Urinary incontinence (UI) is defined as the loss of urine sufficient to cause medical, psychosocial, or hygiene problems. It is estimated that 15% to 35% of all noninstitutionalized elders and >50% to 70% of nursing home and homebound patients have UI. These percentages are likely to be underestimates because the problem is often underreported. It is also underdiagnosed and undertreated. Reasons for underreporting UI include embarrassment, lack of knowledge about UI, and the erroneous thinking that it is a normal part of aging. Additionally, lack of knowledge about the management of UI and the availability of undergarments that can be used discreetly - as well as low expectations regarding treatment-hamper identification of patients with UI.

In most cases, the evaluation of urinary incontinence requires only a history, a physical examination, urinalysis and measurement of postvoid residual urine volume. The initial purposes of the evaluation are to identify conditions requiring referral or specialized work-up and to detect and treat reversible causes that may be present. If the patient does not appear to require referral and a reversible cause is not identified, the next step is to categorize the patient's symptoms as typical of either urge or stress incontinence and treat the patient accordingly. If treatment fails or a presumptive diagnosis of urge or stress incontinence cannot be reached, the final step would be to perform more sophisticated tests or refer the patient for testing to define the cause and determine the best treatment.

The prevalence of urinary incontinence in noninstitutionalized persons older than 60 years of age is 15% to 35%; of these, 25% to 30% have frequent episodes of urinary incontinence. The significance of urinary incontinence may vary from minimal to severe, with extreme activity limitation and social isolation. For example, several reports have linked urinary incontinence in community-dwelling elders with falls and depression. Urinary incontinence also imposes significant psychosocial distress on family, friends, and caregivers.

Urinary incontinence is even more prevalent in the nursing home than in the community. In nursing homes, however, urinary incontinence is known to be very treatable with assisted toileting programs . Nursing home residents are older and frailer than community-dwelling elders and have caregivers available 24 hours per day. As a result, major differences exist in how incontinence can be assessed and treated in the nursing home compared with the community. This paper describes incontinence quality indicators that can be applied to vulnerable community-dwelling elders who may be treated across the spectrum of care, from primary care physicians to surgical specialists.

Urinary incontinence (UI) is defined as any involuntary leakage of urine. 1 Awareness of UI as a clinically important health disorder amenable to treatment has grown among healthcare professionals and the public. Treatment of UI has shifted from a hygienic problem to a disorder calling for individualized diagnosis and treatment. Nurses have long had a leading role in UI assessment and management 2 and nurse practitioners (NPs) are particularly well-suited to screen, diagnose, and manage UI in the primary care and specialty practice settings.

When UI is defined as any urine loss under any circumstances, prevalence in women is approximately 50%, but this number falls to 8% to 36% when prevalence is limited to bothersome urine loss. The prevalence of UI among work-aged men is much lower, from 2% to 9%. Urinary incontinence prevalence rises in elderly adults regardless of sex. Its prevalence in community-dwelling elders in the United States is 20% to 30% and 42% to 56% in nursing homes.

Urinary incontinence, the involuntary loss of urine, is a significant health problem in men and women of all ages. An estimated 40 percent of elderly patients have urinary incontinence. At least 50 percent of nursing home residents have UI with either stress urinary incontinence, urge urinary incontinence, or mixed incontinence. Depending on the case mix, rates can be 70 percent and higher in nursing home facilities with a frail, functionally impaired population. The goal of this CE offering is to provide nurses with the most current information about assessment and evaluation and intervention in post-acute settings. After reading this article, you will be able to: 1. Discuss the assessment and evaluation process of urinary incontinence in the post-acute setting. 2. Identify the common causes of persistent and long-term urinary incontinence. 3. Compare and contrast toileting and bladder retraining programs.

The Urinary Incontinence Clinical Practice Guideline is a tool to guide care decisions. This guideline is a starting place that will guide the care team through a process of addressing urinary incontinence in the long term care facility resident. The document includes a narrative portion that covers definition, recognition, diagnosis, treatment, and monitoring of urinary incontinence. The algorithm summarizes the steps involved in addressing the condition. Tables include information on signs and symptoms of urinary incontinence, risk factors, contributing factors, assessment, treatment options, and indications for chronic indwelling catheters.