Want to know more


The information in this "Want to know more" section is organized according to the following major components of the NURSING PROCESS:


The goals related to Urinary Incontinence (UI) with older adults are:

  • Nursing staff will utilize comprehensive assessment and management for patients identified with UI.
  • Patients with UI will not have UI associated complications.
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Urinary Incontinence (UI) is not a normal consequence of aging. UI is the involuntary loss of urine sufficient to be a problem.

Stress UI is defined as an involuntary loss of urine associated with activities that increase intra-abdominal pressure. Symptomatically, individuals with stress UI usually present with complaints of small amounts of daytime urine loss that occurs during physical activity or with increased intra-abdominal pressure, e.g., coughing, sneezing. Stress UI is more common in women, but also can be found in older men, e.g., post prostatectomy incontinence (Fantl, et al., 1996).

Urge UI is characterized by an involuntary urine loss associated with a strong desire to void (urgency). In addition to urgency, signs and symptoms of urge UI most often include urinary frequency, nocturia and enuresis, and UI of moderate to large amounts. Bladder changes associated with aging make older adults particularly prone to this type of UI (Fantl, et al., 1996).

Overflow UI is an involuntary loss of urine associated with over distention of the bladder, and may be caused by an under active detrusor muscle or outlet obstruction leading to over distention and overflow. Individuals with overflow UI often describe dribbling, urinary retention or hesitancy, urine loss without a recognizable urge, or an uncomfortable sensation of fullness or pressure in the lower abdomen. A common condition associated with this type of UI is BPH (Fantl, et al., 1996).

Functional UI is caused by non-genitourinary factors, such as cognitive or physical impairments that result in an inability for the individual to be independent in voiding. For example, acutely ill hospitalized individuals may be challenged by a combination of an acute illness and environmental changes. This, in turn, makes the voiding process too complex resulting in a functional type of UI (Fantl, et al., 1996)

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.

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  • UI affects approximately 17 million Americans and is prevalent in hospitalized older adults.
  • Risk factors associated with UI include: immobility, impaired cognition, medications, constipation/fecal impaction, low fluid intake, environmental barriers, diabetes mellitus, and stroke.
  • Complications of UI are falls, skin irritation leading to pressure ulcers, social isolation, and depression.
  • Nurses play a key role in assessment and management of UI.
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Assessment Parameters

  • Document the presence/absence of UI for all patients on admission.
  • Document the presence/absence of an indwelling urinary catheter. Determine appropriate indwelling catheter use: severely ill patients, patient with Stage III-IV pressure ulcers of the trunk, urinary retention unresolved by other interventions.
  • For patients who are incontinent:
    • Determine whether the problem is transient, established, or both.
    • Identify and document the possible etiologies of the UI.
    • Elicit assistance with assessment and management from interdisciplinary team members.
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Nursing Care Strategies/Treatment/Management

UI Nursing Care Strategies

Urinary Incontinence - Nursing Care Strategies.pdf
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  • Will have fewer or no episodes of UI or complications associated with UI.

Health Care Providers

  • Will document continence status at admission and throughout hospital stay.
  • Will use interdisciplinary expertise and interventions to assess and manage UI during hospitalization.
  • Will include UI in discharge planning needs and refer PRN.


  • Incidence and prevalence of acute UI will decrease.
  • Hospital policies will require assessment and documentation of continence status.
  • Will provide access to guidelines for managing acute and chronic UI.
  • Staff will receive administrative support and ongoing education regarding assessment and management of UI.
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  • Provide patient/caregiver discharge teaching regarding outpatient referral and management.
  • Incorporate continuous quality improvement criteria into existing program.
  • Identify areas for improvement and enlist multidisciplinary assistance in devising strategies for improvement.


Reprinted with Permission from Springer Publishing Company. Dowling-Castronovo, A., & Bradway, C. W. (2003). Urinary incontinence. In M. Mezey, T. Fulmer, I. Abraham (Eds.), D. Zwicker (Managing Ed.), Geriatric nursing protocols for best practice (2nd ed., pp. 83-98). New York: Springer Publishing Company, Inc.

Last updated - May 2005

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