In February 2021, I presented a webinar for you sponsored by Curbell Medical, Inc.: Toileting-related Falls: Key Solutions (available here). I discussed evidence about urinary incontinence — one of two frequently reported elimination issues most often reported as potential fall risk factors (the second being nocturia — Roggeman, et al, 2020).
The two common urinary incontinence management solutions have been catheterization (indwelling or intermittent) and incontinent briefs or pads. For years, a third option has been available for men: condom catheters. In 2019, a new product was designed by TillaCare™, as I learned while engaging with Dr. Kristi Campoe in the Care Team Conversation podcast (Episode 4: Incontinence Management in Women, available here)
We all know the complications associated with indwelling catheterizations and incontinent briefs: urinary tract infections; dermatitis; odor; and embarrassment. Let’s briefly review urinary incontinence and fall risk.
Urinary incontinence (UI), or the involuntary loss of urine, is a highly prevalent condition in older adults 60 years and older, ranging from 9.9% to 36.1% in population-based studies (World Health Organization [WHO], 2017, p. 1). According to WHO, women are twice as likely to have UI than older men. For years, researchers have studied the relationship between UI and fall risks, i.e. urinary frequency, nocturia (toileting at night), and rushing to the bathroom to avoid urge incontinence most likely increasing the risk of falling. These risk factors combine to result in falls (including falls with injury), especially in bathrooms. Yet, many studies have had conflicting results due to study design, methodological issues, or sampling issues. However, the most recent systematic literature review has confirmed that urinary incontinence is an important risk factor for falls in both general and older populations. In other words, this is not just an older adult population issue (Moon, et al., 2021). Falls can occur for several reasons, such as losing balance while trying to get out of bed or the chair to get to the bathroom, slipping on a wet floor trying to get up from the toilet, or losing balance when trying to undress quickly to toilet. Unknown is how many patients have experienced a near fall or a fall as a result of such conditions. Our concern for all older adults is their greater risk for injury due to incontinence-related fall — serious injury, loss of function (or possibly life), and keeping them safe by reducing their risks. Urinary continence is treatable and managed.
Incontinence always involves urinary leakage. The symptoms of leakage help to explain the type of incontinence, which varies. Symptoms of incontinence include urine leaking when one coughs, sneezes, laughs, exercises, or lifts something heavy. These symptoms are associated with stress incontinence. Other symptoms can include an intense urge to urinate followed by involuntary loss of urine, and needing to urinate often. These symptoms are linked to a type of incontinence referred to as urge incontinence. This type of incontinence is often caused by urinary tract infections or other conditions. Another type of incontinence occurs when the bladder does not empty completely, and patients start to have dribbling. This is overflow incontinence. There are other types of incontinence that you can learn about here .
There are differing medical and urological reasons for urinary incontinence (as well as different types of incontinence) which can be evaluated and treated to reduce the frequency of incontinence and correct the underlying causes. Urinary incontinence is a fall risk factor that can even be eliminated with proper treatment or managed through bladder management programs. But if patients are trying to manage on their own, they are often using incontinent briefs — especially women, who until recently had no other solution.
As I mentioned, older adults, embarrassed by incontinence, try to manage and contain bladder accidents before talking to their primary provider. These actions will involve trying incontinence pads and/or briefs. Not all incontinent pads or briefs are the same. An incontinence specialist can help patients select and trial products. The products that patients wear during the day may be different than those worn at night. If they need to wear incontinent briefs at night, there are absorbent briefs to wear that have super absorbent material to maintain skin dryness so that patients can sleep, neutralize the urine to reduce skin irritation and protect from bed wetting. All efforts should be made to reduce patients getting up at night to toilet, and help them rest with as much uninterrupted sleep as possible. Nocturia (getting up to toilet at night) is a fall risk factor. Now, another solution exists: UriCap Female.
In 2019, American Medical Technologies partnered with TillaCare to launch UriCap, as a non-invasive, leak-free, external urine collection product – the Cap, designed for the female anatomy, and the collection system to prevent contact between the urine and skin.
During our Care Team Conversation, Dr. Campoe shared that the UriCap Female is revolutionary for women’s management of urine, not just incontinence. The product allows non-invasive external urine collection for women. It’s specifically designed for the female anatomy around the urethra. The UriCap Female device, connected to an extension tube that collects urine in a collection bag, provides the same freedom for invasive catheterization as provided for men. Dr. Campoe shared with us that this product is beginning to be used in hospitals, nursing homes, and home care in the US for 24-hour urine collections, measurement of urinary output, and urinary collection in women who are partially immobile, are sitting up, or are bedridden. More information is available to you here.
All nurses and other health care providers know about the high incidence of catheter associated UTIs (CAUTIs) and the resulting high rate of infections, hospital readmissions, complications, and cost. All efforts should be made to use external urine collection — now an innovative and cost-effective solution exists for women.
A clinical trial is to begin enrollment in Örebro County, Sweden, registered as an interventional study (Clinical Trial) to evaluate use of UriCap Female instead of incontinence aids to treat urinary incontinence among women 75 years and older (https://clinicaltrials.gov/ct2/show/NCT05275257)
Do all you can to engage your patients to assess incontinence issues so these issues can be diagnosed, treated, and managed, thus reducing and preventing complications.
Thank you for reading my message. I welcome your comments. Again, please listen to Dr. Campoe’s conversation and invitation to help you. I would love to hear back from you.
All my best, Pat
Moon, S., Chung, H.S., Kim, Y.J., Kim, S.J., Kwon, O., Lee, Y.G., Myung, J., & Cho, S.T. (2021). The impact of urinary incontinence on falls: A systematic review and meta-analysis. PLos One, 16(5): PMID: 34010311 https://pubmed.ncbi.nlm.nih.gov/34010311/
Roggeman, S., Weiss, J.P., Van Laecke, E., et al. (2020). The role of urinary tract symptoms in fall risk assessment tools in hospital: A review. F1000Res., 2020; 9: F1000 Faculty Rev-236. Retrieved fromhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7135676/
World Health Organization. (2017). Evidence profile: Urinary incontinence. Integrated care for older people (ICOPE). Guideline on community-level interventions to manage declines in intrinsic capacity. Available at: file:///Users/owner/Downloads/WHO-MCA-17.06.08-eng.pdf