CNA Workbook WHAT IS INCONTINENCE? Incontinence is the inability to control the flow of urine or feces from your body. Approximately 26 million Americans are incontinent. Many people don t report it because it s viewed as a normal part of aging, or because they are embarrassed. There are a number of reasons why incontinence develops: Weak bladder Weakened muscles around the bladder (common in women who have given birth) A blocked urinary passage Damage to the nerves that help control the bladder Diseases that limit movement (such as those that confine a person to bed) Types of Incontinence Many people think a person is either continent or incontinent. They do not realize that there are many different types of incontinence. Listed below are the types of incontinence as well as their causes and some helpful hints for caring for incontinent residents. Stress incontinence occurs when sudden pressure is applied to the bladder, causing small amounts of urine to leak out. It usually does not occur at nighttime. Urge incontinence is associated with a frequent, sudden urge to urinate with little control over the bladder. It is also known as overactive bladder, spastic bladder or reflex incontinence. Urination may occur more than seven times per day and two times per night and it may be triggered by increased fluid intake. Urge incontinence can be associated with a urinary tract infection (UTI). Overflow incontinence occurs when a person cannot completely empty the bladder. This leads to frequent urination or a constant dribbling of urine, or both. You might notice a weak urine stream, painful urination, excessive nighttime urination, incomplete voiding and dribbling. Functional incontinence involves an intact urinary system and circumstances that prevent normal toilet usage. This is the most common type of incontinence among the elderly and those with arthritis, Parkinson s disease or Alzheimer s disease, which cause Page 1 of 6
limitations with moving, thinking or communicating. Also, referred to as environmental incontinence. Remove environmental obstacles. Determine the person s mental and physical ability. Mixed incontinence is two or more types of incontinence at the same time usually stress and urge incontinence. The causes of the two forms are not necessarily related. Transient incontinence, also known as temporary incontinence, can be caused by severe constipation, infections in the urinary tract or vagina or by certain medications. Fecal incontinence is the loss of normal control of the bowel, often caused by muscle or nerve damage. It is often underreported, but affects as many as one million Americans. Treat underlying conditions such as inflammatory bowel disease or cancer to help alleviate fecal incontinence. HelpfulHint Incontinence can affect a person s quality of life and self esteem as well as their social activities. You can help by keeping the person dry and comfortable and assisting them in maintaining their dignity. Make sure that the skin stays protected by applying a moisture barrier cream, paste or ointment after the skin is cleaned. Barriers can offer a layer of protection between the skin and the urine or stool. Creams offer a light layer of protection and are also soothing to the skin. Pastes are thick and better protect the skin from urine and stool. A thin layer of paste should be applied to the skin so it does not rub off onto the brief, preventing the brief from absorbing moisture. Ointments are for damaged skin that needs additional protection as well as treatment. Page 2 of 6
Common Care for the Different Types of Incontinence Consider the following helpful hints when caring for residents with each type of incontinence. Place check marks next to the things you already do for your residents. Functional Incontinence Answer call bells promptly. Place call bells within easy reach. Provide urinals and bedpans. Help the resident as needed. Provide clothing that is easy to remove for toileting. Provide prompted toileting for residents who are cognitively impaired. Encourage drinking adequate amounts of fluid to stay hydrated. If a resident cannot talk, watch for changes in behavior that might indicate a resident is wet, constipated or uncomfortable. Stress Incontinence Provide a bladder pad to contain episodes of incontinence. Report stress incontinence to nurses. Ask if the resident was checked for any infections. Encourage the resident to do pelvic floor exercises, if appropriate. Encourage the resident to empty the bladder before attending activities, such as daily exercise classes. Encourage drinking adequate amounts of fluid to stay hydrated. Assist the resident with perineal care and application of bladder control pads as needed. Urge Incontinence Answer call bells promptly. Encourage the resident to void every 30 120 minutes while awake. Encourage urge suppression. When the resident feels a strong urge to void, tell them not to run to the bathroom. Instead, have them sit and contract and release their pelvic floor muscles until the urge is over. Then get up and go to the bathroom. Page 3 of 6
Mixed incontinence Answer call bells promptly. Encourage the resident to void every 30 120 minutes while awake. Encourage urge suppression. When the resident feels a strong urge to void, tell them not to run to the bathroom. Instead, have them sit and contract and release their pelvic floor muscles until the urge is over. Then get up and go to the bathroom. Overflow incontinence Perform catheter care as needed. Transient (temporary) incontinence Report any unusual findings such as fever, redness or cloudy urine to the nursing team. Perform catheter care as needed. Fecal incontinence Encourage adequate amounts of fluid to stay hydrated. Encourage eating foods high in fiber. Perform meticulous perineal care. Assist the resident with the application of absorbent products as needed. Page 4 of 6
Let s Get the Facts Straight People believe many false things about incontinence. Here are some incontinence facts. Most types of incontinence can be treated or managed. Incontinence is not normal and is usually triggered by other underlying causes. Catheterization is invasive, can lead to infection and should be used only when there is a medical reason. Restricting fluid could contribute to a urinary tract infection (UTI) and is not necessary. Behavioral methods, such as bladder training, are crucial for improving bladder control. Incontinence can easily lead to skin breakdown, especially if urine or feces are left on the skin. When skin breaks down, it can quickly lead to a wound, which can be made worse if the area of skin is under pressure. Incontinence Myths Myth: Incontinence cannot be treated. Reality: Most types of incontinence can be treated or managed. Myth: Incontinence is a normal part of aging. Reality: Incontinence is not normal and is typically triggered by other underlying causes. Myth: Catheterization is the best method for the management of incontinence. Reality: Catheterization is invasive, could lead to infection and should be used only when there is medical justification. Myth: Fluid restriction is a good method for the treatment of incontinence. Reality: Fluid restriction could contribute to a urinary tract infection (UTI) and is not necessary. Myth: Encouraging the resident to postpone urination is bad. Reality: Behavioral methods such as bladder training are crucial for improving bladder control. Myth: The use of a large disposable brief is the best method for the management of incontinence. Reality: Treatment methods should be based on each patient s physical assessment and condition. Page 5 of 6
Important Words to Know Dermis: The inner layer of the skin that provides strength, support and elasticity Epidermis: The outer, protective layer of the skin Erythema: Redness of the skin; a warning sign that something is wrong Incontinence associated dermatitis: An inflammation of the skin that occurs when urine or stool comes in contact with perineal or perigenital skin Maceration: A softening of the skin that occurs when it is constantly wet Pressure ulcer: An area of skin, usually over a bony area, that is damaged by pressure (also referred to as a pressure sore, bedsore, dermal ulcer or decubitus ulcer) Skin tear: A separation of the layers of the skin (epidermis, dermis and/or subcutaneous layer) Subcutaneous: The under layer of the skin, also called the fatty or adipose layer, that provides cushioning Page 6 of 6