Good Counsel on Continence
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S he calls herself a huge patient advocate — a gatekeeper for urinary incontinence. In addition to her responsibilities in a hospital-based outpatient wound care center, she helped establish an incontinence clinic at a women’s healthcare center that features a straightforward, practical approach to treatment. Although she sees mostly women, she also has earned the trust of male patients by respecting their concerns regarding problematic urinary issues. In short, JoAnn Ermer-Seltun has, as she puts it, “a passion for pee.”
When JoAnn Ermer-Seltun, RN, MS, FNP, CWOCN, graduated from the Tucson (Ariz.) Medical Center’s Enterostomal Therapy program in 1999, she was “totally ostomy and wound.” Doing home care in Mason City, Iowa, she saw that many skin issues were related to incontinence. She used simple behavioral techniques to address these problems, which gradually increased her knowledge and her ability to manage patients who suffered from incontinence. She pursued a Masters degree and certification as a family nurse practitioner in order to obtain greater autonomy and better impact the care of patients with incontinence or wounds.
Two afternoons a week, JoAnn works at the continence clinic she and Susan Sieh, MD, established at Mercy Medical Center- North Iowa Women’s Health Center in Mason City. JoAnn has come to believe that urinary incontinence is the most under-reported and under-diagnosed medical condition. She follows basic pharmacological and behavioral approaches to manage incontinence and often prescribes a pessary. Adjunctive therapies or diagnostics such as biofeedback and urodynamics are outsourced.
“You can’t and don’t have to do it all, “ JoAnn says. She works with Urology and an OB-GYN when she feels she has done everything she can for a patient when advanced diagnostics or surgical evaluation are necessary.
“Women come to me having had UI for long periods of time,” JoAnn says. “They’ll tell me they’ve been ‘managing’ when actually they’re just tolerating the situation. Frequently, their healthcare providers aren’t sure what to do, especially when these patients may have more pressing medical problems. Incontinence is comparatively a quality-of-life issue. By addressing some of the small, intricate details of management, I can make their lives better.”
Every patient participates in a fluid modification program; fluid amount (too little or much) and the types of fluids consumed affect continence. Before JoAnn evaluates patients, she has them keep a 3-day “uro-log” that documents types of beverages, frequency and quantity of consumption, and quantity and frequency of voids and leakage. She also has patients complete a questionnaire about bladder control. She compares the uro-log to the questionnaire to see if they match and recommends behavioral modifications accordingly. “Sometimes, simply increasing or decreasing fluids or changing the type of beverages consumed can make a big difference,” she says. “This is within the scope of WOC nurses.”
Her other “ace in the hole” (as she calls it) is urge inhibition and bladder retraining — ie, encouraging patients not to respond every time their bladders give them a little twinge while retraining the bladder “to go” according to a prescribed schedule. She says most of the time, no medication is needed if patients are attentive to bodily signals and follow the bladder-retraining schedule.