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WCET Journal Volume 35 Number 4 – October/December 2015

Term Definition Additional information including causes

Bowel (faecal) incontinence 1. Faecal incontinence is the inability to control bowel movements, causing stool (faeces) to leak unexpectedly from the rectum1.

2. Complaint of involuntary loss of faeces. Could be solid, liquid, passive faecal incontinence: such as soiling without sensation or warning or difficulty wiping clean, or coital faecal incontinence: occurring with vaginal intercourse2.

Severity ranges from occasional leakage of stool while passing gas, to a complete loss of bowel control. Common causes include: diarrhoea, constipation, and muscle or nerve damage. The muscle or nerve damage may be associated with ageing or giving birth.

Continence Control of the bladder and/or bowel

Constipation Bowel movements are infrequent and/or incomplete, stools are dry or hard and/or there is a need for frequent straining or manual assistance to defecate2.

Chronic retention of urine Non-painful bladder where there is a high PVR2.

PVR is post-voiding residual.

Enuresis Any involuntary loss of urine2. If it is used to denote incontinence during sleep, it should always be qualified with the adjective ‘nocturnal’2.

Neurogenic bladder A person lacks bladder control due to a brain, spinal cord, or nerve condition1.

Neurogenic bladder may also result from neurological conditions such as diabetes mellitus, spinal cord injury, tumour/lesion, or pelvic nerve damage from surgery or radiation therapy.

Pelvic organ prolapse This diagnosis by symptoms and clinical examination, assisted by any relevant imaging, involves the identification of descent of one or more of the anterior vaginal wall (central, paravaginal or combination cystocele), posterior vaginal wall (rectocele), the uterus (cervix) or the apex of the vagina (vaginal vault or cuff scar) after hysterectomy2.

Rectal prolapse External protrusion of the rectum2.

Definitions for continence

Karen ZulkowskiDNS, RN Associate Professor Montana State University, Bozeman MT, Executive Editor JWCET

Previous issues have defined terms for ostomy and wound. These definitions are for continence or incontinence-related problems

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Urinary incontinence Involuntary loss or leakage of urine. (There are several types of urinary incontinence, and an individual may experience more than one type at a time3.)

May involve a number of transitory or chronic progressive factors that affect the bladder and/or the urethral sphincter.

Any condition, medication, or factor that affects lower urinary tract function, bladder capacity, urination, or the ability to toilet can predispose to urinary incontinence and may contribute to incomplete bladder emptying.

Urinary retention The inability to completely empty the urinary bladder by micturition3.

Urine retention may result from outlet obstruction (for example, benign prostatic hypertrophy [BPH], prostate cancer, and urethral stricture), hypotonic bladder (detrusor under act ivi ty) or both. Hypotonic bladder may be caused by outlet obstruction, impaired or absent contractility of the bladder (neurogenic bladder) or other causes.

Urinary tract infection (UTI) A clinically detectable condition associated w i t h i n v a s i o n b y d i s e a s e c a u s i n g microorganisms of some part of the urinary tract, including the urethra (urethritis), bladder (cystitis), ureters (ureteritis), and/or kidney (pyelonephritis)3.

An infection of the urethra or bladder is classified as a lower tract UTI and infection involving the ureter or kidney is classified as an upper tract UTI.

Urosepsis A systemic inflammatory response to infection (sepsis) that appears to originate from a urinary tract source. It may present with symptoms such as fever, hypotension, reduced urine output, or acute change in mental status3.

Voiding dysfunction Abnormally slow and/or incomplete micturition which is diagnosed by symptoms and urodynamic investigations2.

Abnormal slow urine flow rates and abnormally high post-void residuals (PVR)

Transient urinary incontinence

Temporary episodes of urinary incontinence that are reversible once the cause(s) of the episode(s) is (are) identified and treated3.

May be related to a variety of causes, for example: delirium, infection, atrophic urethritis or vaginitis, some pharmaceuticals (such as sedatives/hypnotics, diuretics, anticholinergic agents), increased urine production, restricted mobility or faecal impaction. The incontinence is transient because it is related to a potentially improvable or reversible cause.

Urge incontinence(overactive bladder)

Associated with detrusor muscle overactivity (excessive contraction of the smooth muscle in the wall of the urinary bladder, resulting in a sudden, strong urge to expel moderate to large amounts of urine before the bladder is full)3.

Characterised by abrupt urgency, frequency, and nocturia (part of the overactive bladder diagnosis). It may be age-related or have neurological causes (for example, stroke, diabetes mellitus, Parkinson’s disease, multiple sclerosis) or other causes such as bladder infection, urethral irritation, etc. The resident can feel the need to void, but is unable to inhibit voiding long enough to reach and sit on the commode.

Mixed incontinence Combination of stress incontinence and urge incontinence3.

Many elderly persons (especially women) will experience symptoms of both urge and stress called mixed incontinence

1. Medicine U.L.o. Bowel Incontinence. Medline Plus, 2014.2. Society IC. Incontinence. P Abrams et al., Editors, 2013.3. CMS. MDS 3.0 Manuel V01 07. 2011, HHS.