Incontinence

Adults—Urinary Incontinence

More than 50 percent of adult residents in long-term care facilities are estimated to have either urinary or fecal incontinence. Incontinence can dramatically influence quality-of-life issues, often leading to social isolation, depression, and institutionalization (in the case of older adults). Nevertheless, it is largely unrecognized and underaddressed in the healthcare setting. Neurologic impairment, immobility, and gender—females are more likely to suffer urinary incontinence than males—are major independent risk factors in adults.

Urinary incontinence in adults can be originate from wide range of medical and psychological causes. In many cases, incontinence is only transient. Common causes of transient incontinence include medication side effects, delirium, fecal impaction (often from constipation), urinary tract infections or other infections, irritation of the vagina or urethra, psychological factors such as depression, or physical mobility limitations. There are several forms of more chronic incontinence commonly experienced by individuals.

Urge Incontinence—This form of incontinence results from overactivity of the detrusor muscle, a muscle in the bladder wall that promotes elimination. Urge incontinence is generally believed to be the most common form of chronic incontinence. Individuals with this form of incontinence commonly describe a sudden feeling of needing to void before involuntary voiding. Treatments include behavioral management, such as timed voiding schedules and visualization techniques, as well as pharmacologic treatment through medications that decrease contractions of the detrusor muscle.

Stress Incontinence—This form of incontinence results from impaired urethral closure. Individuals with this type of incontinence often describe involuntary loss of urine associated with sneezing, coughing, laughing, or lifting objects. Treatment options include pelvic muscle exercises, weight loss in obese patients, use of estrogen, pharmacologic treatments, and surgical procedures, which are generally used for those who fail medical management.

Overflow Incontinence—This form of incontinence results from incomplete emptying of the bladder and abnormally high bladder volumes. This often results from mechanical obstruction of outflow, such as by an enlarged prostate, or from decreased contraction of the detrusor muscle. Individuals generally complain of frequent dribbling of urine, which can be constant, and a feeling of incomplete emptying of the bladder. They often also complain of a decreased force of urinary stream. Treatment options include intermittent catheterization, pharmacologic therapy, and surgery.

Functional Incontinence—This form of incontinence results from the inability of an individual to transport in a timely manner to a location to void. Examples include individuals with severe mobility limitations or with dementia.

...