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Incontinence
Ostomy Wound Management on the Web is a comprehensive resource for clinical information on wound care as well as Incontinence. We hope the articles below provide timely information for your practice.
The Impact of Urinary Incontinence in African American Women
Urinary incontinence is a major health problem for many individuals, especially older women. Research on urinary incontinence is common in Caucasians, but scarce in women of diverse cultures. Using data from a previous (parent) descriptive correlational study on risk factors for urinary incontinence in African American women (N = 233), a descriptive study of the impact of urinary incontinence was conducted among 85 college-educated African American women who were members of a prestigious African American organization and reported symptoms of urinary incontinence. Information about frequency and duration of incontinence, activities affected by urinary incontinence, and ratings of how much they were bothered by their urinary incontinence was obtained. Mean age of the study group was 51.94 years (range 20 to 80 years). Fifty-four of the participants (64%) reported one or more vaginal delivery, 33% had undergone a hysterectomy, and symptoms of urinary incontinence had been present from 3 months to 30 years. Stress, urge, and mixed incontinence were reported. Eleven women (13%) had sought treatment for their urinary incontinence, 20% said urinary incontinence bothered them a great deal, 8.5% reported behavioral modifications, and a portion of the women said they had to spend extra money on incontinence supplies. In this group of African American women, urinary incontinence rates were similar to those reported in Caucasian women. Research to increase clinician knowledge base and improve the care of African American women is needed.
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A Nursing Analysis of the Causes of and Approaches for Urinary Incontinence among Elderly Women in Nursing Homes (PART 1)
Urinary incontinence is a widespread but often ignored problem among elderly women residing in nursing homes. Despite numerous research studies performed within this setting, few have been able to demonstrate lasting change in the care of and enduring outcomes in this population. However, neither the most commonly used definitions of incontinence nor current management approaches are meeting the needs of institutionalized frail elderly, particularly women, who are twice as likely as men to demonstrate symptoms of the condition. Costs in terms of quality of life and expense of care are staggering. Because many believe that a holistic approach may provide direction for management of urinary incontinence, and because nursing is a holistic profession, a solution to the challenges involved in treating incontinence among the elderly potentially lies in utilizing a nursing as opposed to medical framework for the analysis of factors and care. Specifically, the complexities of testing necessary to differentiate current diagnoses might be simplified by classifying incontinence in a different way, such as using nurse-identified levels of need as opposed to physiologically-based factors. The use of nursing theory to guide patient assessment and an evaluation of systems of care provides a fresh approach to this long-standing problem. Keywords: urinary incontinence, nursing home population, women, diagnosis, treatment
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Using Epidemiology in Patient Education for Post-Prostatectomy Urinary Incontinence
This article reviews and discusses the prevalence and incidence of and risk factors for urinary incontinence after prostate cancer surgery. The reported prevalence rates of urinary incontinence in men vary among studies due to different definitions and methodologies; however, it is agreed that urinary incontinence is a common condition, especially immediately after surgery. Although few risk factors have been identified, damage to the sphincter or its nerves is an accepted underlying pathology. Urinary incontinence can be devastating to men and sensitivity to emotional and educational needs is critical. Ostomy/Wound Management 2001;47(12):20?25
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The Anal Bag: A Modern Approach to Fecal Incontinence Management
In the past 30 years, colostomy and urostomy bags have dramatically improved the quality of life of ostomy patients. However, the anatomical characteristics and physiological motility of the pelvic floor have hampered the development of suitable disposable containers that can be applied directly to the anus. Use of a recently developed anal bag that insulates the anus and peri-anal area and collects stool was evaluated in two inpatient care settings in Italy from 1994 to 2004. The study included four nurses and eight physicians (four gastroenterologists, two cardiologists, and two gerontologists) involved in the care of 120 patients (65 men, 55 women, ages 45 to 96 years). The study population consisted of patients who were elderly and bedridden (47), had pressure ulcers (15), were affected by fecal incontinence or bedridden in intensive care (10), had coronary problems (10), and were receiving high-dose chemotherapy (10); patients who had undergone anorectal surgery (28) were added to the study to evaluate the anal bag for postoperative use to prevent contamination and contain exudate and fluid. Study participants were divided into groups based on length of anal bag use (3 days, 1 week, or 4 months or more). Objective evaluation at each bag change included skin reactions to the adhesive. Study participants? feelings and perceptions as well as nurse and physician evaluations of the anal bag were assessed using questionnaires and four-point rating scales. No adverse reactions to the product were observed and none of the high-risk patients developed a pressure ulcer. The majority of patients (91, 76%) tolerated the bag well and reported it was not painful to remove or apply (102, 85%). Nurses and physicians all considered the device easy to use and appreciated its potential to prevent contamination and cross-contamination. This device may help improve the management of fecal incontinence and prevent complications. KEYWORDS: fecal incontinence, bedridden patients, patient hygiene, faecis isolatio, anal bag
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Incontinence-Associated Skin Damage in Nursing Home Residents: A Secondary Analysis of a Prospective, Multicenter Study
More than half of the nursing home population is incontinent of urine or feces, presenting challenges to perineal skin health. To determine the occurrence and severity of skin damage in nursing home residents with incontinence, a secondary analysis of data collected from a multisite, open-label, quasi-experimental study of cost and efficacy of four regimens for preventing incontinence-associated dermatitis in nursing home residents was performed. Sixteen randomly selected nursing homes from across the US were included in the study. Participating nursing home residents were incontinent of urine and/or feces and free of skin damage. Of the 1,918 persons screened, 51% (n = 981) qualified for prospective surveillance. Perineal skin was assessed over a 6-week period; frequency, type, and severity of skin damage were observed. Skin damage developed after a median of 13 (range 6 to 42) days in 45 out of 981 residents (4.6%), of which 3.4% was determined to be incontinence-associated dermatitis. Some residents (14 out of 45, 31%) had incontinence-associated dermatitis or other skin damage in more than one area. This study is one of the first to report the characteristics of incontinence-associated dermatitis in a large sample of nursing home residents. The sample size and random selection of nursing homes impart generalizability to the findings. Incontinence-associated dermatitis is a risk in nursing home residents, especially those with fecal incontinence. These findings suggest that the rate and severity of incontinence-associated dermatitis are low with close monitoring and use of a defined skin care regimen that includes a pH-balanced cleanser and moisture barrier. KEYWORDS: skin damage, dermatitis, incontinence, pressure ulcer, skin treatment, moisture barrier, nursing home
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An Evaluation of Two Incontinence Skin Care Protocols in a Long-Term Care Setting
Caring for the skin of patients with incontinence is an essential activity in long-term care. A prospective descriptive study to compare the effect of two skin care protocols on skin condition, pain, and caregiver time was conducted. Thirty-two (32) skilled nursing facility residents with incontinence participated in the 3-week study. Patients were randomly assigned to a standard care regimen (soap and water cleansing after each incontinence episode, followed by application of a moisturizing lotion) or study care protocol (no-rinse skin cleanser after each episode and application of a barrier cream with durable properties after the first incontinence episode of each shift). Number and type of incontinence episodes, skin condition, pain, and caregiver time spent were assessed. Skin integrity was maintained in the majority of control (69%) and study group (72%) patients and improvement occurred in 8% of control and 17% of the study group (NS). Study protocol procedures took less time to complete than control procedures (a savings of 79 minutes/patient/day). A positive correlation between pain intensity and level of skin impairment was observed (r = 0.88). The results of this study suggest that at this facility, use of soap, water, and a moisturizer may be less effective and more time-consuming than using a no-rinse cleanser and a durable barrier product.
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The State of the Science on Urinary Incontinence. A look at the proceedings of the conference, "Urinary Incontinence: Research, Practice, and Policy Issues"
This article is excerpted from the executive summary of the full report of the symposium and also appears in the American Journal of Nursing, March 2003 (reprinted with permission). The report is available at www.nursingcenter.com/ui. Ostomy/Wound Management is grateful to the collaborators, sponsors, and publishers involved in this project for allowing us to bring this information to our readers.
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A Review of Perineal Skin Care Protocols and Skin Barrier Product Use
Perineal skin damage secondary to incontinence is painful, prevalent, and preventable. Skin care professionals consider regular application of skin protectants for patients with incontinence the standard of care for preventing perineal skin injury secondary to incontinence. Although protocols to improve care exist, the extent to which they are implemented and followed has not been documented. A study was conducted to ascertain the extent to which perineal skin care protocols are consistent with Wound, Ostomy and Continence Nurses Society Clinical Practice Guidelines and to estimate the level of compliance related to the use of protective perineal skin barriers. A convenience sample of 76 perineal skin care protocols was obtained from acute care (n = 55), long-term care (n = 9), and nondisclosed types of extended care facilities (n = 12). All protocol interventions were compared to the Wound, Ostomy and Continence Nurses guidelines. Healthcare Products Information Services data were used to obtain the total amount of skin protectants sold to US healthcare facilities in 2002. Skin protectant use was compared to previously published urinary and fecal (urofecal) incontinence prevalence data. All 76 protocols lacked one or more of the interventions considered important in perineal skin care. Although 75% of the protocols included the use of skin protectants, Healthcare Products Information Services data and urofecal prevalence data suggest underutilization of skin protectants; an estimated 10 cents per day versus an anticipated average cost of 23.5 cents per application is being spent. Further study is warranted and necessary to ensure the application of evidence-based protocols of care in practice. KEYWORDS: perineal, skin, wounds, incontinence, dermatitis
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Promoting Continence: Simple Strategies with Major Impact
Urinary incontinence is a common problem, especially among women, yet it remains underreported and undertreated. This is partly due to patients' beliefs that little can be done and partly due to healthcare professionals' perception that treatment is limited to surgery, advanced behavioral strategies requiring specialized equipment, or containment devices. Nurses are in a strategic position to reduce the incidence of incontinence by teaching bladder health strategies (ie, fluid management, appropriate voiding intervals, constipation prevention, weight control, smoking cessation, and pelvic muscle exercises), actively assessing patients for incontinence, and initiating appropriate referrals and primary interventions. Patients with significant neurologic deficits, structural abnormalities such as pelvic organ prolapse, or urinary retention should be referred for further workup. However, most patients can be treated with primary continence restoration strategies, which include identifying and correcting reversible factors such as urinary tract infection or atrophic urethritis; instruction in pelvic floor muscle exercises; and instruction regarding urge inhibition strategies. Implementing these simple strategies can significantly improve bladder function and continence in the majority of patients.
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A Nursing Analysis of the Causes of and Approaches for Urinary Incontinence among Elderly Women in Nursing Homes (PART 2)
Urinary incontinence is a widespread but often ignored problem among elderly women residing in nursing homes. Despite numerous research studies performed within this setting, few have been able to demonstrate lasting change in the care of and enduring outcomes in this population. However, neither the most commonly used definitions of incontinence nor current management approaches are meeting the needs of institutionalized frail elderly, particularly women, who are twice as likely as men to demonstrate symptoms of the condition. Costs in terms of quality of life and expense of care are staggering. Because many believe that a holistic approach may provide direction for management of urinary incontinence, and because nursing is a holistic profession, a solution to the challenges involved in treating incontinence among the elderly potentially lies in utilizing a nursing as opposed to medical framework for the analysis of factors and care. Specifically, the complexities of testing necessary to differentiate current diagnoses might be simplified by classifying incontinence in a different way, such as using nurse-identified levels of need as opposed to physiologically-based factors. The use of nursing theory to guide patient assessment and an evaluation of systems of care provides a fresh approach to this long-standing problem. Keywords: urinary incontinence, nursing home population, women, diagnosis, treatment
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