Functional Urinary Incontinence (FUI)

“Regardless of age, mobility, mentation, or institutionalization, incontinence is never normal.”•

DEFINITION:

“Functional Incontinence” refers to loss of urine that occurs in residents whose urinary tract function is sufficiently intact that they should be able to maintain continence, but who cannot remain continent because of external factors (e.g., inability to utilize the toilet facilities in time)•

ASSESSMENT:

Identifying FUI is a matter of excluding other forms of urinary incontinence. Several reliable UI screening tools exist to assist the nurse to screen for Urge, Stress and Overflow urinary incontinence.

 ♀ Urogenital Distress Inventory (UD)I and Incontinence Impact Questionnaire and their short forms UDI-6, IIQ-7•
 ♂ Male Urogenital Distress Inventory (MUDI) and the Male Urinary Symptom Impact Questionnaire (MUSIQ)•

ETIOLOGY:

Any mental and/or physical impediment that delays getting to and/or using the toilet when necessary.

• Delirium, dementia
• Infection-urinary (symptomatic)
• Atrophic urethritis/vaginitis
• Pharmaceuticals: tricylic antidepressants, alcohol, sedatives, hypnotics, anticholinergics, polypharmacy, etc.
• Psychological disorders: stress, anxiety, depression, etc.
• Excessive urine output: (e.g. heart failure or hyperglycemia)
• Restricted mobility: pain, poor dexterity, poor vision, arthritis, Parkinson's disease, multiple sclerosis, deconditioning, obesity, clothing design, toilet access, lighting, etc.
• Stool impaction

MANAGEMENT:

• Identify and correct conditions that cause or contribute to the problem
  • pain management
  • eliminate environmental barriers: lighting, clear pathways, easy access clothing, lower bed rails
  • toileting assistance as needed
• Prepare an individualized care plan:
  • Promote the expectation of continence by implementing scheduled toileting, timed voiding, or prompted voiding.
  • Incorporate physical and occupational therapy to optimize patient self care.
  • Collaborate with pharmacy to review medication for polypharmacy.
  • Provide individualized patient/caregiver education.
  • Avoid indwelling catheter when possible.
  • Prevent skin breakdown by cleansing immediatelyafter an incontinent episode.
  • Trial incontinence products and barrier ointments prn.

Instant Feedback:

Restricted mobility can cause UI in a person with normal urinary function and normal cognition.

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