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
Urge ↓ contractility/outlet obstruction (e.g. BPH, anticholinergic medications, T2DM, pelvic trauma, spinal cord disease, MS, polio) Hesitancy, weak stream, sense of incomplete emptying
Functional aPhysical, emotional, or cognitive disability Depression, pain, evidence of physical, sensory, or cognitive impairment

Evaluation

  • Perform a thorough Medication Reconciliation/History:
    • Alcohol, α-Adrenergic agonists, α-Adrenergic blockers, ACE inhibitors, Anticholinergics, Antipsychotics, Calcium channel blockers, oral estrogen, GABAergic agents, NSAID’s, narcotics
      • 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 Q1-2hours
  • Indications for a foley:
    • Inability to void
    • Need for accurate UOP monitoring when patient unable to comply
    • Urinary Incontinence AND open sacral or perineal wound
    • Perioperative Use
    • Comfort care at end of life
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