The COLLEY MODEL
Supporting the continence assessment process in adults
The Colley Model is not intended to replace a specialist continence or bladder assessment, or advice from a doctor or other health care professional. It has been developed as a support to those working in any care setting when carrying out an initial assessment of bladder symptoms in adults. The overall aim of the model is to assist those assessing an adult with continence problems to identify the underlying cause or causes of the symptoms and implement positive treatment or referral. The assessor can refer to the model if needed when using the specific Assessment Form on this website.
Please note: This model will not be suitable for certain groups of people with complex bladder needs such as those with spinal cord injury and those having undergone gender reassignment surgery. Patients with multiple symptoms and underlying complications should be referred to the local Bladder & Bowel Service.
The model highlights symptoms which could be due to underlying, serious pathology, using ‘red flags’. The assessor must take action to ensure such findings are investigated. These are further explained by clicking onto the numbered or starred boxes where the flags appear.
A specific Glossary for use with the Colley Model is available on this website and can be found here.
Those with some previous knowledge of this topic can dip in and out of the model to reinforce their findings, or look for treatment options when the diagnosis is clear.
The Colley Model & associated notes are subject to copyright. © Wendy Colley OBE, 2020.
The model is for printing by individuals only. Any organisation or company wishing to reproduce the model should contact: firstname.lastname@example.org
TYPES OF URINARY INCONTINENCE
The model is based on the common types of urinary incontinence seen in all care settings which are:
Stress urinary incontinence
Urgency urinary incontinence – can be a symptom of overactive bladder syndrome
Mixed urinary incontinence – when stress urinary incontinence and urgency urinary incontinence occur in the same individual
Overflow urinary incontinence – due to voiding difficulty (bladder outlet obstruction or underactive detrusor), and
Functional urinary incontinence (disability associated urinary incontinence)
Accurate diagnosis is the key to a successful outcome for the patient and bladder symptoms may have more than one underlying cause and contributing factors. An individual, holistic approach which considers realistic outcomes and gives most benefit to the patient, will promote compliance with the treatment plan.
The Excellence in Continence Care document (NHS England, 2018) suggests the ‘assessment of patients using three simple tests: urine test/ bladder/bowel diary and bladder scan’ as one way Commissioners can use to measure local continence pathways. These are not ‘simple’ tests but tests which require accuracy in undertaking and skill in interpreting the results. Not everyone has access to a bladder scanner, but if there is any doubt as to whether or not the patient is emptying the bladder, advice from the local Bladder & Bowel service must be sought. The bladder scan is included under ‘Observation / Physical examination’ (please see the notes referring to blue box number 6), but it is relevant to also refer to blue box number 12 in the second column of the model.
Prior to assessment the assessor must obtain consent from the patient and offer a chaperone, in line with local policies. Each patient is first assessed for stress urinary incontinence and responses appear in the orange coloured boxes. If there are no other symptoms, there is no need to continue but look at the contributing factors and implement a treatment plan. In this instance, for completion it would be useful to have performed a bladder scan for residual urine. Patients with stress urinary incontinence only, would not be expected to have any significant residual urine.
REMEMBER, this is the start. Regular re-assessment must be planned to measure progress, adjust treatment regimens and consider referral if progress is not being achieved.
Click on each numbered blue box for further explanation and instruction and starred boxes for specific contributing factors and treatment. ALWAYS refer the patient for specialist advice from a GP or the local Bladder & Bowel Service if in any doubt whatsoever.
References and further reading:
Colley, W., 1991. The Colley Model. Nursing Times, 87(7), pp. 61-63.
Colley, W., 1996. Charting New Waters. Nursing Times, 92(24), pp. 59-68.
NHS England, 2018. Excellence in Continence care: Practical guidance for commissioners, and leaders in health and
social care, s.l.: Publications Gateway Reference: 08266
Unplanned Admissions Consensus Committee, 2019/2020. Best Practice Guide, 4th edition