INCONTINENCE IN THE NURSING-HOME

Urinary and fecal incontinence are prevalent, disruptive, and expensiv e health problems in the nursing home population. Nursing home residen ts who are incontinent of urine should have a basic diagnostic assessm ent, including a focused history and bladder record, a targeted physic al examination, a urinalysis, and a determination of postvoid residual urine volume done by catheterization or ultrasonography. Potentially reversible conditions, such as fecal impaction and drug side effects, should be identified and treated. Selected residents should have furth er urodynamic evaluation or other diagnostic tests. Prompted voiding, a simple, noninvasive behavioral intervention, is effective in managin g daytime urinary incontinence in one quarter to one third of incontin ent nursing home residents. If it is to be effective over a long perio d of time, this intervention must be targeted to those residents most likely to respond. Selected nursing home residents will benefit from o ther behavioral interventions, drug therapy, or surgery. Because of th e morbidity associated with it, long-term catheterization should only be used for specific indications. Like urinary incontinence, fecal inc ontinence may be caused by potentially reversible conditions. After su ch conditions have been excluded, fecal incontinence can generally be managed effectively by avoiding fecal impaction and by using a systema tic bowel-training protocol.