Temple University School of Podiatric Medicine Journal Review Club
Editor's note: This post is part of the Temple...
by Holly M. Hovan MSN, APRN, ACNS-BC, CWOCN-AP
With World Continence Week upon us, it is an appropriate time to discuss some types and causes along with treatment of urinary incontinence. Incontinence can have a significant impact on patient quality-of-life and skin health, subjects that will also be discussed.
The most common types of incontinence that we learn about are stress, urge, mixed (stress and urge), transient, neurogenic, and functional. Briefly, the types of incontinence mentioned can be broken down as below:
Stress urinary incontinence: Think of anything that causes stress on the abdomen and/or bladder (coughing, sneezing, lifting a heavy object, etc.). Most common in women but can occur in men.
Urge urinary incontinence: “Gotta go”—the patients who must go as soon as the “urge” hits them.
Mixed urinary incontinence (stress and urge): A combination of stress and urge as above.
Transient urinary incontinence: Think of the meaning of transient—it comes and goes. This type of incontinence also can come and then go again. It may be associated with acute infection, confusion, or surgery.
Neurogenic urinary incontinence: Those with a neurological issue—spinal cord injury, neurologic injury, etc. Think of spasms, neurogenic bladder.
Functional urinary incontinence: Think of function… walking, moving, falls risk, weakness on one side, etc. These patients are incontinent for functional reasons, usually weakness making it difficult to make it to the bathroom (or reach the urinal) without assistance. Cognitive impairment may also lead to functional urinary incontinence—think of dementia patients or those with delirium.
Incontinence Assessment Considerations
To determine the type of incontinence a patient has, it is important to obtain subjective and objective info and to complete a physical assessment. Assessing and noting the symptoms along with any factors that precipitate the urinary incontinence are important.
Urinary Incontinence Management Strategies
Keep in mind that a patient may have more than one type of urinary incontinence. Understanding the type of urinary incontinence that a patient has is important to guide treatment (medications, pelvic floor exercises, surgery, containment, toileting schedules, etc.).
Another concept to keep in mind with management of urinary incontinence is to develop an individualized treatment plan based on the patient’s goals. Younger patients and those with a more active lifestyle may prefer more aggressive measures, whereas older adults or those with several pre-existing co-morbidities may prefer an approach to maintain quality of life yet manage the problem as best as able. Bladder diaries can be helpful when determining the best treatment plan.
Moisture-associated skin damage (MASD) and incontinence-associated dermatitis (IAD) are problems that arise from urinary incontinence as a result of the caustic nature of urine on skin. Moisture barrier ointments should be used in individuals who are incontinent of urine, with the type of moisture barrier ointment selected based on the severity and presentation of the skin damage (full thickness, partial thickness, fungal, etc.).
Another strategy for management is containment. Containment includes the use of pull-ups, briefs, pads, or any other device to contain the urine. When using containment, we should try to select a product that is breathable and not apply diapers or pull-ups in bed because of moisture trapping. Instead, use an air-permeable incontinence pad. External or condom catheters should be used on a case-by-case basis if deemed appropriate by the provider because of the risk for skin breakdown on a fragile mucous membrane.
Incontinence can be a life-limiting problem and can affect quality of life if it is not assessed and managed appropriately. It is important to work with your interdisciplinary team as much as possible and consult specialty services when needed. Keeping the patient’s treatment goals in mind and taking a restorative approach can be helpful. Scheduling toileting for older adults and frequent skin checks are important. Pelvic floor exercises may be helpful depending on the situation and cognitive status of the patient. Limiting food or drinks that are bladder irritants may help. Use your resources, consider the patient’s treatment goals and plan of care, and remember to take the whole patient or scenario into consideration, not just a small piece of the puzzle.
In future blogs, I hope to address different treatment types of and management strategies for urinary incontinence more specifically, from supportive to more aggressive.
About the Author
Holly is a board certified gerontological nurse and advanced practice wound, ostomy, and continence nurse coordinator at The Department of Veterans Affairs Medical Center in Cleveland, Ohio. She has a passion for education, teaching, and our veterans. Holly has been practicing in WOC nursing for approximately six years. She has much experience with the long-term care population and chronic wounds as well as pressure injuries, diabetic ulcers, venous and arterial wounds, surgical wounds, radiation dermatitis, and wounds requiring advanced wound therapy for healing. Holly enjoys teaching new nurses about wound care and, most importantly, pressure injury prevention. She enjoys working with each patient to come up with an individualized plan of care based on their needs and overall medical situation. She values the importance of taking an interprofessional approach with wound care and prevention overall, and involves each member of the health care team as much as possible. She also values the significance of the support of leadership within her facility and the overall impact of great teamwork for positive outcomes.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.