AIMS:Patients coming for urodynamics expect those delivering the service to be fully trained, with assurance of competence and quality. This document proposes a single UKCS Certification and Re-certification process for all health care professionals who perform or interpret urodynamics. METHODS:The Working Group of the United Kingdom Continence Society engaged with stakeholders in relevant professional societies and institutions, recirculating drafts until consensus was reached. RESULTS:A process of Certification has been designed to ensure that patients attending urodynamics undergo high quality investigations, the results of which are accurately interpreted, in order to guide both the patient and their clinicians in the patient's future management. CONCLUSIONS:The United Kingdom Continence Society strongly recommends that all urodynamic investigations are carried out by, or under the supervision of, certified individuals. This document presents such a process of Certification and Re-certification that aims to ensure that quality standards are maintained and that patients have high quality urodynamics.

Aim To pragmatically investigate rectal emptying difficulty in women to identify if managing their symptoms with an innovative device is more effective and satisfactory than their usual care. Background Rectal emptying difficulty has a mostly unknown influence on women and frequently a hidden issue. Self-management alternatives are underappreciated. Despite the magnitude of the problem and its influence on women’s lives and healthcare, non-surgical alternatives have received little attention. Methods This cohort study of 35 female participants, recruited via secondary care outpatient clinics, used composite questionnaires before and after an 8-week intervention using the device. The questionnaire comprised of a quality of life instrument (International Consultation on Incontinence Questionnaire-Vaginal Symptoms and obstructed defaecation syndrome questionnaires), bowel diary recordings and participant feedback on using the device. Findings The device helped participants reduce the need to use their fingers (z= −2.844; p≤0.004) and offered participants improved lifestyle. There was significant reduction in difficulties to evacuate (p≤0.004), digitation to evacuate (p≤0.018), the feeling of incomplete evacuation (p≤0.002), straining to evacuate (p≤0.008) and lifestyle alteration (p≤0.046). The sense of incomplete emptying before and after using the device was significant (z= −2.646; p≤0.008), and feeling of being blocked improved (z= −3.317; p≤0.001). Stool consistency did not change. Medication to evacuate, returning to the toilet to evacuate and time needed showed no difference. Twenty-four participants (68.5%) completed the Patient Global Impression of Improvement question postintervention. Overall, 16 participants (66.7%) reported that the device was better than not using it. The results have clinical value, suggesting the device can assist women enhance their quality of life and improve physical symptoms associated with rectal emptying difficulties. Conclusions Most women with rectal emptying difficulty in this study found the device effective when compared with their usual care. Furthermore, it offers an additional conservative measure option within healthcare provision.

Background One-third to half of people with intellectual disabilities suffer from chronic constipation (defined as two or fewer bowel movements weekly or taking regular laxatives three or more times weekly), a cause of significant morbidity and premature mortality. Research on risk factors associated with constipation is limited. Aims To enumerate risk factors associated with constipation in this population. Method A questionnaire was developed on possible risk factors for constipation. The questionnaire was sent to carers of people with intellectual disabilities on the case-loads of four specialist intellectual disability services in England. Data analysis focused on descriptively summarising responses and comparing those reported with and without constipation. Results Of the 181 people with intellectual disabilities whose carers returned the questionnaire, 42% reported chronic constipation. Constipation was significantly associated with more severe intellectual disability, dysphagia, cerebral palsy, poor mobility, polypharmacy including antipsychotics and antiseizure medication, and the need for greater toileting support. There were no associations with age or gender. Conclusions People with intellectual disabilities may be more vulnerable to chronic constipation if they are more severely intellectually disabled. The associations of constipation with dysphagia, cerebral palsy, poor mobility and the need for greater toileting support suggests people with intellectual disabilities with significant physical disabilities are more at risk. People with the above disabilities need closer monitoring of their bowel health. Reducing medication to the minimum necessary may reduce the risk of constipation and is a modifiable risk factor that it is important to monitor. By screening patients using the constipation questionnaire, individualised bowel care plans could be implemented.

Background Constipation is overrepresented in people with intellectual disabilities. Around 40% of people with intellectual disabilities who died prematurely were prescribed laxatives. A quarter of people with intellectual disabilities are said to be on laxatives. There are concerns that prescribing is not always effective and appropriate. There are currently no prescribing guidelines specific to this population. Aims To develop guidelines to support clinicians with their decision-making when prescribing laxatives to people with intellectual disabilities. Method A modified Delphi methodology, the RAND/UCLA Appropriateness Method, was used. Step 1 comprised development of a bespoke six-item, open-ended questionnaire from background literature and its external validation. Relevant stakeholders, including a range of clinical experts and experts by experience covering the full range of intellectual disability and constipation, were invited to participate in an expert panel. Panel members completed the questionnaire. Responses were divided into ‘negative consensus’ and ‘positive consensus’. Members were then invited to two panel meetings, 2 weeks apart, held virtually over Microsoft Teams, to build consensus. The expert-by-experience group were included in a separate face-to-face meeting. Results A total of 20 people (ten professional experts and ten experts by experience, of whom seven had intellectual disability) took part. There were five main areas of discussion to reach a consensus i.e. importance of diagnosis, the role of prescribing, practicalities of medication administration, importance of reviewing and monitoring, and communication. Conclusions Laxative prescribing guidelines were developed by synthesising the knowledge of an expert panel including people with intellectual disabilities with the existing evidence base, to improve patient care.

OBJECTIVE:This scoping review aims to identify interventions used by women for the management of rectal emptying difficulty secondary to obstructive defecation. INTRODUCTION:Rectal emptying difficulty is typically a symptom of obstructive defecation syndrome. Even though a range of interventions are already available for this condition, this review is necessary to increase understanding of what interventions women find useful and are acceptable for them. This depth of understanding will facilitate the development of a specific care pathway to support women living with rectal emptying difficulty secondary to obstructive defecation syndrome. INCLUSION CRITERIA:This review will consider studies that include adult women (over 18 years of age) living in the community who have experienced difficulty with rectal emptying secondary to obstructive defecation and who have not had surgical intervention. Exclusion criteria include prolapse surgery and surgical techniques, oral laxatives, vaginal pessaries, cognitive impairment, pregnancy, and those residing in care homes. METHODS:The databases to be searched include MEDLINE, Embase, CINAHL, PsycINFO, Emcare, AMED, Web of Science, Scopus, PROSPERO, Open Grey, ClinicalTrials.gov, International Clinical Trials Registry Platform Search Portal, UK Clinical Trials Gateway, International Standard Randomised Controlled Trial Number Registry, JBI Evidence Synthesis, Epistemonikos, Cochrane Library, and gray literature. Studies conducted in English from any time period will be considered for inclusion. The titles and abstracts will then be screened by two independent reviewers for assessment against the inclusion criteria for the review.

Aims In 2016, the International Continence Society (ICS) Standardization Steering Committee appointed a working group to address the confusing plethora of synonyms currently used to describe single-use body worn absorbent incontinence products by recommending preferred terminology. Methods An online questionnaire was posted in 2016/17 inviting input from stakeholders internationally. The data were analyzed and conclusions progressively refined through working group discussions, an open meeting at the 2017 annual ICS conference, and a review of further iterations-including from the parent ICS Standardization Committee-until consensus was reached. Partway in, the International Organization for Standardization started a project with similar scope and the two organizations liaised to harmonize their conclusions while respecting each other's processes. Results A hundred people from 18 countries responded to the questionnaire. About a third (32.2%) of those declaring their nationality were from the UK and a further third (34.5%) from other English-speaking countries. Two-thirds (67.8%) lived in Europe; around a quarter (23%) in North America; and 9.2% in Australasia. Seven main design categories of products were identified and, while clear consensus was readily achieved in naming some of them, others required more work to determine the best term among multiple contenders. Conclusions The working group concluded that the seven product design categories should be called: (a) pads; (b) unbacked pads; (c) male pads; (d) male pouches; (e) pull-on pads (protective underwear); (f) all-in-ones (wrap-around pads, adult briefs); and (g) belted pads (belted products), in which the bracketed terms are judged acceptable (though not preferred) alternatives.

Neurourology and UrodynamicsVolume 38, Issue 2 p. 838-856 SOUNDING BOARD United Kingdom Continence Society: Minimum standards for urodynamic studies, 2018 The Working Group of the United Kingdom Continence Society, The Working Group of the United Kingdom Continence Society Southmead Hospital, Bristol, UKSearch for more papers by this authorPaul Abrams, Corresponding Author Paul Abrams paul.abrams@bui.ac.uk orcid.org/0000-0003-2776-2200 Southmead Hospital, Bristol, UK Correspondence Paul Abrams, Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK Email: paul.abrams@bui.ac.ukSearch for more papers by this authorSharon Eustice, Sharon Eustice orcid.org/0000-0002-1538-5594 Cornwall Partnership NHS Foundation Trust, Truro, UKSearch for more papers by this authorAndrew Gammie, Andrew Gammie orcid.org/0000-0001-5546-357X Southmead Hospital, Bristol, UKSearch for more papers by this authorChristopher Harding, Christopher Harding orcid.org/0000-0002-9407-382X Freeman Hospital, Newcastle Upon Tyne, UKSearch for more papers by this authorRohna Kearney, Rohna Kearney orcid.org/0000-0002-1489-4397 St Mary's Hospital, Manchester, UKSearch for more papers by this authorAngie Rantell, Angie Rantell orcid.org/0000-0002-9123-5352 King's College Hospital, London, UKSearch for more papers by this authorSheilagh Reid, Sheilagh Reid orcid.org/0000-0002-8050-7332 Royal Hallamshire Hospital, Sheffield, UKSearch for more papers by this authorDouglas Small, Douglas Small orcid.org/0000-0002-6952-2427 Southern General Hospital, Glasgow, UKSearch for more papers by this authorPhilip Toozs-Hobson, Philip Toozs-Hobson orcid.org/0000-0002-1859-9934 Birmingham Women's NHS Foundation Trust, Birmingham, UKSearch for more papers by this authorMark Woodward, Mark Woodward orcid.org/0000-0002-9808-8842 Bristol Royal Hospital for Children, Bristol, UKSearch for more papers by this author The Working Group of the United Kingdom Continence Society, The Working Group of the United Kingdom Continence Society Southmead Hospital, Bristol, UKSearch for more papers by this authorPaul Abrams, Corresponding Author Paul Abrams paul.abrams@bui.ac.uk orcid.org/0000-0003-2776-2200 Southmead Hospital, Bristol, UK Correspondence Paul Abrams, Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK Email: paul.abrams@bui.ac.ukSearch for more papers by this authorSharon Eustice, Sharon Eustice orcid.org/0000-0002-1538-5594 Cornwall Partnership NHS Foundation Trust, Truro, UKSearch for more papers by this authorAndrew Gammie, Andrew Gammie orcid.org/0000-0001-5546-357X Southmead Hospital, Bristol, UKSearch for more papers by this authorChristopher Harding, Christopher Harding orcid.org/0000-0002-9407-382X Freeman Hospital, Newcastle Upon Tyne, UKSearch for more papers by this authorRohna Kearney, Rohna Kearney orcid.org/0000-0002-1489-4397 St Mary's Hospital, Manchester, UKSearch for more papers by this authorAngie Rantell, Angie Rantell orcid.org/0000-0002-9123-5352 King's College Hospital, London, UKSearch for more papers by this authorSheilagh Reid, Sheilagh Reid orcid.org/0000-0002-8050-7332 Royal Hallamshire Hospital, Sheffield, UKSearch for more papers by this authorDouglas Small, Douglas Small orcid.org/0000-0002-6952-2427 Southern General Hospital, Glasgow, UKSearch for more papers by this authorPhilip Toozs-Hobson, Philip Toozs-Hobson orcid.org/0000-0002-1859-9934 Birmingham Women's NHS Foundation Trust, Birmingham, UKSearch for more papers by this authorMark Woodward, Mark Woodward orcid.org/0000-0002-9808-8842 Bristol Royal Hospital for Children, Bristol, UKSearch for more papers by this author First published: 16 January 2019 https://doi.org/10.1002/nau.23909Citations: 12Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume38, Issue2February 2019Pages 838-856 RelatedInformation

The aim of this paper was to consider the available evidence for the current management of pelvic organ prolapse, which is a common presentation in primary care. However, not all women will present, only presenting when symptoms become bothersome. Particular attention was paid to understanding the problem of rectocele and its influence on obstructive defaecation symptoms. The burden of rectocele and its consequences are not truly known. Furthermore, healthcare professionals may not always enquire about bowel symptoms and patients may not disclose them. Complex emotions around coping and managing stress add to the challenges with seeking healthcare. Therefore, the impact on the lived experience of women who have difficulty with rectal emptying can be significant. The review identified a dearth of knowledge about women living with the problem of obstructive defaecation resulting in the use of digitation. Improving the management of digitation, an under-reported problem, is necessary to improve the quality of life for women. Primary care needs to increase access to conservative measures for women struggling with bothersome symptoms, such as constipation, the need to digitate or anxiety.

British Journal of NursingVol. 26, No. 22 Clinical FocusResponse to Time for a measuring stickSharon EusticeSharon EusticeSearch for more papers by this authorSharon EusticePublished Online:14 Dec 2017https://doi.org/10.12968/bjon.2017.26.22.1224aAboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 14 December 2017Volume 26Issue 22ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 14 December 2017 Published in print 14 December 2017 Information© MA Healthcare LimitedPDF download

Hypothesis / aims of study Toileting assistance programmes involve verbally prompting and/or physically assisting a person to go to the toilet. These programmes target urinary incontinence that may occur as a consequence of a person’s inability to reach and use the toilet or bathroom because of functional or cognitive impairment. The aim is to avoid or minimise episodes of urinary incontinence rather than alter bladder or pelvic floor function. The literature reveals various terms used to refer to toileting assistance programmes, including ‘prompted voiding’, ‘habit retraining’, ‘habit training’, ‘timed voiding’, ‘scheduled toileting’, ‘patterned urge-response toileting’, ‘individualised scheduled toileting’ and ‘systematic voiding programmes’. A synopsis of four Cochrane systematic reviews using meta-study technique on bladder training and toileting assistance programmes indicated considerable variation in the literature about the terms (Roe 2007a; Roe 2007b). Essentially, it has been unclear how these programmes operationally differ from one another and where they partly overlap. Therefore, the aim was to identify, describe and compare the defining features of toileting assistance programmes.

AimsThe working group initiated by the ICS Standardisation Steering Committee has updated the International Continence Society Standard Good Urodynamic Practice published in 2002.MethodsOn the basis of the manuscript: ICS standard to develop evidence-based standards, a new ICS Standard was developed in the period from December 2013 to December 2015. In July, a draft was posted on the ICS website for membership comments and discussed at the ICS 2015 annual meeting. The input of ICS membership was included in the final draft before ICS approval and subsequent peer review (for this journal).ResultsThis evidence-based ICS-GUP2016 has newly or more precisely defined more than 30 terms and provides standards for the practice, quality control, interpretation, and reporting of urodynamics; cystometry and pressure-flow analysis. Furthermore, the working group has included recommendations for pre-testing information and for patient information and preparation. On the basis of earlier ICS standardisations and updating according to available evidence, the practice of uroflowmetry, cystometry, and pressure-flow studies are further detailed.ConclusionICS-GUP2016 updates and adds on to ICS-GUP2002 to improve urodynamic testing and reporting both for individual care and scientific purposes.

Despite the growing prevalence of incontinence and the recognition that it is a significant factor in admissions to hospitals and residential care, continence care is receiving less funding. This article compares the findings of a continence care survey undertaken in 2007 with one published in 2013. The survey shows there has been a reduction in numbers of specialist continence staff, particularly senior posts, an increased number of patients seeking help, a decrease in funding, fewer continence products being supplied and growing waiting lists.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The objective of the review is to determine the effectiveness of toileting assistance programmes for managing urinary incontinence in adults.

Many specialist clinicians in the field of continence have preached about the importance of clinical assessment, yet it is still poorly done and services struggle to enthuse frontline clinicians of the importance of classifying common conditions that lead to the symptom of incontinence. A recent Royal College or Physicians audit of continence care in older people across the United Kingdom (UK) found that care was inadequate for the over 65s (Wagg et al, 2006). Even if guidelines for best practice are available, education must accompany this to support staff in delivering therapeutic care (Coffey et al, 2007).

Nocturia has been defined as one or more voids [of urine] at night, each of which is preceded and followed by sleep (Abrams et al, 2002; van Kerrebroeck et al, 2002). It is a condition that can influence health status and quality of life; for example, daytime sleepiness can occur as a result of loss of sleep at night, and the resultant loss of energy can render many older people prone to accidents, such as falls (Box 1).

The purpose of this paper is to share the lessons learnt from a clinical experience that involved a woman who developed difficulties passing urine after the birth of her second child. Maximising learning is a crucial aspect of health professionals' work in an increasingly litigious society where the NHS regularly receives negative publicity and staff fear prosecution (Department of Health, 2001).