Urinary Incontinence

Population studies from multiple countries reported UI prevalence between 5% and 70%, with most reporting between 25% and 45%. Prevalence increases with age, with more than 40% for the 70-year-old and older population (Milsom & Gyhagen, 2018). Of those receiving home care services, 40% have UI; and more than one third of short-term nursing home residents and close to 75% of long-term NH residents have UI (Gorina et al., 2014). Medications, constipation/fecal impaction, low fluid intake, environmental barriers, diabetes mellitus, stroke immobility, impaired cognition, malnutrition, and depression are factors specific to identifying older adults at risk of UI (Fantl et al., 1996; Holroyd-Leduc & Straus, 2004; Kresevic, 1997; Meijer et al., 2003; Offermans et al., 2009; Shamliyan et al., 2007; Thomas et al., 2005). Complications of UI include falls, skin irritation leading to pressure ulcers, social isolation, and depression (Bogner et al., 2002; Brown et al., 2000; Fantl et al., 1996; Goksin & Asiret, 2018; Hamid et al., 2015; Meng et al., 2016; Morris & Wagg, 2007). Nurses play a key role in the assessment and management of UI.


A.  Definitions

  1. UI is defined as the complaint of involuntary urine loss (Abrams et al., 2003; Haylen et al., 2010) or involuntary loss of urine sufficient to be a problem (Fantl et al., 1996; National Association for Continence, 1998).
    • Transient UI is characterized by the sudden onset of potentially reversible symptoms that typically have a duration of less than 6 months (Specht, 2005).

B.  Types of established UI include the following:

  1. Stress UI is defined as an involuntary loss of urine associated with activities that increase intra-abdominal pressure; more common among women, but occurs in men after a prostatectomy (Abrams et al., 2003; Fantl et al., 1996; Hunter et al., 2004; Jayasekara, 2009).
  2. Urge UI is characterized by an involuntary urine loss associated with a strong desire to void (urgency; Abrams et al., 2003; Fantl et al., 1996). An individual with OAB may complain of urinary urgency, with or without UI (Abrams et al., 2003; Haylen et al., 2010).
  3. Mixed UI is defined as a combination of stress UI and urge UI (Fantl et al., 1996; Jayasekara, 2009).
  4. Overflow UI is an involuntary loss of urine associated with overdistention of the bladder and may be caused by an underactive detrusor muscle or outlet obstruction, leading to overdistention of the bladder and overflow of urine (Abrams et al., 2003; Doughty, 2000; Fantl et al., 1996; Jayasekara, 2009).
  5. Functional UI is caused by nongenitourinary factors, such as cognitive or physical impairments that result in an inability of the individual to void independently (Fantl et al., 1996; B. Hodgkinson et al., 2008); however, continence may be achieved with support of caregivers (Barrie, 2016).

C.  Epidemiology

  1. In different healthcare settings across the globe, prevalence rates range between 5% and 70%, with most reporting between 25% and 45% (Milsom et al., 2014). In the United States, more than 33 million individuals report some type of UI or bladder condition (https://www.nafc.org/urinary-incontinence).
  2. UI studies specific to the acute care setting demonstrate that UI is present in 10% to 42% of older adults (Dowd & Campbell, 1995; Fantl et al., 1996; Kresevic, 1997; Palmer et al., 1992; Schultz et al., 1997); and prevalence of UI ranges from 8% to 46% among community-dwelling adult populations (Du Moulin et al., 2008; Erekson et al., 2016; Kwong et al., 2010; Lee et al., 2009; Sims et al., 2011); 37% among those living in residential care facilities; 40% of those receiving home care services; and more than a third of short-term nursing home residents and close to 75% of long-term NH residents have UI (Gorina et al., 2014). Therefore, implementation of an evidence-based protocol to guide assessment and care planning is essential.


A.  Document the presence or absence of UI for all patients (DuBeau et al., 2010).

B.  Document the presence or absence of an indwelling urinary catheter (John et al., 2018).

C.  For patients with UI, the nurse collaborates with interprofessional team members to:

  1. Determine whether the UI is transient, established (stress/urge/mixed/overflow/functional), or both and document (DuBeau et al., 2010; Fantl et al., 1996; Jayasekara, 2009; Johnson, Bulechek, McCloskey-Dochterman, Maas, & Moorhead, 2001; Qaseem et al., 2014). The mnemonic TOILETED (see Box 25.1), the UDI-6, and the MUDI may be used to help guide nursing assessment (Dowling-Castronovo, 2018; Lemack & Zimmern, 1999; Robinson & Shea, 2002; Uebersax et al., 1995).
  2. Identify and document the possible etiologies of UI (DuBeau et al., 2010; Fantl et al., 1996).


A.  General principles that apply to prevention and management of all forms of UI

  1. Identify and treat causes of transient UI (DuBeau et al., 2010).
  2. Upon admission to a healthcare facility, identify and continue successful prefacility management strategies for established UI.
  3. Develop an individualized plan of care using data obtained from the history and physical examination and in collaboration with other team members. Implement toileting programs as needed (Gibson et al., 2018; Gray, 2017; Ostaszkiewicz et al., 2004; Rathnayake, 2009c; Thomas et al., 2019).
  4. Avoid medications that may contribute to UI (American Geriatrics Society Beers Criteria® Update Expert Panel, 2019; Newman & Wein, 2009).
  5. Avoid indwelling urinary catheters whenever possible to avoid the risk of CAUTI (Bouza, San Juan, Muñoz, Voss, & Kluytmans, 2001; Dowd & Campbell, 1995; Gould et al., 2009; Zimakoff et al., 1996).
  6. Monitor fluid intake and maintain an appropriate hydration schedule.
  7. Limit dietary bladder irritants (Gray & Haas, 2000; Vaughan et al., 2011).
  8. Consider adding weight management as a long-term goal in discharge planning to achieve a healthy BMI (Qaseem et al., 2014; Subak et al., 2005; Suskind et al., 2017).
  9. Modify the environment to facilitate continence (Fantl et al., 1996; Jirovec, 2000; Palmer, 1996).
  10. Provide patients with usual undergarments in expectation of continence, if possible.
  11. Prevent skin breakdown by providing immediate cleansing after an incontinent episode and utilizing barrier ointments (Callaghan et al., 2018; Ersser et al., 2005; Fader et al., 2007, 2008; Getliffe et al., 2007; Gray, 2017).
  12. Pilot test absorbent products to best meet patient, staff, and institutional preferences (Dunn et al., 2002), bearing in mind adult briefs have been associated with UTIs (Zimakoff et al., 1996).
  13. Assign exercise deemed safe and appropriate by healthcare providers (Ouslander et al., 2005; Talley et al., 2017).
  14. Perform constipation management (Fantl et al., 1996; Hill, 2016; B. Hodgkinson et al., 2008; Hunter, 2016; McClurg et al., 2016; Mounsey et al., 2015; Qaseem et al., 2014; Schuster et al., 2015; Vaughan et al., 2011).

B.  Strategies for specific problems:

  1. Stress UI
    • Teach PFMEs (DuBeau et al., 2010; B. Hodgkinson et al., 2008; Qaseem et al., 2014).
    • Provide toileting assistance and bladder training as needed (DuBeau et al., 2010; Qaseem et al., 2014).
    • Consider referral to other team members if pharmacological or surgical therapies are warranted (Bonner & Boyle, 2017; Deeks et al., 2017; Wright et al., 2017).
  2. Urge UI and OAB
    • Implement bladder training (retraining; DuBeau et al., 2010; Qaseem et al., 2014; Teunissen et al., 2004).
    • If patient is cognitively intact and motivated, provide information on urge inhibition (Gray, 2005; Hill, 2016; Smith, 2000).
    • Teach PFMEs to be used in conjunction with bladder training, and instruct in urge inhibition strategies (Flynn, Cell, & Luisi, 1994; Rathnayake, 2009a; Teunissen et al., 2004).
    • Collaborate with prescribing team members if pharmacological therapy is warranted.
    • Initiate referrals for those patients who do not respond to the aforementioned strategies.
  3. Overflow UI
    • Allow sufficient time for voiding.
    • Discuss with interprofessional team the need for determining a PVR (Newman & Wein, 2009; Shinopulos, 2000; see Box 25.2).
    • Instruct patients in double voiding and Crede’s maneuver (Doughty, 2000).
    • If catheterization is necessary, sterile intermittent catheterization is preferred over indwelling urinary catheterization (Saint et al., 2006; Terpenning et al., 1989; Warren, 1997).
    • Initiate referrals to other team members for patients requiring pharmacological or surgical intervention.
  4. Functional UI
    • Provide individualized scheduled toileting, timed voiding, or prompted voiding (Eustice et al., 2000; Gibson et al., 2018; Jirovec, 2000; Lee et al., 2009; Ostaszkiewicz et al., 2004; Thomas et al., 2019).
    • Provide adequate fluid intake.
    • Refer for physical and occupational therapy as needed (Hill, 2016).
    • Modify environment to maximize independence with continence (Fantl et al., 1996; Jirovec, 2000; Jirovec et al., 1988; Palmer, 1996).


A.  Patients will:

  1. Have fewer or no episodes of UI or complications associated with UI.

B.  Nurses will:

  1. Document assessment of continence status. If UI is identified, document and determine type of UI.
  2. Use interprofessional expertise and interventions to assess and manage UI.
  3. Include UI in discharge planning needs and refer as needed.

C.  Institutions will:

  1. Set achievable goals for preventing, reducing, and resolving transient UI.
  2. Require assessment and documentation policies for continence status (Fung et al., 2007; Schnelle & Smith, 2001).
  3. Provide access to evidence-based guidelines for evaluation and management of UI.
  4. Instruct staff to receive administrative support and ongoing education regarding assessment and management of UI.


A.  Provide patient/CG discharge education and referral to specialists, as needed.

B.  Incorporate CQI criteria into existing program (Anger et al., 2016; Fung et al., 2007), and measure quality indicators using an if-then approach (Schnelle & Smith, 2001).

C.  Identify areas for improvement and enlist interprofessional collaboration in devising strategies for improvement (Bonner & Boyle, 2017; Deeks et al., 2017; Wright et al., 2017).


American College of Physicians releases new recommendations for treating urinary incontinence in women


2012 Update: Guidelines for Adult Urinary Incontinence Collaborative Consensus Document for the Canadian Urological Association



BMI             Body mass index

CAUTI        Catheter-associated urinary tract infection

CG               Caregiver

CQI             Continuous quality improvement

NH              Nursing home

OAB            Overactive bladder

PFME          Pelvic floor muscle exercises

PVR            Postvoid residual

UI                Urinary incontinence


Updated: November 2020

Boltz PhD, RN, GNP-BC, FGSA, FAAN, M., Capezuti PhD, RN, FAAN, E., Zwicker DrNP, APRN, BC, D., & Fulmer PhD, RN, FAAN, T. T. (2020). Evidence-Based Geriatric Nursing Protocols for Best Practice (6th ed.). Springer Publishing. Retrieved November 4, 2020, from https://www.springerpub.com/evidence-based-geriatric-nursing-protocols-for-best-practice-9780826188144.html#description


Abrams, P., Cardozo, L., Fall, M., Griffiths, D., Rosier, P., Ulmsten, U., … Wein, A.; Standardisation Sub-Committee of the International Continence Society. (2003). The standardisation of terminology in lower urinary tract function: Report from the Standardisation Sub-Committee of the International Continence Society. Urology, 61(1), 37–49. doi:10.1016/S0090-4295(02)02243-4. Evidence Level I.

American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. (2019). Journal of the American Geriatrics Society, 67(4), 674–694. Evidence Level I.

Anger, J. T., Alas, A., Litwin, M. S., Chu, S. D., Bresee, C., Roth, C. P., … Wenger, N. S. (2016). The quality of care provided to women with urinary incontinence in 2 clinical settings. Journal of Urology, 196(4), 1196–1200. doi:10.1016/j.juro.2016.05.005. Evidence Level V.

Barrie, M. (2016). Dealing with patients with concurrent dementia and urinary incontinence. Journal of Community Nursing, 30(3), 37–46. Retrieved from https://www.jcn.co.uk/journal/06-2016/continence/1853-dealing-with-patients-with-concurrent-dementia-and-urinary-incontinence. -Evidence Level V.

Bogner, H. R., Gallo, J. J., Sammel, M. D., Ford, D. E., Armenian, H. K., & Eaton, W. W. (2002). Urinary incontinence and psychological distress in community-dwelling older adults. Journal of the American Geriatrics Society, 50(3), 489–495. doi:10.1046/j.1532-5415.2002.50115.x. Evidence Level IV.

Bonner, A., & Boyle, J. (2017). Are women’s needs being met by specialist health services managing urinary incontinence in the remote Top End NT? Australian and New Zealand Journal of Obstetrics and Gynaecology, 57(3), 351–357. doi:10.1111/ajo.12601. Evidence Level V.

Bouza, E., San Juan, R., Muñoz, P., Voss, A., & Kluytmans, J. (2001). A European perspective on nosocomial urinary tract infections II. Report on incidence, clinical characteristics and outcome (ESGNI-004 study). Clinical Microbiology and Infection, 7(10), 532–542. doi:10.1046/j.1198-743x.2001.00324.x. Evidence Level IV.

Brown, J. S., Sawaya, G., Thom, D. H., & Grady, D. (2000). Hysterectomy and urinary incontinence: A systematic review. Lancet, 356(9229), 535–539. doi:10.1016/S0140-6736(00)02577-0. Evidence Level I.

Callaghan, R., Hunt, S., Mohamud, L., & Small, B. (2018). Case study series: Medi Derma-S Total Barrier Cream for the management and prevention of mild incontinence-associated dermatitis. Wounds UK, 14(1), 76–82. Retrieved from https://www.woundsinternational.com/resources/details/case-study-series-medi-derma-s-total-barrier-cream-management-and-prevention-mild-incontinence-associated-dermatitis. Evidence Level IV.

Deeks, L., Naunton, M., & Nahon, I. (2017). Case study: Urinary incontinence—The role of a pharmacist in an aged care residential medication management review. Australian & New Zealand Continence Journal, 23(2), 30–34. Evidence Level V.

Doughty, D. B. (2000). Retention with overflow. In D. B. Doughty (Ed.), Urinary & fecal incontinence nursing management (2nd ed., pp. 159–180). St. Louis, MO: Mosby. Evidence Level VI.

Dowd, T. T. (1991). Discovering older women’s experience of urinary incontinence. Research in Nursing & Health, 14(3), 179–186. doi:10.1002/nur.4770140304. Evidence Level IV.

Dowd, T. T., & Campbell, J. M. (1995). Urinary incontinence in an acute care setting. Urologic Nursing, 15(3), 82–85. Evidence Level IV.

Dowling-Castronovo, A. (2018). Urinary incontinence assessment in older adults: Part II—Transient urinary incontinence. In S. Greenberg (Ed.), Try This: Best Practices in Nursing Care to Older Adults, (11.1). Retrieved from https://consultgeri.org/try-this/general-assessment/issue-11.1.pdf. Evidence Level VI.

Du Moulin, M. F., Hamers, J. P., Ambergen, A. W., Janssen, M. A., & Halfens, R. J. (2008). Prevalence of urinary incontinence among community-dwelling adults receiving home care. Research in Nursing & Health, 31(6), 604–612. doi:10.1002/nur.20291. Evidence Level IV.

DuBeau, C. E., Kuchel, G. A., Johnson, T., Palmer, M. H., & Wagg, A.; Fourth International Consultation on Incontinence. (2010). Incontinence in the frail elderly: Report from the 4th International Consultation on Incontinence. Neurourology and Urodynamics, 29(1), 165–178. doi:10.1002/nau.20842. Evidence Level I.

DuBeau, C. E., Simon, S. E., & Morris, J. N. (2006). The effect of urinary incontinence on quality of life in older nursing home residents. Journal of the American Geriatrics Society, 54(9), 1325–1333. doi:10.1111/j.1532-5415.2006.00861.x. -Evidence Level IV.

Dunn, S., Kowanko, I., Paterson, J., & Pretty, L. (2002). Systematic review of the effectiveness of urinary continence products. Journal of Wound, Ostomy, and Continence Nursing: Official Publication of the Wound, Ostomy and Continence Nurses Society/WOCN, 29(3), 129–142. doi:10.1097/00152192-200205000-00007. Evidence Level I.

Erekson, K., Cogn, X., Townsend, M., & Ciarleglio, M. (2016). Ten year prevalence and incidence of urinary incontinence in older women: A longitudinal analysis of the health and retirement study. Journal of American Geriatrics Society, 64(6), 1274–1280. doi:10.1111/jgs.14088. Evidence Level IV.

Ersser, S. J., Getliffe, K., Voegeli, D., & Regan, S. (2005). A critical review of the inter-relationship between skin vulnerability and urinary incontinence and related nursing intervention. International Journal of Nursing Studies, 42(7), 823–835. doi:10.1016/j.ijnurstu.2004.12.003. Evidence Level I.

Eustice, S., Roe, B., & Paterson, J. (2000). Prompted voiding for the management of urinary incontinence in adults. Cochrane Database of Systematic Reviews, (2), CD002113. doi:10.1002/14651858.CD002113. Evidence Level I.

Fader, M., Cottenden, A. M., & Getliffe, K. (2007). Absorbent products for light urinary incontinence in women. Cochrane Database of Systematic Reviews, (2). doi:10.1002/14651858.CD001406.pub2. Evidence Level I.

Fader, M., Cottenden, A. M., & Getliffe, K. (2008). Absorbent products for moderate-heavy urinary and/or faecal incontinence in women and men. Cochrane Database of Systematic Reviews, (4), CD007408. doi:10.1002/14651858.CD007408. Evidence Level I.

Fantl, A., Newman, D. K., Colling, J., DeLancey, J. O., Keeys, C., & Loughery, R. (1996). Urinary incontinence in adults: Acute and chronic management (Report No. Publication No. 92–0047). Rockville, MD: Agency for Health Care Policy and Research. Evidence Level I.

Flynn, L., Cell, P., & Luisi, E. (1994). Effectiveness of pelvic muscle exercises in reducing urge incontinence among community residing elders. Journal of Gerontological Nursing, 20(5), 23–27. doi:10.3928/0098-9134-19940501-06. Evidence Level IV.

Fung, C. H., Spencer, B., Eslami, M., & Crandall, C. (2007). Quality indicators for the screening and care of urinary incontinence in vulnerable elders. Journal of the American Geriatrics Society, 55(Suppl. 2), S443–S449. doi:10.1111/j.1532-5415.2007.01354.x. Evidence Level I.

Getliffe, K., Fader, M., Cottenden, A., Jamieson, K., & Green, N. (2007). Absorbent products for incontinence: “Treatment effects” and impact on quality of life. Journal of Clinical Nursing, 16(10), 1936–1945. doi:10.1111/j.1365-2702.2007.01812.x. Evidence Level IV.

Gibson, J. M. E., Thomas, L. H., Harrison, J. J., Watkins, C. L., & the ICONS Project Team and the ICONS Patient, Public and Care Involvement Groups. (2018). Stroke survivors’ and carers’ experiences of a systematic voiding programme to treat urinary incontinence after stroke. Journal of Clinical Nursing, 27(9/10), 2041–2051. doi:10.1111/jocn.14346. Evidence Level IV.

Goksin, I., & Asiret, G. D. (2018). Determination of quality of life in 65 and above age women with urinary incontinence. International Journal of Caring Sciences, 11(1), 302–308. Retrieved from http://www.internationaljournalofcaringsciences.org/docs/35_goskin_original_11_1.pdf. Evidence Level III.

Gorina Y., Schappert, S., Bercovitz, A., Elgaddal, N., & Kramarow, E. (2014). Prevalence of incontinence among older Americans. Vital Health Statistics, 3(36), 1–33. Retrieved from https://www.cdc.gov/nchs/data/series/sr_03/sr03_036.pdf. Evidence Level IV.

Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., Pegues, D. A.; & the Healthcare Infection Control Practices Advisory Committee. (2009). Guideline for prevention of catheter--associated urinary tract infections. Retrieved from https://stacks.cdc.gov/view/cdc/11561. Evidence Level I.

Gray, M. (2005). Assessment and management of urinary incontinence. Nurse Practitioner, 30(7), 32–33, 36. doi:10.1097/00006205-200507000-00006. Evidence Level VI.

Gray, M. (2017). Case studies in geriatric urology: Focus on continence in the older adult. Urologic Nursing, 37(3), 143–170. doi:10.7257/1053-816X.2017.37.3.143. Evidence Level V.

Gray, M. L., & Haas, J. (2000). Assessment of the patient with urinary incontinence. In D. B. Doughty (Ed.), Urinary & fecal incontinence: Nursing management (2nd ed., pp. 209–284). St. Louis, MO: Mosby. Evidence Level VI.

Hamid, T. A., Pakgohar, M., Ibrahim, R., & Dastjerdi, M. V. (2015). “Stain in life”: The meaning of urinary incontinence in the context of Muslim postmenopausal women through hermeneutic phenomenology. Archives of Gerontology and Geriatrics, 60(3), 514–521. doi:10.1016/j.archger.2015.01.003. Evidence Level IV.

Hill, A. (2016). Multimodal physical therapy intervention of urinary incontinence and overactive bladder in the older adult. Topics in Geriatric Rehabilitation, 32(4), 264–273. doi:10.1097/TGR.0000000000000121. Evidence Level V.

Hodgkinson, B., Synnott, R., Josephs, K., Leira, E., & Hegney, D. (2008). A systematic review of the effect of educational interventions for urinary and faecal incontinence by health care staff/carers/clients in the aged care, on level knowledge, frequency of incontinence episodes and hours spent on the management of incontinence episodes. JBI Library of Systematic Review, 6(1), 1–66. doi:10.11124/01938924-200806010-00001. Evidence Level I.

Hodgkinson, C. P. (1965). Stress urinary incontinence in the female. Surgery, Gynecology & Obstetrics, 120, 595–613. Evidence Level V002E

Holroyd-Leduc, J. M., & Straus, S. E. (2004). Management of urinary incontinence in women: Scientific review. Journal of the American Medical Association, 291(8), 986–995. doi:10.1001/jama.291.8.986. Evidence Level I.

Hunter, K. (2016). ICS updates in continence care: The role of the nurse continence specialist in continence services. Urology News, 21(1). Retrieved from https://www.urologynews.uk.com/features/features/post/ics-updates-in-continence-care-the-role-of-the-nurse-continence-specialist-in-continence-services. Evidence Level V.

Hunter, K. F., Moore, K. N., Cody, D. J., & Glazener, C. M. (2004). Conservative management for postprostatectomy urinary incontinence. Cochrane Database of Systematic Reviews, (2), CD001843. doi:10.1002/14651858.CD001843.pub2. Evidence Level I.

Jayasekara, R. (2009). Urinary incontinence: Evaluation. JBI Database Evid Summaries, Publication ES0610. Evidence Level I.

Jirovec, M. M. (2000). Functional incontinence. In D. B. Doughty (Ed.), Urinary and fecal incontinence nursing management (2nd ed., pp. 145–157). St. Louis, MO: Mosby. Evidence Level VI.

John, G., Primmaz, S., Crichton, S., & Wolfe, C. (2018). Urinary incontinence and indwelling urinary catheters as predictors of death after new-onset stroke: A report of the South London Stroke Register. Journal of Stroke and Cerebrovascular Diseases, 27(1), 118–124. doi:10.1016/j.jstrokecerebrovasdis.2017.08.018. Evidence Level III.

Johnson, M., Bulechek, G., McCloskey-Dochterman, J., Maas, M., & Moorhead, S. (2001). Nursing diagnoses, outcomes, and interventions: NANDA, NOC and NIC linkages. St. Louis, MO: Mosby. Evidence Level VI.

Kresevic, D. M. (1997). New-onset urinary incontinence among hospitalized elders (Doctoral dissertation). Case Western Reserve University. (UMI No. 9810934). Evidence Level IV.

Kwong, P. W., Cumming, R. G., Chan, L., Seibel, M. J., Naganathan, V., Creasey, H., … Handelsman, D. (2010). Urinary incontinence and quality of life among older community-dwelling Australian men: The CHAMP study. Age and Ageing, 39(3), 349–354. doi:10.1093/ageing/afq025. Evidence Level IV.

Lee, P. G., Cigolle, C., & Blaum, C. (2009). The co-occurrence of chronic diseases and geriatric syndromes: The health and retirement study. Journal of the American Geriatrics Society, 57(3), 511–516. doi:10.1111/j.1532-5415.2008.02150.x. Evidence Level IV.

Lemack, G. E., & Zimmern, P. E. (1999). Predictability of urodynamic findings based on the Urogenital Distress Inventory-6 questionnaire. Urology, 54(3), 461–466. doi:10.1016/S0090-4295(99)00246-0. Evidence Level IV.

McClurg, D., Walker, K., Aitchison, P., Jamieson, K., Dickinson, L., Paul, L., … Cunnington, A. L. (2016). Abdominal massage for the relief of constipation in people with Parkinson’s: A qualitative study. Parkinson’s Disease, 2016, 1–10. doi:10.1155/2016/4842090. Evidence Level IV.

Meijer, R., Ihnenfeldt, D. S., de Groot, I. J., van Limbeek, J., Vermeulen, M., & de Haan, R. J. (2003). Prognostic factors for ambulation and activities of daily living in the subacute phase after stroke. A systematic review of the literature. Clinical Rehabilitation, 17(2), 119–129. doi:10.1191/0269215503cr585oa. Evidence Level I.

Meng, Q., Busby-Whitehead, J., & Palmer, M. H. (2016). Absorbent products use and symptom distress in women who have urinary incontinence and heart failure. The International Journal of Clinical Practice, 70, 1019–1026. doi:10.1111/ijcp.12910. Evidence Level IV.

Milsom, I., & Gyhagen, G. (2018). The prevalence of urinary incontinence. Climacteric, 22(3), 217–222. doi:10.1080/13697137.2018.1543263. Evidence Level V.

Milsom, I., Coyne, K., Nicholson, S., Kvasz, M., Chen, C., & Wein, A. (2014). Global prevalence and economic burden of urgency urinary incontinence: A systematic review. European Urologic, 65(1), 79–95. doi:10.1016/j.eururo.2013.08.031. Evidence Level I.

Morris, V., & Wagg, A. (2007). Lower urinary tract symptoms, incontinence and falls in elderly people: Time for an intervention study. International Journal of Clinical Practice, 61(2), 320–323. doi:10.1111/j.1742-1241.2006.01174.x. Evidence Level VI.

Mounsey, A., Raleigh, M., & Wilson, A. (2015). Management of constipation in older adults. American Academy of Family Physicians, 92(6), 500–504. Retrieved from https://www.aafp.org/afp/2015/0915/p500.html. Evidence Level V.

National Association for Continence. (1998, December). Release of findings from consumer survey on urinary incontinence: Dissatisfaction with treatment continues to rise. Spartansburg, SC: Author. Evidence Level IV.

Newman, D. K., & Wein, A. J. (2009). Managing and treating urinary incontinence (2nd ed.). Baltimore, MD: Health Professions Press. Evidence Level VI.

Offermans, M. P., Du Moulin, M. F., Hamers, J. P., Dassen, T., & Halfens, R. J. (2009). Prevalence of urinary incontinence and associated risk factors in nursing home residents: A systematic review. Neurourology and Urodynamics, 28(4), 288–294. doi:10.1002/nau.20668. Evidence Level I.

Ostaszkiewicz, J., Johnston, L., & Roe, B. (2004). Timed voiding for the management of urinary incontinence in adults. Cochrane Database of Systematic Reviews, 4(1), CD002802. doi:10.1002/14651858.CD002802.pub2. Evidence Level I.

Ouslander, J. G., Griffiths, P., McConnell, E., Riolo, L., & Schnelle, J. (2005). Functional incidental training: Applicability and feasibility in the Veterans Affairs nursing home patient population. Journal of the American Medical Directors Association, 6(2), 121–127. doi:10.1016/j.jamda.2005.01.004. Evidence Level II.

Palmer, M. H. (1996). Urinary continence: Assessment and promotion. Gaithersburg, MD: Aspen. Evidence Level VI.

Palmer, M. H., Baumgarten, M., Langenberg, P., & Carson, J. L. (2002). Risk factors for hospital-acquired incontinence in elderly female hip fracture patients. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 57(10), M672–M677. doi:10.1093/gerona/57.10.M672. Evidence Level IV.

Qaseem, A., Dallas, P., Forciea, M. A., Starkey, M., Denberg, T. D., & Shekelle, P.; Clinical Guidelines Committee of the American College of Physicians. (2014). Nonsurgical management of urinary incontinence in women: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 161(6), 429–440. doi:10.7326/M13-2410. Evidence Level I.

Rathnayake, T. (2009a). Urinary incontinence: Bladder training. JBI Database of Evidence Summaries, Publication ES5237. Evidence Level I.

Rathnayake, T. (2009c). Urinary incontinence: Timed voiding. JBI Database of Evidence Summaries, Publication ES5330. Evidence Level I.

Robinson, J. P., & Shea, J. A. (2002). Development and testing of a measure of health-related quality of life for men with urinary incontinence. Journal of the American Geriatrics Society, 50(5), 935–945. doi:10.1046/j.1532-5415.2002.50223.x. Evidence Level IV.

Saint, S., Kaufman, S. R., Rogers, M. A., Baker, P. D., Ossenkop, K., & Lipsky, B. A. (2006). Condom versus indwelling urinary catheters: A randomized trial. Journal of the American Geriatrics Society, 54(7), 1055–1061. doi:10.1111/j.1532-5415.2006.00785.x. Evidence Level II.

Schnelle, J. F., & Smith, R. L. (2001). Quality indicators for the management of urinary incontinence in vulnerable community-dwelling elders. Annals of Internal Medicine, 135(8 Pt 2), 752–758. doi:10.7326/0003-4819-135-8_Part_2-200110161-00015. Evidence Level V.

Schultz, A., Dickey, G., & Skoner, M. (1997). Self-report of incontinence in acute care. Urologic Nursing, 17(1), 23–28. Evidence Level IV.

Schuster, B., Kosar, L., & Kamrul, R. (2015). Constipation in older adults, stepwise approach to keep things moving. Canadian Family Physician, 61(2), 152–158. Retrieved from https://www.cfp.ca/content/61/2/152.long. Evidence Level V.

Shamliyan, T., Wyman, J., Bliss, D. Z., Kane, R. L., & Wilt, T. J. (2007). Prevention of urinary and fecal incontinence in adults. Evidence Report/Technology Assessment, (161), 1–379. Evidence Level I.

Shinopulos, N. (2000). Bedside urodynamic studies: Simple testing for urinary incontinence. Nurse Practitioner, 25(6 Pt 1), 19–22, 25. doi:10.1097/00006205-200025060-00002. Evidence Level VI.

Sims, J., Browning, C., Lundgren-Lindquist, B., & Kendig, H. (2011). Urinary incontinence in a community sample of older adults: Prevalence and impact on quality of life. Disability and Rehabilitation, 33(15–16), 1389–1398. doi:10.3109/09638288.2010.532284. Evidence Level IV.

Smith, D. A. (2000). Urge incontinence. In D. B. Doughty (Ed.), Urinary & fecal incontinence: Nursing management (2nd ed., pp. 91–104). St. Louis, MO: Mosby. Evidence Level VI.

Specht, J. K. (2005). 9 Myths of incontinence in older adults: Both clinicians and the over-65 set need to know more. American Journal of Nursing, 105(6), 58–68; quiz 69. doi:10.1097/00000446-200506000-00029. Evidence Level V.

Subak, L. L., Whitcomb, E., Shen, H., Saxton, J., Vittinghoff, E., & Brown, J. S. (2005). Weight loss: A novel and effective treatment for urinary incontinence. Journal of Urology, 174(1), 190–195. doi:10.1097/01.ju.0000162056.30326.83. Evidence Level II.

Suskind, A. M., Cawthon, P. M., Nakagawa, S., Subak, L. L., Reinders, I., Satterfield, S., … Hugan, A. J. (2017). Urinary incontinence in older women: The role of body composition and muscle strength: From the Health, Aging, and Body Composition Study. Journal of the American Geriatrics Society, 65(1), 42–50. doi:10.1111/jgs.14545. Evidence Level IV.

Talley, K. M. C., Wyman, J. F., Bronas, U., Olson-Kellogg, B. J., & McCarthy, T. C. (2017). Defeating urinary incontinence with exercise training: Results of a pilot study in frail older women. Journal of the American Geriatrics Society, 65(6), 1321–1327. doi:10.1111/jgs.14798. Evidence Level II.

Terpenning, M. S., Allada, R., & Kauffman, C. A. (1989). Intermittent urethral catheterization in the elderly. Journal of the American Geriatrics Society, 37(5), 411–416. doi:10.1111/j.1532-5415.1989.tb02636.x. Evidence Level IV.

Teunissen, T. A., de Jonge, A., van Weel, C., & Lagro-Janssen, A. L. (2004). Treating urinary incontinence in the elderly—-Conservative therapies that work: A systematic review. Journal of Family Practice, 53(1), 25–30, 32. Evidence Level I.

Thomas, L. H., Barrett, J., Cross, S., French, B., Leathley, M., Sutton, C., & Watkins, C. (2005). Prevention and treatment of urinary incontinence after stroke in adults. Cochrane Database of Systematic Reviews, 2005(3), CD004462. doi:10.1002/14651858.CD004462.pub4. Evidence Level I.

Thomas, L. H., Coupe, J., Cross, L. D., Tan, A. L., & Watkins, C. L. (2019). Interventions for treating urinary incontinence after stroke in adults. Cochrane Database of Systematic Reviews, (2), CD004462. doi:10.1002/14651858.CD004462.pub4. Evidence Level I.

Uebersax, J. S., Wyman, J. F., Shumaker, S. A., McClish, D. K., & Fantl, J. A. (1995). Short forms to assess life quality and symptom distress for urinary incontinence in women: The Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourology and Urodynamics, 14(2), 131–139. doi:10.1002/nau.1930140206. Evidence Level IV.

Vaughan, C., Juncos, J., Burgio, K., Goode, P., Wolf, R., & Johnson, T. (2011). Behavioral therapy to treat urinary incontinence in Parkinson disease. Neurology, 76(19), 1631–1634. doi:10.1212/WNL.0b013e318219fab3. Evidence Level III.

Warren, J. W. (1997). Catheter-associated urinary tract infections. Infectious Disease Clinics of North America, 11(3), 609–622. doi:10.1016/S0891-5520(05)70376-7. Evidence Level VI.

Wright, J. D., Schorge, J. O., Kilcoyne, A., & Tambouret, R. H. (2017). Case 16-2017—A 69-year-old woman with urinary incontinence. New England Journal of Medicine, 376(21), 2066–2073. doi:10.1056/NEJMcpc1616398. Evidence Level V.

Zimakoff, J., Stickler, D. J., Pontoppidan, B., & Larsen, S. O. (1996). Bladder management and urinary tract infections in Danish hospitals, nursing homes, and home care: A national prevalence study. Infection Control and Hospital Epidemiology, 17(4), 215–221. doi:10.2307/30141023. Evidence Level IV.