Gotta go: Are patients running to the bathroom?
Good assessment improves incontinence
More than 25 million Americans experience urinary incontinence, according to the Spartanburg, SC-based National Association for Continence. Thirty-one percent are women ages 42-50, and 38% are 60 or older.1
Many home health patients accept incontinence as a normal part of life, and their physicians often are not aware of techniques that can improve an incontinent patient’s quality of life. That is why home health nurses have a unique opportunity to identify an area in which the patient’s day-to-day life can be improved, say experts interviewed by Hospital Home Health.
"Home health nurses have to deal with a lot of items in an assessment, but it’s important to ask specifically about symptoms of incontinence because most patients won’t bring it up," says Carolyn Crumley, RN, MSN, CWOCN, wound, ostomy, and continence clinical nurse specialist and president at WOC Care in Lee’s Summit, MO.
"They don’t think that anything can be done because when they’ve mentioned it to the physician, they are told to purchase pads to absorb the urine," she says.
It is important to address incontinence because the patient can develop urinary tract infections, compromise skin integrity, and fall more often than the continent patient who doesn’t have to hurry to the bathroom, Crumley says.
Psychosocial effects of incontinence include loss of self-esteem, depression, and withdrawal from other people and from normal activities, she adds.
The types of questions an assessment should include are:
- Do you have trouble making it to the bathroom in time?
- How often do you urinate during the day?
- How severe are your episodes of incontinence?
— occasional loss of a few drops;
— frequent loss of small amount of urine;
— frequent loss of moderate amount of urine on a daily basis;
— frequent loss of moderate to large amount every day or night;
— total loss of all urine with no voluntary control at all.
- How often do you change your pad?
If the patient is incontinent, have him or her keep a three-day bladder diary in which every trip to the bathroom is documented along with what the patient was doing at the time, how much urine leaked, and how much fluid was taken in during the day, Crumley suggests.
Often, incontinent patients will limit the amount of fluids with the belief that they can control the incontinence by reducing fluid intake, Crumley says.
"In fact, the opposite happens since a lower fluid intake increases the risk of dehydration and the occurrence of constipation. Constipation contributes to incontinence." For this reason, the nurse also needs to ask about bowel patterns, she adds.
The bladder diary also is important as the home health nurse identifies the products that will be most helpful for the patient, says Gloria Harrison, RN, CCCN, continence consultant with Griffiths Urodynamics and Pro-Continence Consulting, Northern Alberta Continence Service in Edmonton, Alberta, Canada.
"You can find out what they have been using, if they’ve been using pads, and how the product has worked," she says.
"It’s important to understand why they choose products, as well as to take a look at whether or not the product meets their needs," she adds.
Another medical cause that needs to be evaluated by a physician is urinary tract infection, Crumley says.
"A urinary tract infection in an older women causes a sense of urgency to urinate, increases frequency of urination, and contributes to a lack of control over urination," she says.
Because there usually is no pain or fever, a physician may not check for an infection unless the home health nurse has discovered through the assessment that there is a problem with frequency and lack of control, she adds.
There are four types of incontinence: stress, urge, overflow, and functional. Each type requires different approaches based upon the patient and the severity of the symptoms, Crumley says.
Most incontinence patients usually have a combination of the types, she says. "If the patient has both urge and functional incontinence, bring in a physical or occupational therapist to help with the mobility issues and have the caregiver set up a regular toileting schedule," she suggests.
Also, consider bedside toilets for patients who have trouble making it to the bathroom, Crumley adds.
"I also believe that external catheters are underused," Harrison says. External catheters can be used on a temporary basis to enable a wife to take a husband out for dinner or shopping without having to deal with assisting him in a public restroom, she says.
Even with incontinence that cannot be completely controlled, it’s important for home health clinicians to identify the causes and address as many issues as possible, Crumley says.
"Always let the patients know that incontinence is not something that should embarrass them or that they should accept. Point out that by working together, we can find ways to keep incontinence from diminishing the quality of their lives," she adds.
[For more information about incontinence and the home health patient, contact:
- Carolyn Crumley, RN, MSN, CS, CWOCN, Wound, Ostomy, and Continence Clinical Nurse Specialist and President of WOC Care, 3712 N.E. Beechwood Drive, Lee’s Summit, MO 64064. Telephone and fax: (816) 478-6019. E-mail: [email protected].
- Gloria Harrison, RN, CCCN, Continence Consultant, Griffiths Urodynamics and Pro-Continence Consulting, Northern Alberta Continence Service 11127 24th Ave., Edmonton, Alberta, Canada, T6J4P7. Telephone: (780) 435-8916. E-mail: harriko@telus planet.net.]
Reference
1. Newman DK. Urinary incontinence and overactive bladder: A focus on behavioral interventions. Topics in Advanced Practice Nursing e-Journal 2001; (1):1.
Incontinence Resources
For more information about incontinence, clinical guidelines, and incontinence products, contact:
- Wound, Ostomy & Continence Nurses Society, 4700 W. Lake Ave, Glenview, IL 60025. Telephone: (888) 224-9626 or (866) 615-8560. Fax: (866) 615-8560. Web site: www.wocn.org. In addition to news about developments in the incontinence field and links to vendors, the web site also has fact sheets and position papers to help guide nurses in the identification and treatment of incontinence.
- National Association for Continence, P.O. Box 8310, Spartanburg, SC 29305-8310. Telephone: (864) 579-7900. Fax: (864) 579-7902. Web site: www.nafc.org. The site contains a list of fact sheets and other publications that are helpful to clinicians treating patients with incontinence.
- Agency for Healthcare Research and Quality, Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907-8547. Telephone: (800) 358-9295 or (410) 381-3150. E-mail: [email protected]. The agency offers Urinary Incontinence in Adults: Acute and Chronic Management, a clinical practice guideline, publication number AHCPR 96-0682. You must include both the title and publication number in your request. Single copies are free.
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