Urinary and Fecal Incontinence

Loss of skin integrity leaves a person at greater risk for skin breakdown. Incontinence is the inability of a person to retain or control urine or feces or both, until an appropriate time and place for elimination. Urine and stool may contain substances that irritate the epidermis and may make the skin more susceptible to breakdown. Some of the factors that may cause incontinence are:

• delirium
• diabetes
• diuretics
• environmental barriers
• fecal impaction
• high-impact physical activities
• immobility, in chronic degenerative disease
• impaired cognition
• low fluid intake
• morbid obesity
• medications
• neurologic conditions
• pelvic muscle weakness
• psychological conditions such as dementia
• smoking
• stroke
• toileting behaviors

Incontinence affects patients in all settings. A recent estimate of the direct costs of caring for persons of all ages with incontinence is $11.2 billion annually in the community and $5.2 billion in nursing homes. Given the magnitude of the problem, it is imperative to understand the types of incontinence and the products used to effectively manage this problem.

Fecal Incontinence

Fecal incontinence is the loss of normal control of the bowels, leading to stool leaking from the rectum (the last part of the large intestine) at unexpected times. Fecal incontinence is a greater risk factor for pressure ulcer development than urinary incontinence. It affects as many as 1 million Americans and is more common in women and in the elderly of both sexes. The types of fecal incontinence include:

• solid or formed, soft, liquid - the wastes that pass from the rectum in the form of solid, soft or liquid stool; also called feces
• gas - air that comes from the breakdown of food

Urinary incontinence

A person with urinary incontinence can't control the passage of urine. This condition may range from an occasional leakage of urine to a complete inability to hold any urine. Urinary incontinence affects about 13 million Americans. Additionally, more than 50% of nursing home residents experience some degree of urinary incontinence. The different types of urinary incontinence include:

• Stress incontinence: associated with the impaired urethral closure that allows small amounts of urine leakage when intra-abdominal pressure on the bladder is increased by sneezing, coughing, laughing, lifting, standing from a sitting position or climbing stairs.
• Urge incontinence: associated with detrusor muscle overactivity
• Overflow incontinence: associated with leakage of small amounts of urine when the bladder has reached its maximum capacity and has become distended.
• Functional incontinence: occurs in those who can't remain continent because of external factors even though their urinary tract function is intact.
• Transient incontinence: temporary episodes of urinary incontinence that are reversible once their cause is identified and treated.
• Mixed incontinence: combination of stress and urge incontinence.