Continence Care
Core assessment
Continence care starts with pattern and cause, not just pads. Obtain a voiding diary, medication review, urinalysis when indicated, postvoid residual (PVR), and focused examination. Distinguish stress incontinence (leak with cough/sneeze/activity), urgency incontinence (sudden urge with leakage), overflow incontinence (frequent small leakage with incomplete emptying or high PVR), functional incontinence (access or cognition barriers), and mixed incontinence. For bowel concerns, assess stool frequency, consistency, fiber/fluid intake, medications, constipation, impaction, and toileting access. Skin assessment is essential because urine and stool are both damaging.
Interventions and traps
Start with conservative measures: timed voiding or bladder training, pelvic floor muscle training with proper technique, fluid and caffeine modification, constipation management, and individualized toileting. Avoid treating asymptomatic bacteriuria. Do not use an indwelling catheter for incontinence unless clinically necessary; intermittent catheterization is preferred for retention when appropriate. A common trap is giving an anticholinergic bladder relaxant for overflow incontinence without relieving retention. Another is assuming leakage means a urinary infection. For fecal incontinence, address impaction and stool consistency before considering containment alone.
Rule of thumb
Use a 3-day voiding diary and interpret PVR with symptoms; a persistently elevated PVR (often >150–200 mL) suggests incomplete emptying. Example: an older adult with dribbling, a palpable bladder, and PVR of 400 mL has overflow incontinence-catheterize/relieve retention and investigate, rather than starting urge-suppression therapy first.