Patient-Centered Concerns: Incontinence
Recommendations
| Identify and Treat the Cause | ||
|---|---|---|
| 1 | Take a careful history from the person with urinary incontinence; determine the type, reversibility, and appropriate treatment approaches. | Level of Evidence Not Assessed |
| Address Patient-centered Concerns | ||
|---|---|---|
| 2 | Consider the potentially serious adverse effects that even mild urinary incontinence has on a patient’s quality of life and reassure them that many cases are treatable. | Level of Evidence Not Assessed |
| 3 | Provide information and advice on treatment options available in both primary and secondary care | Level of Evidence Not Assessed |
| 4 | Assess and address quality of life using a validated quality of life and incontinence severity questionnaire, e.g., • International Consultation on Incontinence Questionnaire (ICIQ) • Bristol Female Lower Urinary Tract Symptoms (BFLUTS) • Incontinence Quality of Life (I-QOL) • Stress and Urge Incontinence and Quality of Life Questionnaire (SUIQQ) • Urinary Incontinence Severity Score (UISS) • SEAPI-QMM • Incontinence Severity Index (ISI) • King’s Health Questionnaire (KHQ). | Level of Evidence Not Assessed |
| Provide Local Care | ||
|---|---|---|
| 5 | Develop and implement an appropriate cause-specific treatment strategy and monitor treatment success. | Level of Evidence Not Assessed |
| 6 | Implement appropriate strategies for fluid management and skin care. | Level of Evidence Not Assessed |
| 7 | Recommend containment products and reassess their suitability. | Level of Evidence Not Assessed |
| 8 | Consider absorbant products as: - a coping strategy pending definitive treatment - an adjunct to other ongoing therapy - long term management of urinary incontinence only after other treatment options have been explored | Level of Evidence Not Assessed |
| 9 | Inspect genital-perineal area daily to identify signs of contact dermatitis and skin excoriation. | Level of Evidence Not Assessed |
| 10 | Prevent skin breakdown by providing immediate cleansing after an incontinent episode and utilizing appropriate skin and barrier creams. | Level of Evidence Not Assessed |
| Provide Organizational Support | ||
|---|---|---|
| 11 | Facilitate healthcare professionals to gain relevant knowledge and skills to offer appropriate advice and information | Level of Evidence Not Assessed |
Background
The prevalence of urinary, fecal and double incontinence increases with age. As a result, these disabling conditions are common in the elderly population living in the community and even more common among nursing home residents.Urinary incontinence has significant psychological, social and quality-of-life impact. Incontinence often begins gradually and increases in frequency and severity to the point that affected individuals discontinue normal activities, adapting their behaviour to avoid embarrassment about urine leakage. Among the elderly, incontinence negatively affects morale of patients and their caregivers and causes social isolation and unnecessary institutionalization.
Fecal incontinence can have a devastating effect on quality of life, with substantial physical and psychological effects. It can lead to loss of independence and mobility, social isolation, and an altered sense of self.
• Physical: Incontinence causes wetness, odour, discomfort, and skin irritation.
• Psychological: Incontinence can damage self-esteem, due to feelings of shame and embarrassment. Depression and social isolation can result.
• Sexual: Incontinence can affect sexual relationships because of the fear of urine leakage during sexual activity.
• Quality of life: Incontinence affects quality of life at least as much as other chronic illnesses.
Feelings of shame about incontinence may prevent sufferers from discussing the problem with their physician. As a result, potentially reversible incontinence may never be identified, investigated, or treated appropriately.
References
| Essential Publications |
|---|
| 1 | Disease-specific quality of life measure |
Quality Indicator
|
Type: Scale Description |
| Stothers L. Reliability, validity, and gender differences in the quality of life index of the SEAPI-QMM incontinence classification system. Neurourology and Urodynamics 2004;23(3):223–8. | |||
| 2 | Disease-specific quality of life measure |
Quality Indicator
|
Type: Scale Description |
| Avery K, Donovan J, Peters TJ, et al. ICIQ: A brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourology and Urodynamics 2004;23(4):322–30. | |||
| Evaluates symptoms and impact of urinary incontinenece. | |||
| 3 | Disease-specific quality of life measure |
Quality Indicator
|
Type: Scale Description |
| Jackson S, Donovan J, Brookes S, et al. The bristol female lower urinary tract symptoms questionnaire: Development and psychometric testing. British Journal of Urology 1996;77(6):805–12. | |||
| Bristol Female Lower Urinary Tract Symptoms (BFLUTS). Development and psychometric testing. | |||
| 4 | Disease-specific quality of life measure |
Quality Indicator
|
Type: Scale Description |
| Patrick DL, Martin ML, Bushnell DM, et al. Quality of life of women with urinary incontinence: further development of the incontinence quality of life instrument (I-QOL). Urology 1999;53(1):71–6. | |||
| Incontinence quality of life instrument: further development | |||
| 5 | Disease-specific quality of life measure |
Quality Indicator
|
Type: Scale Description |
| Kulseng-Hanssen S and Borstad E. The development of a questionnaire to measure the severity of symptoms and the quality of life before and after surgery for stress incontinence. BJOG: an International Journal of Obstetrics and Gynaecology 2003;110(11):983–8. | |||
| Stress and Urge Incontinence and Quality of Life Questionnaire (SUIQQ) | |||
| 6 | Disease-specific quality of life measure |
Quality Indicator
|
Type: Scale Description |
| Stach-Lempinen B, Kujansuu E, Laippala P, et al. Visual analogue scale, urinary incontinence severity score and 15 D – Psychometric testing of three different health-related quality-of-life instruments for urinary incontinent women. Scandinavian Journal of Urologyand Nephrology 2001;35(6):476–83. | |||
| Urinary Incontinence Severity Score (UISS): Psychometric testing of three different health-related quality-of-life instruments for urinary incontinent women. | |||
| 7 | Disease-specific quality of life measure |
Quality Indicator
|
Type: Scale Description |
| Kelleher CJ, Cardozo LD, Khullar V, et al. A new questionnaire to assess the quality of life of urinary incontinent women. British Journal of Obstetrics and Gynaecology 1997;104(12):1374–9. | |||
| King's Health Questionnaire (KHQ): assess quality of life in urinary incontinent women. | |||
| 8 | Disease-specific quality of life measure |
Quality Indicator
|
Type: Scale Description |
| Hanley J, Capewell A, Hagen S. Validity study of the severity index, a simple measure of urinary incontinence in women. British Medical Journal 2001;322(7294):1096–7. | |||
| Incontinence Severity Index (ISI): validity study | |||