Leson 8: Functional Urinary Incontinence

Question 1

Pathology

Answer 1

• leakage caused by factors outside the urinary tract
• bladder and sphincter function relatively normal

Question 2

Etiology

Answer 2

Cognitive impairments
- Unable to correctly process/respond to signals of bladder fullness
- Bladder empties at capacity

Severe immobility/incoordination/frailty

Question 3

Presentation

Answer 3

• Moderate to large volume leakage at regular intervals
• Patient not always aware of urge to void
• Patient may not respond appropriately to toileting + verbal cues to void

Question 4

Diagnostics

Answer 4

Based on clinical assessment
- Assess cognitive function
— MMSE
— Mini-cog
— Clock drawing test

Assess mobility
- “Get up and go” test

Rule out
- Reversible factors
- Retention
- Overactive bladder

Question 5

Management - Immobility

Answer 5

Environmental adjustments
- Eliminate safety obstacles
- Footwear with nonskid soles
- Use of walking aids
- Elevated toilet seat
- Pull-up pants
- Bedside commodes
- Urinals

Scheduled toileting

Absorbent products + skin care

Question 6

Management - Cognitive Impairment

Answer 6

• Toileting program with > 2 hour intervals
• Consider trial of anticholinergics
• Scheduled voiding/habit training
• Caregiver takes pt to bathroom on schedule
• Goal = reduce incontinence episodes
• Indications = pt can toilet with assistance and respond to voiding cues

Question 7

Management - Functional Intervention Training

Answer 7

Scheduled voiding with musculoskeletal strengthening exercises

Question 8

Management - Prompted Voiding

Answer 8

• Determine usual voiding frequency
• When time to void
  — Ask pt to report continence status
  — Verbally reward patient if dry
  — Offer opportunity to toilet
  — Verbally reward willingness to attempt toileting
  — Praise successful toileting

Question 9

Management - Containment + Absorptive Products

Answer 9

Condom catheter for men
- Need consistent penile protrusion of at least 1”
- Size correctly
- Apply to clean, dry skin with full adhesion

Non-adhesive sheath/reservoir system
- Require consistent penile protrusion of at least 1”
- Hard shell penile cups supported by briefs
- Sport sheath external catheter for men with limited penile protrusion