Assessment of incontinence A thorough history is essential to the evaluation of urinary incontinence. The clinical presentation of urinary incontinence, based on severity, frequency, and amount of debilitation will vary from resident to resident. Your resident(s) may be reluctant to initiate discussions about incontinence; therefore, all residents, especially those older than 65 years, should be asked focused questions about voiding problems.
Resident complaints may be minor and situational or severe, constant, and debilitating. When obtaining a clinical history, determining whether the problem is a social and/or hygienic problem and the degree of disability attributable to the incontinence also is important. In addition, the following points regarding the clinical presentation should be sought when obtaining the history:
• Severity and quantity of urine lost and frequency of incontinence episodes
• Duration of the complaint and whether problems have been worsening
• Triggering factors or events • Constant versus intermittent urine loss • Associated frequency, urgency, dysuria, pain with a full bladder, and history of urinary tract infections (UTIs)
• Concomitant symptoms of fecal incontinence or pelvic organ prolapse
• Coexistent complicating or exacerbating medical problems
• Obstetrical history • History of pelvic surgery and other urologic procedures
• Spinal and CNS surgery • Lifestyle issues, such as smoking, alcohol or caffeine abuse
• Medications
Experiencing incontinence can have a profound psychological effect on your residents. Many feel uncomfortable discussing the issue, even with their physician. However, simple questions allow clinicians to assess the resident’s condition and identify the type of incontinence they might be
experiencing. Make sure to provide privacy and be patient during the incontinence assessment.
Incontinence histories can be very complex and time consuming. Sending the questionnaire to residents in advance so that they can give appropriate time and thought to their answers may be helpful.
Potential complications The warm, moist environment that incontinence episodes produce can lead to complications such as urinary tract infections, incontinence- associated dermatitis and fungal infections. Excellent perineal care is one essential component for preventing these complications:
• Urinary tract infections are infections
occurring in any part of the urinary tract and are commonly caused by bacteria that enter from the urethra and travel to the bladder.
• Incontinence-associated dermatitis happens when skin comes in contact with urine or feces. IAD starts with the skin becoming macerated from being constantly wet. If the skin continues to be in contact with urine or feces, the skin can then become inflamed.
• Fungal infections can look like incontinence-associated dermatitis with inflamed red skin in the perineal area. Sometimes you will see little red dots or bumps.
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