Urinary incontinence (UI) assessment should be part of every comprehensive geriatric nursing assessment, which should include:
- Reason for seeking care
- Health history
- Review of systems
- Psychosocial/Cognitive assessment
- Functional assessment
- Environmental assessment
- Familial and social support
- Patient expectations
Health professionals need to raise the subject of incontinence with at risk patients. Only about half of community dwelling adults over 60 years old seek help for their uncomplicated UI.• The social stigma associated with UI often results in shame, depression, social isolation and reluctance to discuss symptoms. Reassuring the patient and caregivers that UI is common and that many symptoms can be controlled or eliminated may improve the quality of the assessment interview.
The adverse effects of UI depend upon multiple factors, including the patient's: health and cognitive status, age, gender, type of UI, health beliefs, coping skills and financial and social resources. A holistic nursing assessment will analyse these factors to differentiate between acute and chronic UI, identify the type of UI, identify the reversible causes of UI and identify the educational needs of the patient and caregivers.
Nurses need to be aware of factors that may increase the risk of incontinence:
- ♂ Risk factors
- Prostate disease
- History of nocturnal enuresis or daytime wetting as a child
- ♀Risk factors
- Nocturnal enuresis or daytime wetting as a child
UI screening and tests
- Self-report incontinence screening tools have been developed to help identify incontinence and its effect on quality of life. Two of the more common tools are the Urinary Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Each of these tools has a male equivalent, Male Urogenital Distress Inventory (MUDI) and Male Urinary Symptom Impact Questionnaire (MUSIQ).
- Voiding diary (sample) represents the patient's perception and the pattern of incontinence recorded over time, usually a 3-7 day period.
- Urinalysis to rule out reversible factors: urinary tract infection, diabetes, etc.
- Pressure uroflowmetry measures the rate of voiding while measuring bladder and rectal pressures to identify detrusor weakness and urethral obstruction.
- Post void residual volume (PVR) is part of a basic incontinence evaluation. It can provide evidence of incomplete bladder emptying (overflow incontinence).
- Catheterization is most accurate but the risks of trauma, infection and breach of modesty should be considered.
- Ultrasonographic measurement of PVR is an alternative to catheterization. Normal PVR is 50mL. More than 200mL is abnormal.
- Pelvic and rectal examination to identify physical features that may directly affect urinary incontinence, such as prolapsed uterus or bladder, prostate enlargement, significant constipation or fecal impaction, use of a urinary catheter, atrophic vaginitis, distended bladder, or bladder spasms.
- Multichannel Cystometry measures bladder capacity, urge, stress, overactivity and overflow incontinence.
It can be helpful for patients to keep
a written record of continent and incontinent voids.