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CONSIDER: URINARY INCONTINENCE

Transient Urinary Incontinence

A new onset of urinary incontinence (UI) may be an atypical presentation of an underlying acute medical problem. New onset UI in any patient should be evaluated for an underlying medical etiology. If UI is not addressed it may lead to further morbidity and mortality, e.g. untreated UTI leading to urosepsis that may rapidly progress to death.

Definitions

Urinary Incontinence (UI) is not a normal consequence of aging. UI is defined as the involuntary loss of urine sufficient to be a problem.

Transient UI is characterized by the sudden onset of potentially reversible urinary symptoms.

Atypical Presentation

Older adults will not offer a "textbook" clinical presentation. For example, UTI's typically cause dysuria and fever. The older adult with a UTI is more likely to present with UI and/or affective changes supporting the imperative that nursing staff investigate the causes of UI.

 

Most likely Causes New Onset Transient UI: Assessment and Interventions
Causes and assessment Nursing Interventions
Urinary tract infection (UTIs)
  • Must evaluate to prevent progression to urosepsis (occurs in ~50% of UTIs in elderly)
  • Most common nosocomial infection especially with indwelling catheter use
    		•  Ascertain baseline incontinence status

    Check stat urinalysis

    Culture and sensitivity of urine
    Cognitive changes
  • May indicate delirium or depression - evaluate immediately
  • Can impair ability to recognize need to void
    		•  See Also consider:
  • Delirium
  • Depression
    		•
    Medications
  • Diuretics
  • Sedatives/hypnotics - cause sedation
  • Sedating antihistamines
  • Antidepressants
  • Calcium Channel-blockers
  • Alpha blockers
    		•  Evaluate medications as possible cause of UI

    Consider discontinuing or taper likely medicine

    See Also Consider:
  • Medications
    		•
    Immobility Issues
  • Decline in function - due to acute illness
  • Inability to self-toilet - due to environmental barriers
    		•  Assess for underlying acute illness

    P.T. evaluation for functional decline

    See Also Consider: Environmental adjustment: call light in reach, bedside commode/urinal

    Avoid restraints

    See Also Consider:
    Fecal Impaction/Constipation
  • Puts pressure on bladder
    		•  Rectal exam for palpable stool

    Abdominal exam for left lower quadrant mass

    Abdominal x-ray

     

    Last updated - February 2005