Continence Assessment: What to Ask Patients
Continence assessment is an important part of making sure that patients get the proper treatment for their conditions. When caring for a patient with incontinence, it is important to make sure you get all of the facts from the person themselves as much as possible. If they have a caregiver or spouse involved in helping them keep track of their medical needs, it is also important to include that person in the continence assessment meeting. Here are some guidelines for health care providers, including what questions to ask.
Bladder Diary Assessment
The patient or caregiver should be asked to fill out a chart or diary of bladder and bowel function before the assessment if possible. It is generally a good idea to track for at least a week to get a good indication of the problems the person is experiencing. The diary can include:
- Liquids the person drinks including type, amount and time
- Times of urination and any unusual symptoms
- Bowel movements
- Physical activity
A holistic approach is best when doing continence assessment so that confounding conditions can be recognized and addressed. Along with the diary, the person should be asked to note any unusual situations, such as:
- Feeling the urge to urinate but not being able to produce urine
- An uncontrollable urge to urinate that comes on suddenly
- Inability to get to the bathroom on time
- The need to use a pad or other absorption device to prevent leakage of urine
- Rashes caused by incontinence of urine or bowel
- Lifestyle changes made to accommodate urinary or bowel needs
Continence Assessment Conference
Starting with the bladder continence assessment diary, discuss the situation with the patient and, if appropriate, their family member or caregiver. Here is what to ask:
- How often do you go to the toilet?
- How much urine do you pass each time?
- Do you get off the toilet quickly, or wait and try to void again after relaxing?
- How often and how much are you having leakage problems?
- Do you have leakage when doing activities like coughing, lifting, or laughing?
- Do you wake up at night to urinate?
- What are your diet and fluid intake?
- How much coffee or alcohol do you drink?
- What other health problems do you have?
- Have you ever had surgery?
- What current medications do you take and when?
- Do you have any problems with bowel leakage? If so, what is the problem?
- Do you have any difficulty with self-care tasks like dressing, toileting, or getting to and from a toilet?
- Do you smoke?
- For women: Have you ever been pregnant?
- Have you entered menopause?
The physician/health care practitioner may also ask about sex life and treatment wishes.
Functional Continence Assessment
If the health care provider suspects that part of the problem with incontinence is something other than bladder function, it can be important to do a functional assessment, which includes asking questions to determine:
- Mental functioning of the patient
- The patient's ability to move to and from sitting and standing
- The height of the person's bed, chair and toilet and the patient's ability to move between them
- The individual's home environment, including flooring and lighting
- What type of shoes they wear at home
- The patient's eyesight and use of glasses
Functional continence assessment questions can help determine if there are changes that can be made to the environment or assistance that can be given which can improve the situation.
Goal of Continence Assessment
The end goal of continence assessment is to determine ways to help the patient reduce symptoms and live more comfortably with incontinence. Often a thorough questioning of the patient can provide enough information to provide guidance on ways to reduce the problem by using techniques like:
- Bladder training
- Pelvic floor exercises
- Reducing fluid intake
- Planning activities to include bathroom breaks
- Double voiding
- Avoiding triggers
- Planned urinary schedule
- Use of pads and adult underwear when necessary
In order to give effective continence care, health care providers need to be prepared to take the time to ask questions in a continence assessment and to use the patient's answers to deduce the best way to help them manage their condition.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of IncontinenceSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.