Table of contents: Structured Urinary Continence Assessment and Management Plan

1. Screening for Urinary Incontinence and Lower Urinary Tract Symptoms
2.  Assessment for Lower Urinary Tract Symptoms/Incontinence
3.  Frequently Asked Questions
4. Conclusion
5. References

Structured Urinary Continence Assessment and Management Plan (SCAMP) is a comprehensive approach used to diagnose and manage urinary incontinence. It involves a structured assessment process which includes taking a detailed medical history of an individual, physical examination, bladder diary, urinalysis, culture and urodynamic testing. 

A structured urinary continence assessment and management plan is a person-centred approach that considers the individual’s needs, preferences and expectations. It involves educating individuals on the management of their condition, encouraging self-care and regular follow-up to monitor treatment progress. The approach also acknowledges that urinary incontinence is often a multifactorial condition that requires a multidisciplinary team to manage effectively.

Screening for Urinary Incontinence and Lower Urinary Tract Symptoms

The first step in developing a urinary continence management plan is to screen for urinary incontinence and lower urinary tract symptoms (LUTS). This screening involves a thorough evaluation of your urinary system to identify any issues that may be contributing to your incontinence or symptoms. This screening will typically involve the following assessments:

Urinalysis

Urinalysis is a simple test that involves checking your urine for particular substances that may indicate an underlying health condition or infection. This test is valuable in diagnosing urinary tract infections, which can cause incontinence or LUTS, such as urgent or frequent urination.

Post Void Residual Volume

Post void residual (PVR) volume refers to the amount of urine that remains in the bladder after urination. Normally, the bladder should empty completely during voiding, leaving little to no urine in the bladder. However, some people experience incomplete emptying, which can result in an accumulation of urine in the bladder.

Incomplete emptying of the bladder can be caused by several factors, including an obstructed bladder outlet, nerve damage, or weakened bladder muscles. This incomplete emptying can lead to various urinary symptoms, such as urgency, frequency and incontinence. In some cases, it may also increase the risk of urinary tract infections.

Measuring PVR volume  is a simple and non-invasive test that can help diagnose abnormal bladder function. This test involves using a bladder scan to measure the amount of urine remaining in the bladder after emptying. A high PVR volume indicates that the bladder is not emptying properly, which can be suggestive of an underlying condition requiring further investigation.

Prior Urinary Incontinence or LUTS and Risks for Urinary Incontinence

Your medical history plays a vital role in the assessment and management of your urinary incontinence or lower urinary tract symptoms. If you’ve had issues with urinary function in the past, this information will be considered in your management plan. Additionally, any risk factors you have for incontinence, such as obesity or pelvic floor weakness, will be taken into account.

Prior urinary incontinence or LUTS, as well as risk factors for these conditions, can provide valuable information in the assessment and management of urinary continence. If you have experienced incontinence or LUTS in the past, this information can inform your evaluation and help identify the underlying cause of your current symptoms. It is important to be open and honest with your healthcare provider about any previous urinary issues, as well as any treatments you may have tried in the past.

Urinary Catheter/Urostomy

If you have a urinary catheter or urostomy, this will also play a role in the development of your management plan. It’s essential to evaluate the use of the catheter or urostomy and assess the need for continued use.

Urinary catheters and urostomies are medical devices used to collect and dispose of urine when the body is not able to do so naturally. A urinary catheter is a tube inserted into the bladder through the urethra to drain urine, while a urostomy is a surgical procedure in which a section of the urinary system is rerouted through an opening in the abdomen and into a collection bag.

If you have a urinary catheter or urostomy, your healthcare provider will consider the use of these devices in the development of your management plan. The use of a catheter or urostomy may impact your management plan in several ways, including:

 Infection prevention: Catheters and urostomies can increase the risk of urinary tract infections (UTIs). Healthcare providers will need to screen for and manage any UTIs that occur in patients with these devices.

Monitoring of symptoms: Participants with catheters or urostomies may still experience incontinence or LUTS symptoms despite the use of these devices. Monitoring and managing these symptoms will be a key part of the management plan.

Catheter or urostomy care: Proper care and maintenance of catheters and urostomies are essential to prevent infection and other complications. Patients and their caregivers will need to be educated on appropriate catheter or urostomy care.

In some cases, with careful assessment and management, it may be possible to discontinue the use of a urinary catheter or urostomy. Depending on a patient’s individual circumstances, their management plan may include strategies to reduce catheter or urostomy use.

 Assessment for Lower Urinary Tract Symptoms/Incontinence

After the initial screening, a more in-depth evaluation of your urinary system will be conducted to determine the causes of your symptoms. This assessment may encompass several elements:

Relevant Medical History

Your medical history is an essential component of your urinary continence assessment. During your evaluation, the Registered Nurse will ask about your medical history and any prior surgeries or medical conditions that may have affected your urinary system. Common medical conditions that can affect urinary function include diabetes, multiple sclerosis, spinal cord injuries, and prostate cancer.

Relevant Surgical History

Your surgical history is an important factor in the assessment of your urinary health. Certain surgeries can impact the urinary system and contribute to the development of incontinence or LUTS. Some examples of surgeries that can affect urinary function include:

Hysterectomy: this surgery involves the removal of the uterus and can affect the position and support of the bladder and urethra, leading to incontinence or LUTS.

Prostate surgery: procedures such as a transurethral resection of the prostate (TURP) or prostatectomy can affect the function of the bladder and urethra, leading to incontinence or LUTS.

Pelvic surgery: surgeries in the pelvic area, including colorectal, bladder and gynaecological surgeries, can damage the nerves and muscles that control urination, leading to incontinence or LUTS.

Medication Review

Your medications will be evaluated to determine whether any may be contributing to your urinary incontinence or LUTS. Medication review is an essential part of the assessment and management of urinary continence. Certain medications can affect urinary function and contribute to the development of incontinence or LUTS. Therefore, your GP and Pharmacist will evaluate your medication list to determine whether any may be contributing to your symptoms.

Some medications that may affect urinary function include diuretics, opioids and certain antidepressants. Diuretics increase urine production and can lead to more frequent urination, while opioid medications can cause constipation, which can impact bladder function. Antidepressants can affect the muscles and nerves in the urinary system, leading to incontinence or LUTS.

Based on the assessment of your medication list, your healthcare provider may recommend a change in medication or dosage. In some cases, stopping medication use altogether may be recommended. However, it’s important never to stop or adjust any medication without first consulting with your healthcare provider.

It’s also essential to inform your healthcare provider of any over-the-counter medications or supplements you may be taking, as these can also impact urinary function and continence care

Hydration

Hydration plays an important role in urinary function and the development of urinary symptoms. Dehydration can often cause symptoms of urinary frequency, urgency, and bladder irritation. Therefore, during your assessment of urinary continence, your healthcare provider will ask questions about your hydration levels to ensure you are drinking enough water.

Adequate hydration is essential for the proper function of the urinary system. Drinking enough water helps to flush out toxins and waste from the body, and it helps to keep the bladder and urethra healthy. Drinking the proper amount of water varies for each individual and can depend on factors such as age, activity level, and overall health.

Your service provider may ask about your daily water consumption, urine output, and the colour of your urine. A high urine output and a light-coloured urine are both indicators of good hydration levels. In contrast, low urine output and dark-coloured urine can both be signs of dehydration.

If dehydration is identified as a contributing factor to your urinary symptoms, your healthcare provider may recommend increasing your water intake. This might involve drinking more water, using hydration tracking apps, or eating foods with high water content. In some cases, lifestyle modifications and dietary changes are recommended in tandem with medical management options.

Renal Function

The kidneys are responsible for filtering waste products from your blood and excreting them through the urine. Therefore, assessing your renal function is an important step in the evaluation of any urinary-related issues that you may be experiencing.

During an evaluation of urinary continence, your healthcare provider may order a blood test to evaluate your kidney function. This test measures the levels of creatinine and blood urea nitrogen (BUN) in the blood, which are waste products that the kidneys usually filter out of the body. Elevated levels of these markers can indicate that your kidneys are not functioning properly.

In some cases, further testing, such as a urine test, may be required to confirm kidney-related issues further. These tests can help identify any infections and other problems that may be causing urinary symptoms.

If your renal function tests show abnormal results, your healthcare provider may refer you to a nephrologist or urologist for further evaluation and management. Depending on the severity of any underlying kidney conditions, they may recommend medication, dietary changes, or further testing as appropriate.

Bowel Assessment

Assessing bowel function is an important part of the evaluation of urinary health. The bowel and urinary systems share certain nerves and muscles and issues in one area can often affect the other area. Therefore, during the assessment of urinary continence, your healthcare provider will evaluate how well your bowels are functioning and identify any issues that may affect your urinary system.

Common bowel issues that can impact urinary function include chronic constipation, faecal incontinence, and irritable bowel syndrome (IBS). Chronic constipation can put pressure on the bladder and contribute to urinary urgency and frequency. Faecal incontinence can also contribute to urinary incontinence, as loss of bowel control can put pressure on the bladder or lead to weakened pelvic floor muscles. IBS can cause frequent trips to the bathroom, leading to increased use of pelvic floor muscles and potentially contributing to urinary incontinence.

During an assessment of urinary continence, your healthcare provider may ask about your bowel habits, including bowel movements, consistency, and frequency. They may also perform a physical exam to assess for any muscle weakness or nerve damage. In some cases, further diagnostic tests, such as a colonoscopy, may be recommended.

If bowel issues are contributing to your urinary symptoms, your healthcare provider may recommend lifestyle modifications, such as increased fibre intake, as well as pelvic floor muscle training. In some cases, medication or surgery may be recommended.

Abdominal Assessment

An abdominal assessment will be performed to ensure the presence of physical abnormalities that could be affecting urinary function or causing symptoms. The urinary system and the abdomen share certain nerves, muscles, and organs, and abnormalities in one area can often affect the other area. Therefore, during the assessment of urinary continence, your healthcare provider will perform an abdominal assessment to ensure any physical abnormalities that could impact urinary function or cause symptoms are identified such as a distended bladder.

During an abdominal assessment, your healthcare provider will examine the organs in your abdominal area, including the liver, spleen, kidneys, and bladder. They will look for signs of swelling, tenderness, or pain, which could indicate the presence of underlying conditions impacting urinary function such as a urinary tract infection, kidney stones, or an enlarged prostate.

In addition to physical examination, diagnostic testing such as ultrasound may be ordered to confirm any abnormalities that were identified during the abdominal assessment. These tests can help provide more detailed information about the urinary system and any underlying conditions contributing to urinary symptoms.

 Perineal Assessment

A perineal assessment will evaluate your pelvic floor muscles, which play a significant role in urinary function by supporting the ureters. The provider will check for signs of weakness or damage to these muscles. This assessment aims to evaluate your pelvic floor muscles, which have a significant impact on urinary function. During the assessment, your healthcare provider will check for signs of weakness or damage to these muscles, which can contribute to urinary incontinence.

The perineum is the area between your genitals and anus. During a perineal assessment, your healthcare provider may ask you to lie down and relax your pelvic floor muscles. They will then visually inspect the area and check the strength and flexibility of your pelvic floor muscles by asking you to perform certain exercises such as pelvic floor muscle contractions.

In addition to visual inspection and muscle strength testing, your healthcare provider may also conduct an internal exam of the pelvic muscles to determine any potential muscle damage or weakness. This exam can help identify muscle imbalances, tissue damage, or tissue weakness that may be contributing to your urinary symptoms.

If pelvic floor muscles imbalances or damage is detected during the assessment, the provider may recommend pelvic floor muscle training exercises that aim to improve muscle function and strengthen the pelvic floor. In some cases, your provider may also recommend the use of certain devices designed to support the pelvic floor muscles or refer you to a physical therapist that specialises in pelvic floor disorders.

 Cognition/Communication

If you have cognitive or communication impairments, it is essential that your service provider take these into account while evaluating and managing your urinary incontinence. Cognition and communication difficulties may affect your ability to communicate clearly about your symptoms or understand the provider’s recommendations and instructions for managing your condition.

During your assessment, your healthcare provider may inquire about any cognitive or communication impairments that may affect your ability to manage urinary continence. They may also ask about the level of support you have from family members, caregivers, or other healthcare professionals.

As needed, your provider may adjust their communication approach to ensure you can easily understand the diagnosis, treatment options and management plan effectively. They may provide written material or visual aids to aid in the process. They may also work with your family members or other caregivers to ensure that you have the necessary assistance and support to manage your urinary incontinence.

If cognitive or communication impairments are significant, your healthcare provider may refer you to a specialist who can further evaluate and provide appropriate management for your needs.

Dexterity

Your dexterity and ability to manage equipment related to urinary continence are critical concerns that your provider will consider while evaluating and managing your urinary incontinence. The provider will evaluate your ability to use any tools or equipment needed to manage your condition, such as urinary catheters, collecting devices, or medication dispensers.

During your assessment, your healthcare provider may ask you to demonstrate or explain how you use the equipment required to manage your urinary incontinence. They will evaluate your fine motor skills and dexterity as it pertains to handling these devices and following instructions.

If you experience difficulty in using such devices, your healthcare provider will make appropriate recommendations to improve your ability or make alterations to accommodate your limitations. For instance, they may suggest using devices with larger gripping surfaces or colour-coded caps to help you identify and manage them better.

In some cases, your healthcare provider may train you about the best techniques to manage your urinary incontinence devices, such as proper hand washing and how to avoid certain risks related to their use. Additionally, if you live alone and cannot manage the devices, your healthcare provider may refer you to a caregiver who can provide assistance and support.

 Current Mobility

Your level of mobility and activities of daily living are essential aspects that your healthcare provider will consider when developing your management plan for urinary incontinence. This information will help ensure that the plan is tailored to your unique needs and abilities.

During your assessment, your healthcare provider may inquire about your current mobility and daily activities. They may ask if you use any assistive devices, such as a walker or wheelchair, or if you require any assistance with daily activities such as dressing, bathing, or toileting. These questions will determine how your urinary incontinence management plan can be adjusted to optimise your independence and quality of life.

If you have mobility limitations, your provider may recommend specific modifications in your plan, such as exercises that strengthen your leg muscles, or devices such as bedside commodes or wheelchair-accessible restrooms. Your healthcare provider may also suggest lifestyle changes that can help manage urinary incontinence, such as fluid management and diet modifications.

If you have difficulty performing daily activities such as dressing or toileting, your provider may recommend adaptive equipment, such as devices to aid with bending or reaching, or suggest changes to your clothing to manage urinary incontinence discreetly.

 Frequently Asked Questions

Are There Any Medications That Can Help With Urinary Incontinence?

There are indeed several options available to those seeking relief. Anticholinergic drugs, for example, work by relaxing bladder muscles and reducing the urge to urinate frequently.

What causes urinary incontinence?

Urinary incontinence can occur due to a wide range of factors such as weak pelvic floor muscles, damage to nerves controlling the bladder, hormonal changes, certain medications, enlarged prostate, constipation, urinary tract infections, etc.

How can I prevent urinary incontinence?

Maintaining a healthy weight, avoiding smoking, limiting caffeine intake, performing pelvic floor muscle exercises, treating constipation, and staying hydrated can help prevent urinary incontinence.

What are the treatment options for urinary incontinence?

Treatment options for urinary incontinence include pelvic floor muscle exercises, medication, bladder training, biofeedback, neuromodulation, and in some cases, surgery.

Can urinary incontinence be cured?

In many cases, urinary incontinence can be managed effectively. However, it may not be possible to cure it entirely, especially when the condition is due to underlying health issues such as nerve damage or an enlarged prostate.

Is urinary incontinence a normal part of aging?

No, urinary incontinence is not a normal part of aging. However, older adults may be more susceptible to urinary incontinence due to weakened pelvic muscles, hormonal changes, and age-related health issues.

Is it necessary to see a healthcare provider for urinary incontinence?

Yes, it is necessary to see a healthcare provider if you experience urinary incontinence. It is essential to identify the underlying cause of your symptoms and receive appropriate treatment to improve your quality of life.

How do you conduct a continence assessment?To conduct a continence assessment, the following steps can be taken:

Take a detailed medical history, including current medication use

Perform a physical examination, including a pelvic exam (for women) and rectal exam (for men)

Ask about the person’s urinary or bowel habits, such as frequency and volume of voiding or bowel movements.

Use a bladder diary to record fluid intake, frequency of urination, and any episodes of leakage.

Assess for any signs of pelvic floor dysfunction, such as prolapse or muscle weakness.

·Evaluate the patient’s mental status and level of physical activity, as these can contribute to incontinence.

What Are Some Common Causes Of Urinary Incontinence?

As a urinary continence assessment and management specialist, it’s important to understand the common causes of urinary incontinence. Some of the most frequent reasons why people experience this condition include weak pelvic muscles, nerve damage, certain medications, and infections. Additionally, menopause and prostate problems can also lead to urinary incontinence. However, it’s important to remember that every patient is different and requires a personalised approach to their treatment plan.At the end of the day, our goal is to provide patients with the freedom they deserve by effectively managing their urinary incontinence.

When Is Surgery Recommended For Urinary Incontinence?

As a registered nurse and urinary continence assessment and management specialist, I often get asked when surgery is recommended for urinary incontinence. While non-invasive treatments such as pelvic floor exercises, bladder training, and medication can be effective for some patients, surgery may be necessary for those with severe cases or specific types of incontinence. At the end of the day, our goal is to help you regain your freedom and quality of life.

If conservative approaches have proven ineffective, surgery could be worth considering after a thorough evaluation and discussion with your General Practitioner.

Conclusion

As a registered nurse, I understand how frustrating and embarrassing it can be to deal with urinary incontinence. However, there are many options for managing this condition and improving your quality of life. Through proper assessment and evaluation, we can identify the underlying cause of your urinary incontinence and create a structured management plan tailored to your unique needs. Whether it’s making simple lifestyle changes like modifying your diet or exercise routine, exploring medication options, or trying non-invasive treatments such as pelvic floor exercises or biofeedback therapy, we’ll work together to find the best solution for you. Remember that urinary incontinence is a common issue that affects many people, but with the right approach and support, you can take control of your bladder health. Don’t let embarrassment hold you back from seeking help – take the first step towards freedom and confidence today. 

References

Goode, P. S., Burgio, K. L., & Alli, F. (2019). Management of urinary incontinence in women. JAMA, 322(10), 994-1006. doi: 10.1001/jama.2019.11890Haslam, J. (2004). Nursing management of stress urinary incontinence in women. British Journal of Nursing, 13(1), 32-40.

Haslam, J. (2004). Nursing management of stress urinary incontinence in women. British Journal of Nursing, 13(1), 32-40.

Huang, M. J., Sue, F. Y., & Chen, W. M. (2019). The efficacy of pelvic floor muscle exercise in treating adult female stress urinary incontinence: A systematic review and meta-analysis. International Journal of Nursing Studies, 92, 18-27. doi: 10.1016/j.ijnurstu.2019.01.004

Liu, C., Wu, J., Li, T., & Wang, Y. (2018). Chinese obstetricians’ knowledge and practice regarding pelvic floor dysfunction. International Journal of Women’s Health, 10, 79-86. doi: 10.2147/IJWH.S152712