SPPICES: Urinary
Incontinence
Organizational Goal
• To organize continence services in an
integrated fashion that focuses on the
identification of patients, assessing their
condition and implementing the most
appropriate treatment plan. This model of
good practice will allow staff to achieve
more responsive and effective continence
services and assist patients.
SPPICES Questions
1.
Do you have problem passing
water/getting to the bathroom on time?
2. Did you wear incontinence products at
home?
3. If there is a catheter, is it still needed?
4. Was your last bowel movement 3 days
ago?
Did you know that...
• 50% - 70% of persons with UI
don’t seek help.
• UI is a very common problem with
treatments that work.
• Most cases of UI can be markedly
improved.
Prevalence
• 15% - 30% of seniors in the community
• 15.3% in acute care facilities
• 50% in nursing homes
Impact of UI
• Physical
• Psychosocial
• Financial
Definition
• A common, disruptive, and potentially
disabling condition in the aging population.
• An involuntary loss of urine in sufficient
amounts or frequency to constitute a social
and/or health problem.
(Kane, Ouslander, & Abrass, 1994)
Requirements for Continence
 Effective lower urinary tract functioning  storage &
emptying
 Adequate mobility and dexterity to use the toilet, toilet
substitute, and to manage clothing
 Adequate cognitive function to recognize toileting
needs and to find a toilet/substitute
 Motivation to be continent
 Absence of environmental and iatrogenic barriers such
as inaccessible toilets/substitutes, unavailable
family/caregivers and drug side effects
Established/Persistent UI:
The Bladder
Normal Aging Changes
Anatomy
Physiology
Types of UI
1.
Acute / Reversible
2. Established/Persistent
Overflow
Urge
Functional
Stress
Causes of Acute/Reversible UI
D
I
A
P
P
E
R
S
Delirium
Infection
Atrophic Vaginitis/ Urethritis
Pharmaceuticals
Psychological causes
Excess fluid
Restricted mobility
Stool impaction
(Resnick, 1992)
Established UI: Overflow
Urine loss (dribbling) associated with an overdistended
bladder due to an obstruction in the urethra.
Signs and Symptoms:
 Leakage of small amounts of urine
 Palpable or percussable bladder, suprapubic tenderness
 Hesitancy on voiding, interrupted urine flow or post void
dribbling
 Urine loss without urge
 Sensation of incomplete voiding or bladder fullness
 Frequency
Established UI: Urge
Involuntary loss of urine (usually larger amounts)
associated with a sudden, strong desire to void.
Signs and Symptoms:
 Sudden “urgency” to void
 Nocturia and / or Enuresis
 Moderate to large amounts of urine loss
 Loss of urine at the sound of water running or when
waiting to access a public toilet
Established UI: Functional
Urinary leakage associated with the inability to toilet
because of impairments in cognition and/or physical
functioning, psychological unwillingness or
environmental barriers.
Signs and Symptoms:
 Report of being unable to get to the
bathroom on time
 Total emptying / large amounts of
urine leakage
 No incontinence when access to a bathroom and
assistance with toileting available
Established UI: Stress
An involuntary loss of urine (usually small amounts)
with increases in intraabdominal pressure (ie. Cough,
laugh, sneeze, exercise).
Signs and Symptoms:
 Small amounts of urine leakage/loss associated with
activity, lifting, coughing, sneezing, and/or laughing
 Urine leakage during the day while person is active
Interventions
•
•
•
•
•
•
•
Environmental Alterations
Lifestyle Management
Scheduling Regimes
Pelvic Muscle Rehabilitation
Continence Products
Catheterization
Occlusive & Pelvic Organ Support
Devices
• Medication
• Surgery
New onset urinary incontinence
Risk factors identified: Delirium/confusion
Clinical
Assessme
nt
Symptom
s
Type of
Incontinenc
e
Intervention
s
Evaluatio
n
Infection, urinary symptoms
Atrophic vaginitis/urethritis
Pharmaceuticals
Psychologic disorders
Endocrine disorders
Restricted mobility
Stool impaction
Frequency
Noctuira
Enuresis
Moderate to large amount
of urine loss
URGE
Bladder training
Kegel exercises
Liners/briefs if needed
Environmental modifications
Consider medical referral as
indicated
Provide urinal/commode
Subjective/obje
ctive report of
improvement
Decreased use of
liners/briefs
Small amount
urine loss
Associated with activity,
Coughing
Sneezing
STRESS
Kegel exercise
Bladder training
Bladder diary to establish
routine
Liners/briefs if needed
Consider medical referral
as indicated
Monitor
weekly
Subjective report of  in
incontinent episodes
Frequent urination
Post void dribbling
Retention
Hesitancy
Sensation of fullness/pressure
in abdomen
Urine loss without urge
OVERFLOW
Allow patient
sufficient time to
void
Encourage double void
PVR using
bladder scanner
Contact MD if appropriate
for I/O or catheterization
order
Provide urinal or
commode
Medication review
PVR
Monitor daily then
weekly
Unable to get
to toilet on time
FUNCTIONAL
Scheduled
toileting
Avoid restraints
Ensure toilet accessible
Provide commode etc at
bedside
Modify fluid intake pattern
Modify environment eg
remove obstacles
Ensure adequate lighting
OT/PT assessment
Monitor weekly
Subjective/objective report
of  in incontinence episodes
Case Study
Mr. Yeung is a 90 year old man with a history of
dementia, CHF, and osteoarthritis. He is on 40mg
lasix BID, and Tylenol # 3 prn for his pain. During
his hospitalization for exacerbation of his CHF, he
has a new onset of urinary incontinence.
What type of UI is Mr. Yeung experiencing?
What would be your plan of action for him?