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Janice Reid Continence Services Manager Western Health & Social Care Trust

Percutaneous Tibial Nerve Stimulation (PTNS) – Improving outcomes for women with Faecal Incontinence. Janice Reid Continence Services Manager Western Health & Social Care Trust. LSA Midwifery Conference Mossley Mill. Aim of Presentation.

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Janice Reid Continence Services Manager Western Health & Social Care Trust

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  1. Percutaneous Tibial Nerve Stimulation (PTNS) – Improving outcomes for women with Faecal Incontinence Janice Reid Continence Services Manager Western Health & Social Care Trust LSA Midwifery Conference Mossley Mill

  2. Aim of Presentation PTNS, the Continence Nurse Specialist and the Patient…. the journey to success together ROAD TO SUCCESS

  3. Lets start with the problem... 6.5 million people in UK today with some kind of bowel problem

  4. Faecal Incontinence is.. Involuntary leakage of • Solid matter • Liquid • Gas (anal incontinence)

  5. Causes • Damage to the rectum or anus • Bowel motility problems • Stool consistency problems • Neurological damage e.g. motor/sensory, MS, Diabetes, post hysterectomy

  6. Impact of Faecal Incontinence • 20 – 30 referrals per year • Limited treatment options • Incontinence still taboo • Social stigma

  7. Let me introduce PTNS… • A first for Northern Ireland • Urgent PC neuromodulation system - uses established technique of electrical stimulation • Can be implemented by specialist nurses in a clinic setting

  8. What’s the evidence? • 78.2% improvement in patients with FI treated with PTNS on alternate days for 4 weeks (Shafik et al 2003) • 17 patients with FI treated with PTNS for 6 weeks – significant improvement in continence scores (Govaert et al 2008) • 100 patients – urge, passive and mixed FI. Statistically significant improvement in mixed & urge (Hotouras et al 2011)

  9. PTNS TREATMENT

  10. Getting started • Funding • Training • Competency framework • Care pathway • Evaluation strategy

  11. Challenges • New to NI – training issues? • New treatment - no long term data

  12. Enablers • The ethos of Transforming Your Care • A focused and motivated team of specialist nurses with a desire to improve the lives of patients with Faecal Incontinence

  13. Case history 1 • 58 yr old nulliparous lady – mixed urge and passive FI • Very weak anal tone / Pelvic floor contraction • After treatment - incidence of FI reduced by 50% • Significant improvement in QoL

  14. Case history 2 • 38 yr old para 1 • Faecal urgency/incontinence/flatus • Weak anal tone • After treatment – 40% reduction in incontinent episodes / flatus now controlled

  15. From the patient….. My life is transformed – thank you I was practically housebound before – I feel I have my life back

  16. From the patient….. For the first time in years I had the confidence to go out for a family meal

  17. In summary… • PTNS – safe, well tolerated, minimally invasive procedure • Significant reduction in Faecal Incontinence episodes • Less medication, less pads • Impact on Quality of Life

  18. Lessons learnt…… • Ask questions!!! • Keep in mind that FI is a symptom – often with multiple contributory factors • Keep the patient as the focus • Never be afraid to act on your vision

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