Urinary Incontinence Assessment

The initial assessment includes a very good history and the use of validated questionnaire to know the type of urinary incontinence and its impact on patient’s quality of life (QoL).

Urinary incontinence (UI) assessment should be part of every comprehensive geriatric nursing assessment, which should include:

• Reason for seeking care
  
• A complete Health history
  
• Review of systems
  
• Psychosocial/Cognitive assessment
  
• Functional assessment
  
• Environmental assessment
  
• Familial and social support
  
• Patient expectations

Key questions for the initial assessment of urinary incontinence.

• Do you leak urine?
  • If yes then do you feel the leak of urine?
  • If yes then does it occur with urgency and on the way to toilet? (Identify trigger factor such as key in latch.)
• Do you wake up at night to void,
  • if yes then how frequent?
  • If urinary leak is without sensation then questions related to neurological/cognitive deficits should be asked co-existing diseases (diabetes, heart disease, neurological impairment should be ruled out).
• Do you leak urine when you cough, sneeze, laugh and during physical exertion? (Identify circumstances, e.g. sexual activity, posture change.)
• Duration of the symptoms?
  • Frequency of leak accidents and the amount of leak.
• Associated symptoms of pelvic organ prolapse (POP)
  • fecal incontinence (FI) should be asked, and the identification of risk factors such as complicated deliveries, pelvic surgery, and chronic constipation.
    Impact on personal and social life?
• Episodes of urinary tract infection or haematuria?

Health professionals need to raise the subject of incontinence with at risk patients. The social stigma associated with UI often results in shame, depression, social isolation, and reluctance to discuss symptoms. Reassuring the patient and caregivers that UI is common and that many symptoms can be controlled or eliminated may improve the quality of the assessment interview.

The adverse effects of UI depend upon multiple factors, including the patient's: health and cognitive status, age, gender, type of UI, health beliefs, coping skills and financial and social resources. A holistic nursing assessment will analyze these factors to differentiate between acute and chronic UI, identify the type of UI, identify the reversible causes of UI and identify the educational needs of the patient and caregivers.

UI screening and tests

• Self-report incontinence screening tools have been developed to help identify incontinence and its effect on the quality of life. Two of the more common tools are the Urinary Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) (Skorupska et al., 2021). These tools have a male equivalent, Male Urogenital Distress Inventory (MUDI) and Male Urinary Symptom Impact Questionnaire (MUSIQ).
  
• Voiding diary (sample) represents the patient's perception and the pattern of incontinence recorded over time, usually a 3-7 day period.
  
• Urinalysis to rule out reversible factors: urinary tract infection, diabetes, etc.
  
• Pressure uroflowmetry measures the rate of voiding while measuring bladder and rectal pressures to identify detrusor weakness and urethral obstruction.
  
• Post void residual volume (PVR) is part of a basic incontinence evaluation. It can provide evidence of incomplete bladder emptying (overflow incontinence).
  • Catheterization is most accurate, but the risks of trauma, infection and breach of modesty should be considered.
  • Ultrasonographic measurement of PVR is an alternative to catheterization. Normal PVR is 50mL. More than 200mL is abnormal.
• Pelvic and rectal examination to identify physical features that may directly affect urinary incontinence, such as prolapsed uterus or bladder, prostate enlargement, significant constipation or fecal impaction, use of a urinary catheter, atrophic vaginitis, distended bladder, or bladder spasms.
  
• Multichannel Cystometry measures bladder capacity, urge, stress, overactivity and overflow incontinence.