Incontinence
Carole K. H. Bartoo
A.Urinary incontinence (UI): The unintentional loss of urine. Inability to hold urine in the bladder due to loss of voluntary control over the urinary sphincters resulting in the involuntary passage of urine. Types include the following:
1.Stress incontinence.
2.Urge incontinence.
3.Mixed incontinence.
The number of older women who do not report incontinence to their primary care practitioners is high (Visser et al., 2012). In one study, 73% responded they felt their involuntary loss of urine was not severe enough to consult the general practitioner; 57% said they found a way to cope with it and 46.9 % felt involuntary loss of urine is a normal part of aging or that there was no cure for their leakage (23.8%). In addition, more than 20% reported their primary care practitioner did not ask about UI.
There are many evidence-based screening tools. A few are listed as follows:
a.International Consultation on Incontinence Questionnaire-Urinary Incontinence, Short Form (ICIQ-UI SF) survey (measures symptoms and impact of UI, www.iciq.net/background.htm).
b.Incontinence Severity Index (ISI, scores frequency and amount of leakage, http://christianacare.org/documents/urogynecology/Incontinence-Severity-Index.pdf ).
c.Urogenital Distress Inventory (UDI, www.bestresultspt.com/userfiles/files/Urogenital%20Distress%20Inventory%20UDI%206.pdf ).
d.Incontinence Impact Questionnaire (IIQ, www.ohsu.edu/xd/health/services/urology/visiting-the-clinic/upload/Female-Urology-Questionnaire-7.pdf ).
B.Fecal incontinence: After age 65, as much as 10% of men and 15% of women experience involuntary loss of liquid or solid stool, which is a social or hygienic problem. Causes are similar to those in UI:
1.Overflow.
2.Loose stools caused by medications, neoplasia, colitis, lactose intolerance.
3.Functional incontinence associated with poor mobility.
4.Dementia related: Uninhibited rectal contraction.
5.Anorectal incontinence: Weak external sphincter.
6.Comorbidity: Stroke, neuropathy, sacral cord dysfunction.
The development of new incontinence or worsening of existing incontinence should be documented in a patient’s chart. New symptoms of incontinence should trigger the general health reviews listed in the section Urinary Incontinence
in Chapter 15. A careful review of medications should also be performed to evaluate if any of the current medications could be causing/contributing to incontinence and consideration of reduction or cessation of these medications.