Urinary Incontinence in Adults: Protecting Sensitive Skin

Elizabeth A. Klumpp

Urinary incontinence (UI) affects approximately 13 million Americans or about 10 to 35 percent of adults and at least half of the 1.5 million nursing home residents. Among the population between 15 and 64 years of age, the prevalence of UI in men ranges from 1.5 to 5 percent and in women from 10 to 30 percent. For non-institutionalized persons older than 60 years of age, prevalence ranges from 15 to 35 percent, with women having twice the prevalence of men.

Survey data from caregivers of the elderly show that approximately 53 percent of the homebound elderly are incontinent. A random sampling of hospitalized elderly patients identified 11 percent as having persistent UI at admission and 23 percent at discharge. A recent estimate of the direct costs of caring for persons of all ages with incontinence is more than $15 billion annually.

UI is defined as involuntary loss of urine that is sufficient to be a problem. UI can be caused by factors affecting either the anatomy or the physiology of the lower urinary tract, or both, as well as other factors. Documented risk factors associated with incontinence are wide ranging and include:

• Immobility commonly associated with chronic degenerative disease
• Diminished cognitive status and delirium
• Medications, including diuretics
• Smoking
• Fecal impaction
• Low fluid intake
• Environmental barriers
• High-impact physical activities
• Diabetes
• Stroke
• Estrogen depletion
• Pregnancy, vaginal delivery, and episiotomy
• Pelvic muscle weakness.

Long-Term Care Settings

Federal guidelines suggest that incontinent nursing home residents have an incontinence evaluation and an attempt at treatment when feasible. It therefore becomes important to identify those individuals who have potential to respond to therapeutic interventions. There is now evidence that suggests those nursing home residents who are likely to benefit from behavioral therapy for their urinary incontinence can be easily identified.

Incontinent nursing home residents who show a response to a simple, non-invasive assessment consisting of a three-day trial of prompted voiding have potential to show long-term benefit in control of their incontinence using prompted voiding.

Alerting Caregivers

New products are appearing that alert caregivers when residents have had an incontinent episode. They enable caregivers to change their residents in a more timely manner to guard against the negative effects of urine on residents' skin.

This new category of incontinence alert products includes systems that contain in-underwear sensors and sensor mats that can be placed on the bed. When an incontinent episode occurs, a loud pulsed audible alarm sounds that can wake the patient or alert a caregiver. The sensor is a foil embossed plastic mat that is tied down over the mattress under the area that is normally wetted. The bed is then made up on top of the mat.

Skin Protection

Many manufacturers of urinary incontinence products also have skin protectants and deodorizers available. Skin protectants, used to prevent breakdown of the skin, should be applied any time skin is in frequent contact with moisture. Moisturizers are used to rehydrate skin that is dehydrated from frequent washing and contact with moisture. Moisture barriers are used to direct moisture away from the skin and are extremely effective in preventing skin maceration.