Hospital Resources - Bowel & Bladder

Incontinence is the inability to control excretory function leading to urinary or fecal incontinence respectively. Loss of a bowel or bladder control does become more prevalent as people age.

Why is it Important?

  • 30% of men and 50% of women over 65 years can have urinary incontinence (3)
  • 4% – 7% of people over 65 have fecal incontinence
  • Often not disclosed as a problem until advanced symptoms

Common Causes Bowel

  • Constipation: weakens the walls of the rectum and/or damages the nerves
  • Diarrhea: certain foods or infections
  • Muscle damage: damage to the external or internal sphincter
  • Nerve damage: childbirth, stroke, spinal cord injury, diabetes, M.S. or any other disease affecting nerves.
  • Reduced elasticity: Inflammatory bowel diseases, previous surgery or radiation
  • Other conditions; rectal prolapse, hemorrhoids

Common Causes Bladder

  • Muscle weakening: vaginal childbirth, brain and spinal cord injury, multiple sclerosis, Parkinson’s disease, diabetes, stroke, fracture of the pelvic bones, medications, prostate gland removal or enlargement
  • Menopause: progressive decrease of estrogen
  • Obesity & overweight: increase the abdominal pressure like walking, lifting, coughing, sneezing and sports
  • Urinary Tract Infections (cystitis): infection in the urinary bladder increases the sensitivity of the bladder
  • Nerve damage: childbirth, stroke or spinal cord injury, diabetes, multiple sclerosis or similar type disease
  • Smoking and Alcohol: coughing, chest infections, can cause a stimulant effect on the bladder muscle

Key Considerations

  • Assess the severity and impact on the resident
  • Implement a toileting regime
  • Complete careful assessment before resorting to continence products

For fecal incontinence review symptoms and perform:

  • Physical and rectal examination
  • Consider: diet changes; medication; fiber supplements antidiarrheal drugs, laxatives and stool softeners: special exercises; behavioural training; surgery

For urinary incontinence a functional assessment is recommended in the elderly.

  • Identify the type and likely cause of bladder dysfunction to determine type of incontinence (transient, urge, stress, overflow, functional)
  • Referral to urology as necessary
  • Considerations: Kegel exercises; bladder retraining; medications: anticholinergic, neurotoxins, estrogen; pessaries, catheters; surgery

References

1. About Fecal Incontinence. (2014). The Canadian Continence Foundation. Retrieved March 10, 2014
    from:
    http://www.canadiancontinence.ca/EN/fecal-incontinence.php

2. Australian Government: Department of Health. (2012). Older Persons. Retrieved March 11, 2014 from:
    http://www.bladderbowel.gov.au/olderpersons/

3. Bostock, N & Kelly, A. (2011) Help for people who care for someone with bladder or bowel problems.
    Retrieved March 11, 2014 from the Australian Government Department of Health and Aging website:
    http://www.bladderbowel.gov.au/assets/doc/ContinenceCarers.html

4. Khaled, I. (2004). The Role of the Primary Care Physician in the Management of Bladder Dysfunction.
    Rev Urol. 2004; 6 (Suppl 1): S38–S44. Retrieved March 2014 from:
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472846/

5. The Canadian Continence Foundation. (2009). Retrieved March 10, 2014 :
    http://www.canadiancontinence.ca/pdfs/impacts-of-incontinence-in-canada.pdf