Assessing Continence

Holistic Approach to Incontinence Assessment

  • Importance of adopting a holistic approach for assessing bladder and bowel function, especially in the context of incontinence.

  • Engage with patients to understand what is important to them in relation to their incontinence.

  • Recognize that many individuals find it difficult to discuss incontinence and trust is essential for open communication.

  • Build confidence in patients that incontinence is not solely associated with aging or gender and that treatment options exist.

Steps in Continence Assessment

  • Begin with understanding what aspects of incontinence impact the patient's quality of life.

  • Explore patient history and listen empathetically to their experiences regarding bladder or bowel issues.

  • Assess causes of incontinence using a body systems approach.

    • Neurological Assessment: Check for conditions such as Parkinson's disease, multiple sclerosis, or dementia that affect continence.

    • Obstetric History: In women, inquire about childbirth experiences, particularly long labor and perineal trauma, which can lead to stress incontinence.

    • Gastrointestinal Assessment: Address constipation and its relationship with urinary urgency and incontinence through pressure on the bladder.

Symptoms Evaluation

  • Ask targeted questions about bladder function:

    • Frequency of urination and instances of nocturia (night-time urination).

    • Identify scenarios causing leakage, like coughing, laughing, or physical exertion.

    • Explore the sensation of urgency, explaining the "key in the lock syndrome" to illustrate the urgency experienced just before reaching the toilet.

Fluid Intake Impact

  • Evaluate the patient's fluid intake; excessive restriction of fluids can worsen incontinence by concentrating urine.

  • Recognize that dehydration in older adults can lead to confusion and exacerbate incontinence.

  • Identify types of fluids consumed (e.g., coffee, alcohol, sugary drinks), as these can irritate the bladder and lead to urgency.

Medication Effects on Bladder Function

  • Acknowledge how various medications influence bladder and bowel function:

    • Diuretics often cause urgency due to rapid kidney processing and increased urine output.

    • Some medications may hinder complete bladder emptying, further complicating symptoms.

  • Suggest modifications in medication timing rather than discontinuation when appropriate.

Key Factors in Continence Assessment

  • Additional factors to consider include:

    • Social history and functional capacity of the patient.

    • Importance of listening attentively to the patient's narrative to understand their experience and respond appropriately.

  • Consult textbooks for comprehensive guidelines and best practices on bladder and bowel function assessment.