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BOWEL CONTINENCE NURSING
Edited by Prof. Christine Norton and Sonya Chelvanayagam

This book is to be welcomed as it gives a comprehensive overview of the complexities involved in caring for and supporting patients with bowel continence problems.  As the authors state, patients with a bowel disorder frequently report difficulty in discussing their symptoms, and as a result can feel misunderstood by the professionals responsible for their treatment.  There are useful examples of patient assessment questionnaires and teaching tools, and extensive references for further reading after each topic.  Patient stories are used to illustrate the need for physical and psychological approaches to symptom management.  The specialisation and developments in stoma care, colorectal and gastroenterology nursing are excellent, but increase the risk of fragmented care if each specialist concentrates on their own area of concern. The book offers an invaluable resource to nurses in any setting, and at all levels of experience, who encounter patients with bowel continence problems.                            Nursing Standard

The editors of this excellent book have brought together a formidable array of multidisciplinary contributors to help make Bowel Continence Nursing accessible and readable to a range of professions. There are 23 chapters on topics including understanding normal bowel function, disordered bowel patterns, how to do a full assessment on patients with faecal incontinence, and what further investigations and treatment options are available. Conservative treatment of faecal incontinence is included as well as surgical interventions. There is a chapter on constipation and another on psychosocial aspects for patients with faecal incontinence. The subjects are wide-ranging and comprehensively covered, and the book is well laid out and easy to read. There are numerous diagrams, illustrations and photographs, and the text is well referenced. Appendix II contains useful addresses and websites. This book is an excellent resource. I highly recommend it to physiotherapists and students working in women's health, and of course, nurses, as the title suggests.         
                     Journal of the Association of Chartered Physiotherapists in Women's Health

The main aim of this text is to provide an evidence base for teaching and practice related to care of people with bowel problems and, more specifically, faecal incontinence. Professor Christine Norton, who will be well known to readers of this journal, has worked in the area of continence since 1979 and was the first Director of the Continence Foundation in the United Kingdom. She practises as a nurse consultant (bowel control) at St Mark's Hospital in London and is an honorary Professor of Nursing in the Florence Nightingale School of Nursing, King's College, London. Her co-editor, Sonya Chelvanayagam, qualified first as a registered mental health nurse and subsequently as a registered general nurse. She worked for several years with patients with faecal incontinence as a research assistant to Professor Norton, and is currently a senior lecturer in mental health at the University of Hertfordshire.
   
The editors have brought together an impressive group of nursing, medical and allied health authors who provide a basis for a detailed understanding of normal as well as disordered bowel function, including constipation and faecal incontinence.
   
There are 23 chapters on topics including the physiology of defecation and continence, the epidemiology and causes of faecal incontinence, rectal bleeding, common ano-rectal conditions, health assessment and diagnostics, and treatment options (conservative, pharmacological and surgical). There are also several chapters that address the assessment and treatment options for specific groups of people with bowel dysfunction such as those with neurological disorders, children, older people and people with an intellectual disability. A major strength in the book is the chapter that addresses the psychological and social impact of faecal incontinence, which is enriched by the use of personal narratives of people with experience of this condition. The themes developed in this chapter are revisited throughout the book and remind us of the complexities involved in caring for and supporting people with bowel continence problems.
    The book is well laid out and easy to read, with a detailed index. Each chapter is comprehensive and has an extensive and up-to-date reference list. There are numerous tables, diagrams, illustrations and photographs, as well as useful examples of patient assessment questionnaires and teaching tools. Where relevant, each chapter identifies the current evidence on a particular topic and makes recommendations for further research.
   
The book is written largely from the perspective of the UK (although there are three Australian authors) and the website and other resources listed in an appendix are all from the UK. However, the content is readily applicable to Australian and New Zealand practice settings.
   
This book is an excellent resource. Focusing specifically on the bowel, it addresses issues that are frequently inadequately addressed in general continence texts. I highly recommend it to nurses, physiotherapists and other health professionals at all levels of experience (including students) who work with people who have bowel dysfunction or faecal incontinence.
                                             
Australian and New Zealand Continence Journal

BOWEL CONTROL: Information and Practical Advice
Prof. Christine Norton and Prof. Michael A. Kamm

Refreshing guidance on an all too common problem …
This is a very welcome and much needed book written by two well known experts in the field of coloproctology from St Mark’s Hospital in Harrow, Middlesex. It is intended mainly for the public and patients with faecal leakage or incontinence, but it is also an excellent book for nurses and GPs wishing to pick up tips to advise their patients. The text offers advice about how to explain the problem of faecal incontinence in lay terms.
    It is a small softbacked book which nevertheless manages to cover comprehensively issues such as normal bowel function and the causes, tests and treatment for bowel leakage, including dietary advice, drug therapy, exercise, complementary therapies and how to deal with skin soreness, wind and smells. The glossary of terms, association addresses and further reading is indispensable.
    Easy to read with colourful illustrations to break up the text, this book will be affordable for most people. One of its most appealing aspects is that it is written to allow someone with this problem to think that they are not alone, that there is nothing to be embarrassed about and that there many things which can be done to help or even to completely overcome the problem.
    Faecal incontinence is not uncommon and it is likely that there are many people suffering who are too embarrassed or frightened to tell anyone. This book gives the patient the knowledge and confidence to seek advice from their GP or practice nurse in the first instance. There have been many books written about urinary incontinence, so it is refreshing to see this informative, practical and easy-to-read book on the subject of bowel leakage.                                                                                                                             Nursing Standard

The loss of bowel control, also known as faecal incontinence, can be a devastating problem. There can be few things more embarrassing than a bowel accident that other people notice, and few conditions that create so much anxiety.
    A new book – written by two specialists from St Mark’s Hospital, London – gives helpful advice about this difficult problem.
    Faecal incontinence affects men and women of all ages. Many people go untreated because they are too embarrassed to ask for help. This is a pity because there are many effective treatments available. There is no right answer to the question of how often the bowel should be emptied – some people open their bowels every day, others only every few days. Faecal incontinence is much more common than most people realise because it is rarely discussed – even among close friends.
    Always seek help – your doctor will have seen many similar cases!  Many surgeries employ a continence nurse who will be able to advise you.
    For more help, contact The Continence Foundation, 307 Hatton Square, 16 Baldwins Gardens, London EC1N 7RJ. Talk to a specialist nurse on their helpline, open Monday to Friday 9.30am to 1pm, on 0845 345 0165.
                                                                                                                             Yours

This easy-to-read and informative booklet aims to give information about possible causes and treatments for bowel incontinence and provide ideas on practical self-help measures. The contents include information about how to seek help for the problem, available management options, and what to expect from treatment.                                                                         Newsletter, National Association for Continence, USA

This book is long overdue and is most welcome to all Inflammatory Bowel Disease (IBD) sufferers with lack of bowel control. As well as describing the complexity of symptoms associated with faecal incontinence, it contains extensive practical advice. Well laid out chapters with clear headings and illustrations make it easy to read and to understand. A description of normal bowel function is followed by an explanation of the causes of bowel leakage as well as the difference between leakage and total lack of control.
    A common problem with lack of bowel control is soreness and irritation of the skin. This subject is dealt with sensitively. Probably the most useful tip in the book was one of the simplest. This is to take a couple of clothes pegs wherever one goes as they may help to keep clothes out of the way in the event of cleaning up after an ‘accident’. In conclusion, this book should be made available as soon as possible to all IBD patients with a bowel control problem.

                                                                                                                        NACC News

Written by a continence nurse and a consultant gastroenterologist, on thick glossy paper with liberal colour illustrations, this is a patients’ information booklet. It starts with descriptions of the mechanics of bowel function, works through ways of curing or improving faecal incontinence, and progresses to dealing with soreness and flatulence, and protective clothing for leakage and soiling. There are lists of useful addresses and suggestions for further reading.
  
Like many booklets for patients, its strengths include providing clear explanations for which some readers cannot ask, and assuring them that they are not alone in their affliction – many people have the same problem (one person in 50 has difficulty with bowel control, with a bias towards women and elderly people).
    The authors show obvious empathy with sufferers and make it clear that they understand their main cause of anxiety is not frequency or volume of incontinence, but the fact that it can happen at all.
 
                                                                                                                      Physiotherapy
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HYSTERECTOMY, VAGINAL REPAIR, AND SURGERY FOR STRESS INCONTINENCE,  5th Edition
Sally Haslett, RGN,RHV,RM,  Molly Jennings MCSP,RSP, Hilary Walsgrove RGN,DPSN,BSc and Wendy Weathritt MCSP,SRP

This booklet has proved its worth over and over again. It will give you all the information you want to tone up before and after your operation.
Woman's Realm
                                                                                                           
The inclusion of Surgery for Stress Incontinence in the title may be helpful for patients in distinguishing between procedures designed purely to correct prolapse and those which aim to prevent involuntary urine loss. ... It is eminently readable, provides valuable information for women undergoing gynaecological surgery and the text is accompanied by clear illustrations of the various activities.  It is to be highly recommended as a valuable resource for both patients and health professionals.
Journal of the  Association of Chartered Physiotherapists in Women's Health                              


This new version updates the previous one in several beneficial ways. The optimal preparation for a patient about to undergo a hysterectomy, or surgery for prolapse or incontinence, can be challenging for the physiotherapist. The pre-, peri- and post-operative care requires a broad perspective and the compilation of much practical and clinically-based information on the part of the physiotherapist. This booklet has assembled all of that in an easy-to-read, clearly illustrated format, written in a language that will appeal to patients and therapists.
    Therapists working in this area will know that significant variations in pre- and post-operative protocols exist between surgeons, hospitals, locations, and differ due to individual patient needs and therapist availability. Therefore some therapists will find the advice offered differs from their own practice, or that of the surgeons whom they work with. However the breadth, thoroughness and practicality of advice contained in the book is welcome, as there is a lack of both evidence-based practice and clinical guidelines in this area. In addition to the information provided in the book, therapists could supplement their patient advice with information from up-to-date professional text books, and outcomes from clinical trials and evidence, where it exists. A trickle of information from clinical research in this area is starting to appear, and should provide evidence-based support to the practical advice provided in this booklet. Knowledge in some areas of health care is expanding rapidly, and hormone replacement therapy (HRT) is one of those. The treating physiotherapist may wish to flag to patients that the advice in this booklet may need to be verified with their medical care-giver, in order to ensure the most relevant and up-to-date advice is being followed.
    There are a few minor items in this booklet related to post-operative advice which some therapists may vary from. While traditionally taught, post-operative coughing to clear secretions may not sit comfortably with all clinicians following pelvic repair surgery. Huffing is preferred by some therapists, unless a strong indication of retained secretions is present. A minor detail perhaps, but I prefer the title “the pelvic floor muscle exercise” to “the pelvic floor exercise” when referring to the title of what is being taught. From then, it may be easier to use the shorter phrase, once this is clear what the exercise is. Five to six sessions of pelvic floor muscle (PFM) exercises per day may be a challenge in the early post-operative days / weeks for some patients, so this may need to be individually tailored. Long-term, and even short-term compliance with PFM exercises can be an issue for many patients. The treating therapist may like to supplement the booklet with some suggested strategies to increase adherence to desired exercise levels. Advice to avoid stop-start of flow when voiding could be added to the “bladder care” section. While extremely useful, the patient (and therapist) resources listed at the completion of the book are specific for U.K. readers. No doubt Australian readers would welcome a short list of local resources which they could access. Perhaps the treating physiotherapist could supply a loose leaf sheet to add to this book for her own patients.
    The number of Australian women who undergo hysterectomy or have surgery for prolapse or incontinence each year is high. Opportunities for patients to consult a women’s health physiotherapist can be extremely limited in parts of Australia, including large metropolitan hospitals. Access to an inexpensive, useful booklet would be a bonus to the many women who would not otherwise receive any women’s health physiotherapy input.
    Overall, this is an excellent, comprehensive booklet, the best I have read in this area. My recommendation is to have a copy of this booklet in your practice / department / ward, as well as order forms for patients to purchase their own copy, to assist in their preparation for and recovery from their surgical episode.
Newsletter of the Continence and Women’s Health Group, Australian Physiotherapy Association

This booklet is highly relevant to women, and their families, facing this type of surgery.  It will address many of the issues that patients may have failed to ask about in clinics when faced with the prospect of surgery.  Whilst a professional may think that they are aware of all the issues covered, reading this booklet helps to focus the consultation and provide practical information the patient requires.  Patients would find this an excellent and well thought out reference point, which will promote their long-term mental and physical wellbeing post-operatively.  Journal of Family Planning and Reproductive Health Care

Everything you ever wanted to know about hysterectomy or vaginal repair has been skilfully compressed into this superb booklet.  Sally Haslett is a nurse, midwife and health visitor, and Molly Jennings is a physiotherapist in obstetrics and gynaecology, and their booklet is the result of considerable experience at St Thomas' Hospital, London, working with women who are having these operations.  The booklet is packed with the answers to such questions as: Will I put on weight or suffer from depression?  Will I still have periods or need contraception?  Will it affect my sex life?  Considerable attention is paid to exercises and activities that will speed the return to normal life, and lots of diagrams and photographs help to explain it all really lucidly.
 WomanTop
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LYMPHOEDEMA: ADVICE ON TREATMENT, 2nd Edition
Dr Claud Regnard, Caroline Badger RGN, Dr Peter Mortimer
This is the second edition of a booklet written by two doctors and a nurse about the management of lymphoedema.  While this distressing condition cannot be cured, it can be treated.  The aim of treatment is to improve the drainage of the lymph fluid that is constantly present in the tissues under the skin and so to reduce the swelling, tightness and aching experienced.  The aim is to reduce the swelling, tightness and aching experienced.  Detailed advice on a daily routine of self-help is given: how to look after the skin; how and when to wear compression sleeves or stockings; how to improve drainage by positioning and moving the limbs in the right way; what exercises to undertake; and how to do simple self-massage.  Illustrations give help where appropriate. ... This little booklet is a model of a guide to self-help.
Patient Voice

This booklet aims to improve the patient's understanding of the physiology behind lymphoedema, and to give her or him a treatment routine to minimize the problem.  It succeeds admirably in both these aims by drawing together the talents of physiotherapist, lymph drainage specialist and physician to offer information and therefore hope for sufferers.  It points out that no one treatment modality will be sufficient to deal with lymphoedema, so all therapies should be used daily. ... Family doctors advising lymphoedema patients can confidently offer this book as a straightforward account of the condition and how to deal with it as effectively as possible.   
Find out more about the book          Family Practice

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NURSING FOR CONTINENCE, 2nd Edition
ed. Prof. Christine Norton, PhD,RGN
A decade has passed since Christine Norton's Nursing for Continence was first published.  It is invigorating to see the second edition of this very popular book. There have been many developments in the continence field during the intervening years and it is heartening to see the author involve other clinical nurse specialists in revising the content.  Particularly encouraging is the fundamental message that all contributors portray -- continence promotion gets results! -- and they all enhance the author's proactive approach.  A basic nursing theme, that continence assessment is a core nursing skill, runs throughout. ... In summary, the book is a must not only for nursing libraries but also for other professionals involved in all aspects of healthcare.   It is a very practical aide for learners and experienced workers alike.
Newsletter, Association for Continence Advice

This research-based, comprehensive and very practical book draws on the expertise of a panel of leading continence nurse specialists.  It covers the whole practice population, including enuretic children, new mothers with stress incontinence, and older men who have an enlarged prostate.  I am sure that this title, now in its second edition, will prove to be an invaluable resource for any general practice, not only to the practice nurse but to the whole primary care team.
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ORAL MORPHINE IN ADVANCED CANCER, 3rd edition
Dr Robert Twycross

The management of pain in advanced cancer poses great challenges for health care professionals - challenges which are not always overcome. ... With better knowledge, however, of the available treatments - not least oral morphine - the improvement in the results obtained can be striking. This excellent little book, now in its third edition, aims to contribute to this improvement in knowledge on the part of health care professionals. ... It is easy to read and understand, and the question and answer style makes it easy to locate specific information quickly. In short, excellent value for money and an essential part of any ward's library.       Journal of Advanced NursingTop Find out more about the book


TRAVEL FIT: Essential exercises for when you travel
Damian Honey, MCSP, SRP and Penny Catt, MCSP, RSP
This new booklet has been researched and written by two chartered physiotherapists as a guide for travellers on how to stay comfortable during travel and avoid skeletal or postural problems which may arise from sitting in a confined space for a long period.  This is a useful booklet for reference or to direct travellers to.  It is also of use to those working at a desk and sitting immobile for long periods of time.
Royal College of Nursing Travel Health Bulletin
                                                                            

Advice is given on good posture during travel to avoid stiffness and discomfort and general exercises to assist this are described.  The book refers to the risk of deep vein thrombosis (DVT), rightly drawing attention to the fact that the risk of DVT is not confined to air travel or to economy class travel.  General advice is given to help to avoid this risk and exercises are described, including exercises carried out against resistance to increase venous blood flow.  All exercises are illustrated with photographs.  Finally there is an appendix giving information on the nature of DVT and the predisposing risk factors associated with it, with advice about measures in addition to exercise.  There is little to criticise about this book.
Travel Wise (British Travel Health Association)

Exercise Guide for Travellers ... A handy guide for travellers has just been published by two physiotherapists.  Penny Catt and Damian Honey are both chartered physiotherapists with neuromusculosketal experience and an interest in posture and exercise.  Their illustrated 40-page booklet has been written for 'anyone who is taking a long journey, whether by car, coach, train or plane'.  An appendix gives an overview of deep vein thrombosis and pulmonary embolus issues.                                                               Frontline
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