What are the prevalence and impact of urinary and fecal incontinence in the inpatient setting?
What are the causes and mechanisms of urinary and fecal incontinence in hospitalized adults?
Which serious underlying diseases or conditions can present with urinary or fecal incontinence?
What are the common causes of urinary retention in hospitalized patients?
Which tests and studies are most useful in the evaluation of urinary and fecal incontinence in the hospital setting?
What treatments are available for urinary and fecal incontinence?
What are the treatments for urinary retention in hospitalized patients?
What are the guidelines for urinary catheter use and management in hospitalized patients?
What are the important elements of incontinence management in transitions of care?
Urinary incontinence (UI) is a common condition that increases with age and affects up to one-third of community-dwelling persons. Although fecal incontinence (FI) is less prevalent, two-thirds of patients with FI also have urinary UI (dual incontinence); only about 20% of patients with UI have dual incontinence. In the hospital setting both UI and FI may coexist with urinary retention (UR). Relatively few studies have addressed the prevalence of both types of incontinence in acute care settings. It has been estimated that 22% to 35% of patients on general medical wards have UI and the prevalence of FI is 10% in acute care settings.
Although incontinence care is often delegated to nursing staff, failure to recognize, evaluate, and treat incontinence and UR as significant “hazards of hospitalization,” especially in older patients, can increase morbidity and functional impairment and increase length of stay. Incontinence can cause skin breakdown, pressure ulcers, increased use of indwelling catheters, and falls. Catheter-associated urinary tract infection (CAUTI) is a “never event” that impacts reimbursement as well as quality of care. Poor quality incontinence management also increases costs from absorbent and containment products, increased use of already limited resources (eg, nursing and aide time), and can lead to increased caregiver burden after discharge.
Normal micturition and defecation involve similar neural control and muscular coordination. Efferent nerves arising from the sacral micturition center at S2–S4 mediate bladder muscle (detrusor) contraction via muscarinic receptors. Contraction of smooth muscle in the proximal urethral and internal anal sphincters is medicated by sympathetic, adrenergic nerves arising from T11-L2. The distal urethral sphincter and the external anal sphincter are voluntarily controlled via somatic cholinergic nicotinic nerves arising from the sacral micturition center. Urethral and anal closure are also maintained through contraction and support from striated muscle and fascial elements in the pelvic floor. Coordination of bladder filling and emptying is controlled by a micturition center in the pons linked to subcortical and frontal pathways that inhibit voiding. Less is known about neurological control of defecation, although similar mechanisms have been proposed that coordinate relaxation of the external anal sphincter with the change of the ano-rectal angle with valsalva. Normal defecation also depends on stool consistency (affected by diet and colonic transit time), rectal compliance and ...