LEARNING OUTCOME AND OBJECTIVES:  Upon completion of this continuing education course, you will have increased your understanding of incontinence assessment and treatment. Specific learning objectives to address potential knowledge gaps include:

• Discuss the impact of incontinence on individuals.
• Identify the different types of incontinence.
• Describe the process of conducting a urinary incontinence assessment.
• Summarize treatment options for urinary incontinence.
• Discuss assessment, diagnosis, and interventions for bowel incontinence.

INTRODUCTION

Incontinence can be a silent and debilitating condition. It can affect individuals in all age groups and walks of life. The classic picture may be of elderly patients in nursing facilities struggling with frequent episodes of bowel and bladder incontinence and wearing diapers. However, this does not tell the full story. Many individuals who are pursuing careers, participating in family activities, and involved in their communities struggle with incontinence on a daily basis. It is estimated that incontinence affects about 33 million people in the United States (NAFC, 2019b).

The definition of urinary incontinence is the inability to control the time and place of voiding, resulting in the involuntary loss of urine. Approximately 43% of people living in the community and close to 70% of those residing in nursing care facilities experience some form of urinary incontinence (WOCN, 2016).

The definition of bowel incontinence, also known as fecal incontinence or accidental bowel leakage, is loss of normal control of the bowel. Bowel incontinence is associated with diminished awareness of rectal fullness and diminished ability to control the urge to defecate or pass gas until an appropriate time and place is available.

Data show that between 0.5% and 1% of individuals in the community under the age of 65 experience bowel incontinence, while 3% to 8% of those over the age of 65 are affected. The frequency of bowel incontinence in nursing homes is estimated to affect 47% to 50% of residents. However, it is believed that the data available on the prevalence of bowel incontinence do not capture the extent of the problem due to underreporting (WOCN, 2016).

The complications associated with urinary and bowel incontinence can seriously impact the physical and emotional well-being of those affected with either or both of these conditions. In a survey of community-dwelling individuals with urinary incontinence, 80% stated they have to deal with incontinence on a daily basis or three to five times per week, and 90% of individuals in the survey expressed feelings of loneliness, isolation, hopelessness, and depression (NAFC, 2019b).

Results from quality of life surveys show that bowel incontinence has a negative impact on nearly every part of an individual’s life, including friendships, marriage, sexuality, employment prospects, and the capacity to take part in exercise. Bowel incontinence has been found to be a consistent factor in elderly placement in care facilities. Bowel incontinence is also a leading cause of falls in the elderly population (WOCN, 2016). In another survey, respondents ranked bowel incontinence and urinary incontinence as the 4th and 8th most stigmatizing health conditions respectively out of a list of 30 choices (Simon Foundation, 2019b).

Patients’ bladder and bowel health, particularly incontinence, are often neglected by healthcare professionals. Studies indicate that for female patients it takes approximately six years from the onset of the symptoms of incontinence until they are diagnosed (NAFC, 2018c). Unless the clinician asks about bowel and bladder health, especially problems with incontinence, the patient is often too embarrassed to bring it up. Older patients who are otherwise healthy may also consider incontinence an expected outcome of aging.