The SF7 Toolkit supports clinical best practices for healthcare providers across the sectors of care and includes self-management tools for older adults and their caregivers. The toolkit provides a common practice framework that complements the unique skills and practices of the various care providers helping older adults. SF7 focuses on seven clinical areas that support resilience, independence, and quality of life: cognition (particularly delirium), mobility, social engagement, continence, pain, nutrition, and polypharmacy. The SF7 toolkit is available by individual topic, or bundled together. 89 pages. Last reviewed November 2018.

Incontinence is the involuntary loss of stool (bowel) or urine (bladder) ⁽¹⁾. Incontinence can negatively affect many parts of a person’s life such as their social interactions, sex life, work and travel ⁽²⁾. Incontinence is often not reported as some people are embarrassed about the topic, or incorrectly believe it is a normal part of the aging process ⁽²⁾. Incontinence is more common in older adults; however, it is not a normal part of aging and is often a sign of other health problems ⁽¹⁾. For this reason, incontinence should always be assessed and diagnosed by a healthcare professional ⁽¹⁾. 

With the right treatment plan, incontinence can often be cured, improved or comfortably managed ⁽¹⁾. There are many treatment and management options – if the person you are caring for is affected by incontinence, you can discuss a care plan with the family physician. 

References

(1)  The Canadian Continence Foundation and Cameron Institute. (2018). What is urinary incontinence? Retrieved from http://www.canadiancontinence.ca/EN/what-is-urinary-incontinence.php

(2)  The Canadian Continence Foundation (2014). The impact of incontinence in Canada: A briefing document for policy-makers. Retrieved from http://www.canadiancontinence.ca/pdfs/impacts-of-incontinence-in-canada.pdf

Incontinence is the inability to control excretory function leading to urinary or fecal incontinence respectively. Loss of a bowel or bladder control does become more prevalent as people age.

Why is it Important?

• 30% of men and 50% of women over 65 years can have urinary incontinence ⁽³⁾
• 4% – 7% of people over 65 have fecal incontinence
• Often not disclosed as a problem until advanced symptoms

Common Causes Bowel

• Constipation: weakens the walls of the rectum and/or damages the nerves
• Diarrhea: certain foods or infections
• Muscle damage: damage to the external or internal sphincter
• Nerve damage: childbirth, stroke, spinal cord injury, diabetes, M.S. or any other disease affecting nerves.
• Reduced elasticity: Inflammatory bowel diseases, previous surgery or radiation
• Other conditions; rectal prolapse, hemorrhoids

Common Causes Bladder

• Muscle weakening: vaginal childbirth, brain and spinal cord injury, multiple sclerosis, Parkinson’s disease, diabetes, stroke, fracture of the pelvic bones, medications, prostate gland removal or enlargement
• Menopause: progressive decrease of estrogen
• Obesity & overweight: increase the abdominal pressure like walking, lifting, coughing, sneezing and sports
• Urinary Tract Infections (cystitis): infection in the urinary bladder increases the sensitivity of the bladder
• Nerve damage: childbirth, stroke or spinal cord injury, diabetes, multiple sclerosis or similar type disease
• Smoking and Alcohol: coughing, chest infections, can cause a stimulant effect on the bladder muscle

Key Considerations

For fecal incontinence review symptoms and perform

• Physical and rectal examination
• Consider: diet changes; medication; fiber supplements antidiarrheal drugs, laxatives and stool softeners: special exercises;  behavioural training; surgery

For urinary incontinence a functional assessment is recommended in the elderly.

• Identify the type and likely cause of bladder dysfunction to determine type of incontinence (transient, urge, stress, overflow, functional)
• Referral to urology as necessary
• Considerations: Kegel exercises; bladder retraining; medications: anticholinergic, neurotoxins, estrogen; pessaries, catheters; surgery

References

1. About Fecal Incontinence. (2014). The Canadian Continence Foundation. Retrieved March 10, 2014 from:
    http://www.canadiancontinence.ca/EN/fecal-incontinence.php

2. Australian Government: Department of Health. (2012). Older Persons. Retrieved March 11, 2014 from:
    http://www.bladderbowel.gov.au/olderpersons/

3. Bostock, N & Kelly, A. (2011) Help for people who care for someone with bladder or bowel problems.
    Retrieved March 11, 2014 from the Australian Government Department of Health and Aging website:
    http://www.bladderbowel.gov.au/assets/doc/ContinenceCarers.html

4. Khaled, I. (2004). The Role of the Primary Care Physician in the Management of Bladder Dysfunction.
    Rev Urol. 2004; 6 (Suppl 1): S38–S44. Retrieved March 2014 from:
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472846/

5. The Canadian Continence Foundation. (2009). Retrieved March 10, 2014 :
    http://www.canadiancontinence.ca/pdfs/impacts-of-incontinence-in-canada.pdf

These clinical practice guidelines and initial management flowchart reflects an interprofessional evidence based approach to management of incontinence in men, women, and the frail elderly. Emphasis is placed on assessment of consumers’ goals, consideration of quality-of-life issues, and use of appropriate outcome measures, such as voiding diaries A continence history, focused physical examination, and consideration of non-urologic contributing factors, lifestyle strategies particularly in elderly people, can establish type of incontinence and guide interventions. 1 Page.

A patient handout in a Q & A format describing urinary incontinence, the causes, types and treatment options. 2 Pages.

A handbook with a focus on incontinence in men. Tips for women are also included. Topics include definitions, types, risk factors (with check lists and "what to do" options), tips for personal care, exercises, recipes, self efficacy questionnaires and resources. 72 Pages.