glottis

Vasopressin
See antidiuretic hormone (ADH)

Vesico-vaginal fistula
A vesico-vaginal fistula is a medical condition where there is a fistula or abnormal connection between the bladder and the vagina. That results in the continuous drainage of urine into the vaginal vault

VFC
See volume / frequency chart

VFR
See voiding flow rate

Videocystometry
Videocystometry is a urodynamic investigation which allows visualization of the moment of leakage during cough and straining tests, in combination with cystometry, and provides information on other abnormalities of the lower urinary tract

Void
Evacuate, excrete or discharge from the body

Voiding
Urinating. Sometimes also called 'peeing' or 'passing water'

Voiding flow rate (VFR)
The volume of urine measured in ml, expelled via the urethra over time, measured in seconds. This is expressed as ml per second (ml/s)

Voiding symptoms
Symptoms which are experienced during the voiding phase

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Watchful waiting
Watchful waiting refers to seeing whether symptoms progress, stay the same or clear on their own before undergoing medical or surgical treatment. Watchful waiting is a phrase that is used in reference to urology conditions including kidney stones, mild urinary tract infections, early-stage kidney cancer, an enlarged prostate, and prostate cancer

WHO
World Health Organisation

References

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Button D, Roe B, Webb C et al 1998, Consensus Guidelines: Continence promotion and management by the primary health care team. London, Whurr

Bowel Continence Nursing. Edited by Christine Norton and Sonya Chelvanayagam.
Beaconsfield Publishers Ltd, 2004

Promoting Continence. A Clinical and Research Resource, second edition.
Edited by Kathryn Getliffe and Mary Dolman.
Bailliere Tindall, 2003

The Standardisation of Terminology of Lower Urinary Tract Function: Report from the Standardisation Sub-committee of the International Continence Society. Neurourology and Urodynamics 21:167-178 (2002)

World Health Organisation (1997) Female Genital Mutilation: A Joint WHO/UNICEF/UNFPA Statement. WHO, Geneva

Clinical Advice by
Wendy Colley OBE
Clinical Resource Manager