How you do it

€ Whether the patient reports urinary or faecal incontinence or both, you'll need to perform initial and continuing assessments to plan effective interventions.

For urinary incontinence

€ Ask the patient when he first noticed urine leakage and whether it began suddenly or gradually. Have him describe his typical urinary pattern: does he usually experience incontinence during the day or at night? Ask him to rate his urinary control: does he have moderate control, or is he completely incontinent? If he sometimes urinates with control, ask him to identify when and how much he usually urinates.
€ Evaluate related problems, such as urinary hesitancy, frequency, and urgency; nocturia and decreased force or interrupted urine stream.
€ Ask the patient to describe treatment he has used for incontinence, whether doctor prescribed or self-prescribed. Know the environment
€ Assess the patient's environment. Is a toilet, commode or bedpan readily available, and how long does the patient take to reach it?

After he's in the bathroom, assess his manual dexterity - for example, how easily does he manipulate his clothes?

€ Evaluate the patient's mental status and cognitive function.
€ Quantify the patient's normal daily fluid intake.
€ Review the patient's medication and diet history for drugs and foods that affect digestion and elimination.
€ Review or obtain the patient's medical history, noting especially the number and route of births and incidence of urinary tract infection (UTI), prostate disorders, spinal injury or tumour, cerebrovascular accident, and bladder, prostate or pelvic surgery.

Also, check for signs and symptoms of delirium, dehydration, urine retention, restricted mobility, faecal impaction, infection, inflammation and polyuria.

Doing the inspection

€ Put on gloves and an apron.
€ Inspect the urethral meatus for obvious inflammation or anatomic defects. Have the female patient bear down while you note any urine leakage. Gently palpate the abdomen for bladder distention, which signals urine retention. If possible, have a urologist examine the patient.
€ Label each specimen container prior to obtaining specimens (ensuring that cross-contamination is eliminated by preventing urine/faecal contact with your pen) for appropriate laboratory tests as ordered. Remove gloves and apron then wash your hands and send specimens to the laboratory with a request form.

Retraining the bladder

€ Begin incontinence management by implementing an appropriate bladder retraining programme.
€ Make sure the patient drinks plenty of fluids to ensure adequate hydration and to prevent UTIs. Restrict fluid intake after 6 p.m.
€ Begin an exercise programme to strengthen the pelvic floor muscles and to help manage stress incontinence.
€ To manage functional incontinence, frequently assess the patient's mental and functional status. Regularly remind him to void.

Respond to his calls promptly, and help him get to the bathroom quickly. Provide positive reinforcement.