![]() Often establishing an effective bowel protocol, including regular toileting for bowel movements, can help with this problem.Ī review of symptoms and quick external observation for atrophic changes in the perineum are key to diagnosing vaginitis or urethritis, conditions common in frail postmenopausal women. Fecal incontinence can also increase the risk of a symptomatic urinary tract infection, especially for female residents, due to atrophic changes and incorrect perineal cleansing. Constipation and other causes common to both types of incontinence can overlap and predispose a resident to develop dual incontinence. Urinary and fecal incontinence are comorbid conditions that affect over 50% of elderly patients in residential care. Stool impaction in particular can cause anatomic changes that contribute to overactive bladder, urine retention, or loss of sphincter control. Depression, delirium, and constipation are other conditions that can contribute to incontinence. Concentrated urine from not drinking enough noncaffeinated or noncarbonated beverages can also irritate the bladder.Įvaluation for fluid shifts, such as pedal edema, should also be considered. When assessing a residential care patient for transient UI, a history of fluid intake should be done since some residents take in large amounts of caffeinated or diet beverages, and both caffeine and aspartame are bladder irritants. A list of pharmaceuticals that contribute to incontinence-the second P in DISAPPEAR-is provided in Table 2. These causes and management recommendations are provided in Table 1. The mnemonic DISAPPEAR is a helpful way to remember the causes of transient UI that are most easily remedied. It also increases social isolation and profoundly affects the quality of life for both residents and caregivers alike.Ī number of UI causes do not involve a primary problem with the genitourinary system and are thus reversible. Incontinence contributes to skin diseases, infections, and injurious falls. Costs associated with UI have been estimated at $5 billion per year. In residential care it is extremely prevalent, affecting over half of all residents. Urinary incontinence (UI) is the involuntary loss of urine. Such strategies benefit elderly residents by reducing the morbidities and indignities of incontinence. Effective strategies for managing all forms of incontinence can be supported by facility policy and culture, and by staff education. Many other chronic conditions, such as Parkinson disease and constipation, can also contribute to loss of bladder control. As with transient incontinence, assessment and management of persistent incontinence can improve symptoms. These include impairments that lead to urge, flow, stress, and functional incontinence. ![]() Most cases of persistent incontinence have structural causes. Assessment and management in these cases can improve symptoms. These causes include poor fluid intake, stool impaction, depression, and the use of certain pharmaceuticals. Reversible causes commonly contribute to transient incontinence for many residents. ABSTRACT: Urinary incontinence is a burdensome chronic condition afflicting a large number of elderly residents in long-term care facilities.
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