Inability of usually continent person to reach toilet in time to avoid

unintentional loss of urine


• Amount of time needed to reach toilet exceeding length of time

between sensing urge to void and uncontrolled voiding

• Loss of urine before reaching toilet

• May be incontinent only in the morning

• Able to empty bladder completely


• Altered environmental factors

• Psychological factors

• Impaired cognition

• Weakened supporting pelvic

• Impaired vision


• Neuromuscular limitations

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Activity/exercise

• Fluid and electrolytes

• Behavior

• Physical regulation

• Elimination

• Self-care


The patient will

• Void at appropriate intervals.

• Have minimal, if any, complications.

• Demonstrate skill in managing incontinence.

• Discuss impact of incontinence on him and family members.

• Identify resources to assist with care following discharge.


Coordinated Movement; Self-Care: Toileting; Symptom Control;

Urinary Continence; Urinary Elimination


Determine: Monitor and record patient’s voiding patterns to ensure

correct fluid replacement therapy.

Perform: Stimulate patient’s voiding reflexes (give patient drink of

water while on toilet, stroke area over bladder, or pour water over

perineum) to trigger bladder’s spastic reflex. Provide hyperactive

patient with distraction, such as a magazine, to occupy attention

while on toilet, reduce anxiety, and ease voiding.

Maintain adequate hydration up to 3,000 ml daily, unless

contraindicated. Scheduling fluid intake promotes regular bladder

distention and optimal time intervals between voidings. Limit fluid

intake to 150 ml after dinner to reduce need to void at night.

Assist with specific bladder elimination procedures, such as the

following: bladder training—this involves muscle-strengthening


exercises, adequate fluid intake, and carefully scheduled voiding

times (encourage voiding every 2 hr while awake and once during

night); rigid toilet regimen—place patient on toilet at specific inter-

vals (every 2 hr or after meals) and note whether voiding occurred

at each interval (this helps patient adapt to routine physiologic func-

tion); behavior modification—refrain from punishing unwanted

behavior (e.g., voiding in wrong place), and reinforce positive behav-

ior using social or material rewards (this helps patient learn alterna-

tives to maladaptive behaviors); use of external catheter—apply

according to established procedure and maintain patency, observe

condition of perineal skin and clean with soap and water at least

twice daily (this ensures effective therapy and prevents infection and

skin breakdown); application of protective pads and garments—use

only when interventions have failed to prevent infection and skin

breakdown and allow at least 4–6 weeks for trial period (establish-

ing continence requires prolonged effort).

Maintain continence based on patient’s voiding patterns and limita-

tions. Respond to call light promptly to avoid delays in voiding routine.

Orient patient to toileting environment: time, place, and activity

to offer security. Provide privacy and adequate time to void to allow

patient to void easily without anxiety.

Replace wet clothes immediately. Select clothing that promotes

easy dressing and undressing (e.g., Velcro fasteners and gowns) to

reduce patient’s frustration with voiding routine.

Inform: Teach family members and support personnel to reduce anxi-

ety that results from noninvolvement. Instruct patient and family

members on continence techniques to use at home to increase

chances of successful bladder retraining.

Attend: Encourage patient and family members to share feelings

related to incontinence. This allows specific problems to be identified

and resolved. Attentive listening conveys recognition and respect.

Manage: Refer patient/family to home healthcare agency, or support

group to provide access to additional community resources.


Pelvic Muscle Exercise; Prompted Voiding; Self-Care Assistance; Uri-

nary Elimination Management; Urinary Habit Training


Dowd, T., & Dowd, E. T. (2006, January–February). A cognitive therapy

approach to promote continence. Journal of Wound, Ostomy and
Continence Nursing, 33(1), 63–68.

Zarowitz, B. J., & Ouslander, J. G. (2006, September–October). Management

of urinary incontinence in older persons. Geriatric Nursing, 27(5), 265–270.