Flo Grayson – Urinary incontinence

Urinary incontinence and infections are a common reason for the carers at Daisy Flower Nursing Home to request a visit.

Bladder control problems are a common problem throughout the country with two out of five women over the age of 60 affected.


Types of Incontinence:

  • Stress Incontinence. Weakness of the urinary outlet
  • Urge Incontinence. Failure of the bladder to store urine because of high bladder pressure
  • Idiopathic: most common and known as overactive bladder
  • Neurogenic: associated with neurological conditions e.g. multiple sclerosis, parkinsonism,
    stroke or spinal cord injury
  • Bladder outlet obstruction
  • Infective: urinary tract infection, but beware coincidental asymptomatic bacteriuria. Only
    diagnose infection as a cause of urgency if acute onset and symptoms resolve on first treatment with antibiotics
  • Mixed Incontinence. A combination of 1 and 2
  • Bladder outlet obstruction. A bladder that is overfull and overflows
  • Abnormal communications of the urinary tract
  • functional incontinence. Incontinence due to more general impairment e.g. cognitive, functional, affective


Assessment
Your consultation with Flo (and all of the elderly residents) should include a screening question about continence issues. If there are any problems then a full assessment should be offered.

Don’t worry if you have no time today. The assessment can be done at a later date. Parts of the assessment done in a number of visits as a full assessment may make Flo tired.


History
• Pain, dysuria and haematuria- (these symptoms need urgent review)
• Bowel function and frequency
• Systemic symptoms and those symptoms that could be associated with diseases that
predispose a patient to urinary incontinence e.g. diabetes
• Associated co-morbidities (CCF, COPD, DM) and previous surgical procedures, particularly
those in or around the pelvis
Obstetric and gynaecological history are also important in female patients
Medication review is essential as many drugs can exacerbate urinary incontinence. Betty is taking furosemide (diuretics reduce the amount of water the body holds, which can cause excessive urine production and incontinence)

Examination
• Assess any cognitive decline – ask the nursing staff and look in her notes/care plan
• Assess gait, check dorsiflexion of the toes (S3) and perineal sensation (L1-L2),
sensation of the sole (S1) and posterior aspect of the thigh (S3). If Betty is unable to mobilise to the toilet in time this may result in incontinence
• Abdo – palpate for masses or enlarged kidneys, palpate and percuss for a distended bladder
• Digital Rectal Examination (DRE) should be performed in all patients to assess anal tone,
presence of constipation or rectal mass and to assess prostate size in males.- you may need to ask the GP to perform this
• Pelvis – Inspection may reveal vaginal atrophy or prolapse. The pelvic floor muscle strength can be assessed during a vaginal examination

Oxford classification
which is a 6 point scale:
0 = no contraction, 1= flicker, 2 = weak, 3 = moderate, 4 = good, 5 =strong contraction.

Ask Flo to cough or strain to enable demonstration of stress incontinence; repeat this with Flo standing if possible.