FUNCTIONAL URINARY INCONTINENCE
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.)
• Fluid and electrolytes
• Physical regulation
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.
SUGGESTED NOC OUTCOMES
Coordinated Movement; Self-Care: Toileting; Symptom Control;
Urinary Continence; Urinary Elimination
INTERVENTIONS AND RATIONALES
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.
SUGGESTED NIC INTERVENTIONS
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.