Functional Urinary Incontinence (FUI)

Definition:

Functional incontinence can occur in persons with normal urinary tract mechanisms when they experience cognitive, physical or enviromental impairments that prevent appropriate toileting before a loss of urine.

Assessment:

Identifying FUI is a matter of excluding other forms of urinary incontinence. Several reliable UI screening tools exist to assist the nurse to screen for Urge, Stress and Overflow urinary incontinence (Dowling-Castronovo, A. 2018).

• ♀ Urogenital Distress Inventory-6 (UDI-6)
• ♀ Incontinence Impact Questionnaire-7 (IIQ-7)
• ♂♀ The International Consultation on Incontinence (ICIQ-SF) Short Form are used to diagnose individuals with urinary incontinence ( Skorupska et al., 2021)
• ♂ Male Urogenital Distress Inventory (MUDI)
• ♂ Male Urinary Symptom Impact Questionnaire (MUSIQ)
  

Etiology:
Any mental and/or physical impediment that delays getting to and/or using the toilet when necessary.

• Delirium, dementia
  
• Infection-urinary (symptomatic)
  
• Atrophic urethritis/vaginitis
  
• Pharmaceuticals: tricylic antidepressants, alcohol, sedatives, hypnotics, anticholinergics, polypharmacy, etc.
  
• Psychological disorders: stress, anxiety, depression, etc.
  
• Excessive urine output: (e.g. heart failure or hyperglycemia)
  
• Restricted mobility: pain, poor dexterity, poor vision, arthritis, Parkinson's disease, multiple sclerosis, deconditioning, obesity, clothing design, toilet access, lighting, etc.
  
• Stool impaction

Management:

• Identify and correct conditions that cause or contribute to the problem
  
  • pain management
    
  • eliminate environmental barriers: lighting, clear pathways, easy access clothing, lower bed rails
    
  • toileting assistance as needed
    
• Prepare an individualized care plan:
  • Promote the expectation of continence by implementing scheduled toileting, timed voiding, or prompted voiding.
    
  • Incorporate physical and occupational therapy to optimize patient self care.
    
  • Collaborate with pharmacy to review medication for polypharmacy.
    
  • Provide individualized patient/caregiver education.
    
  • Avoid indwelling catheter when possible.
    
  • Prevent skin breakdown by cleansing immediatelyafter an incontinent episode.
    
  • Trial incontinence products and barrier ointments prn.

Instant Feedback:

Dowling-Castronovo, A., Spiro, E. L. (2018). Urinary Incontinence Assessment in Older Adults: Part II – Established Urinary Incontinence. Retrieved June 27, 2022, from https://hign.org/sites/default/files/2020-06/Try_This_General_Assessment_11_Part_2.pdf

Skorupska, K., Grzybowska, M.E., Kubik-Komar, A. et al.(2021).  Identification of the Urogenital Distress Inventory-6 and the Incontinence Impact Questionnaire-7 cutoff scores in urinary incontinent women. Health Qual Life Outcomes 19, 87. https://doi.org/10.1186/s12955-021-01721-z