Urinary Incontinence and Foleys

Types of UI

Mechanism

Associated Symptoms
Stress Incompetent urethral sphincter (e.g. post-prostatectomy, post childbirth) UI with physical exertion (cough, laughter, sneeze)
Urge ↑ bladder contraction from detrusor instability (e.g. infection, stone, T2DM, caffeine, meds, BPH) Frequency, nocturia, sudden urge
Overflow ↓ contractility/outlet obstruction (e.g. BPH, anticholinergic medications, T2DM, pelvic trauma, spinal cord disease, MS, polio) Hesitancy, weak stream, sense of incomplete emptying
Functional Physical, emotional, or cognitive disability Depression, pain, evidence of physical, sensory, or cognitive impairment

Evaluation

  • Thorough Medication Reconciliation/History: Alcohol, α-Adrenergic agonists, α-Adrenergic blockers, ACE inhibitors, Anticholinergics, Antipsychotics, Calcium channel blockers, Caffeine, Diuretics, Oral estrogen, and Sedatives-hypnotics, including OTCs i.e. diphenhydramine, tylenol PM 
  • Order Hemoglobin A1C, Electrolytes (particularly calcium), UA 
  • Rule out retention using PVR 
  • Pelvic exam to rule out prolapse 
  • Rectal exam to rule out fecal impaction

Management

  • Skin care for urinary incontinence: 
    • Barrier creams: petroleum, zinc oxide 
    • Diapers only when up out of bed 
    • Chucks while in bed (do not hold moisture up close to the skin like diapers do) 
    • Offer toileting Q2-3hours; Timed toileting for cognitively intact individuals, and Trial of prompted toileting for those with cognitive impairment 
    • Instruct patients to keep a voiding diary outpatient 
    • Referral to PT for pelvic floor therapy 
    • Remove offending medications as able 
    • Consider urology outpatient referral for urodynamic studies 
    • Please refer to the Hospital Medicine Section for Foley Catheter indications
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