Continence Champions: April 2025

Welcome to the latest key papers and publications focussing mainly on continence issues in the nursing profession.

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Experiences of Urinary Incontinence in Women Who Are Post-Menopausal: A Systematic Review
Abstract: To synthesise the qualitative knowledge of urinary incontinence in post-menopausal women to better understand the experiences and impact of urinary incontinence on quality of life. Urinary incontinence can be an unpleasant and stressful experience as many women assume it is a part of the natural ageing process. The experiences of urinary incontinence can impact many women in different ways as some are reluctant to discuss or report the incidences with health professionals. There were 85 studies identified in the review, and 61 were screened for eligibility. Only four were included in the review. Common themes were identified in the studies that included psychological, physical, informational/education, social, practical needs, intimacy and sexual aspects. The psychological and physical aspects were noted in all the included studies. Many of the studies identified the difficulties post-menopausal women endure in managing episodes of urinary incontinence, as many expressed shame and embarrassment when urinary incontinence occurred. The physical aspects included concerns about maintaining good hygiene and managing irritation on their skin from constant washing. The physical aspect also included exhaustion and tiredness from managing urinary incontinence episodes. Many women in the studies expressed a desire to have ongoing education about managing urinary incontinence and the need to discuss the topic more openly. The social impact of urinary incontinence was also captured in the review, as many women expressed the desire to be social with family and friends but felt reluctant due to the fear of urinary incontinence occurring in front of other people. The practical burden of managing urinary incontinence was illustrated in this review, as some women faced many challenges in managing soiled clothing, constant washing of clothing and the skin and the need to visit the bathroom regularly. The intimacy and sexual components of their lives have been disrupted by episodes of urinary incontinence and replaced with excuses for intimate activities. Post-menopausal women living with urinary incontinence experience a range of different burdens across many different areas in trying to manage their condition. Healthcare professionals need to acknowledge that post-menopausal women are reluctant to seek treatment due to shame and feelings that urinary incontinence is a normal part of aging. To ensure quality of life for post-menopausal women living with urinary incontinence, healthcare professionals need to tailor treatment strategies to provide better care.
Source: McKie, Amanda L. International Journal of Urological Nursing, Mar 2025; 19(1):

Adherence and uncertainty during rehabilitation for urinary incontinence: Validation of a scale
Abstract: We sought to create an Italian version of Mishel's Uncertainty in Illness Scale, dedicated to people undergoing conservative rehabilitation for urinary incontinence, for studying uncertainty as a determinant of therapeutic adherence. Urinary incontinence has a high prevalence worldwide, ranging from 25% to 45%. Incontinence is often treatable with conservative interventions but demands a long and intensive commitment from the patient. Results are not immediate, and relapses are possible. These patients can experience uncertainty and difficulty complying with rehabilitation programs, hence the importance of the therapeutic relationship with a healthcare professional. Mishel's theory of uncertainty can be used to measure uncertainty and the effects of such a relationship, but no instrument currently exists for this purpose. Prospective observational study enrolling all male and female adult patients admitted to a nurse-led outpatient pelvic clinic for non-neurogenic urinary incontinence, excluding puerpera. A scale named MUIS-PF (pelvic floor) was created, based on previous versions of Mishel's scale, and administered during the first consultation and at the end of the rehabilitation program. Internal consistency was assessed, and exploratory factor analysis was conducted. A total of 109 patients enrolled (54 M, 55 F) aged 64 ± 5 years, medial initial leakage 245 grams/day, IQR [90; 370]. Seventy-nine percent obtained continence; there were no dropouts during the study. Internal consistency of the MUIS-PF was high (93%), and structure analysis yielded a clear separation of the factors. Patient uncertainty decreased significantly at the end of the program compared to the first consultation (p < 0.001). The MUIS-PF is valid and reliable. Utilizing the correct approach, the nurse could significantly reduce the uncertainty of persons with incontinence by listening, giving clear information and searching for the best solution for their continence issues.
Source: Terzoni, S. International Journal of Urological Nursing, Oct 2024; 18(3):

Short-Term Urinary Incontinence After Radical Prostatectomy Is Still Based on Patients' Age, Nerve-Sparing Approach, and Surgical-Experience, Despite the Higher-Use of Robotic Surgery in 2022 Compared to 2016 Real-World Results of a Large Rehabilitation Center in Germany
Abstract: Background:
Despite constant improvements, incontinence is one of the most relevant and quality-of-life-reducing side effects of radical prostatectomy (RP) and, in addition to patient-specific factors such as age, the experience of the surgeon/center and the surgical technique used play an important role.
Aims:
To present current real-world data on short-term incontinence after RP from one of the largest German rehabilitation centers in 2022 and to compare it to the results from the same institution in 2016.
Methods and Results:
Retrospective, unicentric, univariate analysis of data from 1394 men after RP in 2022 on admission and discharge from the rehabilitation clinic. Incontinence defined as ≥ 1 pad/day was evaluated by quantitative measuring all day incontinence under a defined graduation and compared to the results of 2016. Totally, 1393 men were available for analysis in 2022 compared to 1390 in 2016. Median age for both cohorts was 66 years with minor differences in preoperative PSA levels. Despite different surgical approaches, no significant change in short-term incontinence rates in 2016 and 2022 were noted at discharge (76.9% vs. 77.9%, p = 0.56). A notable increase in patients with ISUP grade Group 2 and a shift towards robotic surgery were observed in 2022 (45.5%–71%). While nerve sparing led to a significant improvement in continence (p < 0.01), lymphadenectomy and T-stage were not related to any significant increase in short-term incontinence rates. Comparing age groups within the cohort, patients > 69 years exhibited the highest risk of short-term incontinence and least likelihood of regaining continence during rehabilitation (p < 0.01). Men treated at a certified prostate cancer center had significantly (p < 0.01) lower short-term incontinence rates.
Conclusion:
Our study shows little improvement in short-term postoperative incontinence rates after RP in Germany in the last 6 years and known risk factors for postoperative incontinence like age, nerve-sparing surgery, and level of experience were reproduced in our analyses. We conclude not only to carefully select but also to counsel patients before being treated for prostate cancer and to strongly advice treatment at certified centers.
Source: Püllen, L. Cancer Reports, Dec 2024; 7(12):

Adults with Intellectual Disabilities and Incontinence: Assessment and Toileting Issues
Abstract: Background:
Urinary and bowel incontinence are more common in adults with intellectual disability (ID), compared to the general population. Little is known about their incontinence experiences and toileting issues. The aim was to learn about their experiences and toileting issues.
Method:
Incontinence and toileting issues assessment was conducted with a community-based sample of 22 adults with ID and urinary incontinence, with or without bowel incontinence. Assessment included the IPSS, ICIQ-UI, and POTI checklists; bladder scans; and urine sample screening for presence of a urinary tract infection.
Results:
The majority (19 adults, 86%) developed urinary incontinence during adulthood. Seven adults (32%) also experienced bowel incontinence, and constipation was the most commonly reported health condition (13 adults, 59%), other than urinary incontinence. Fifty per cent (11 adults) had been treated for a urinary tract infection within the previous 12 months.
Conclusion:
There is an urgent need to develop accessible and reliable incontinence assessment materials with and for adults with ID and their supporters. These assessments should pay close attention to health conditions that can cause incontinence in this group and factors associated with incontinence which are more commonly experienced by adults with ID. These factors are potentially modifiable.
Source: Finlayson, J. Journal of Intellectual Disability Research, Nov 2024; 69(2):

Smart Personalized Continence Care for People with Profound Intellectual and Multiple Disabilities: A Theory and Practice- Based Implementation Guideline for a Digital Innovation
Abstract: Introducing smart technologies can personalize and improve continence care for people with profound intellectual and multiple disabilities within residential care facilities. Currently, continence care is provided according to fixed schedules. This can lead to oversaturated incontinence materials, leading to leakages and an increased chance of incontinence-associated dermatitis or unnecessary changes. Both result in an unneeded burden for individuals with profound intellectual and multiple disabilities and their caregivers. Smart technologies that notify caregivers when incontinence materials need to be changed can improve the quality of life for individuals experiencing incontinence and lead to a more efficient care process for their caregivers. Yet, implementation is challenging. We present a Guideline for Smart Continence Care (SCC) Implementation in Residential Disability Care. The guideline is systematically and iteratively developed by combining implementation literature and daily practice. Lessons learned from applying a draft version at six residential care facilities are integrated. Eight steps are identified and detailed to guide the SCC implementation process: (1) analyze and determine goals for each target group, (2) analyze the innovation, (3) analyze the context, (4) arrange preconditions, (5) formulate implementation strategy, (6) carry out and monitor the implementation, (7) evaluate and adapt implementation strategy, and (8) continued use and upscaling. The guideline is illustrated by examples from actual SCC implementation practice. This guideline is not only useful for those who lead the implementation of SCC in residential care, but may offer guidance for other care technology implementations in various care settings as well.
Source: Van Cooten, V. Journal of Policy and Practice in Intellectual Disabilities, Mar 2025; 22(1):

Urinary incontinence: implications for nursing practice
Abstract: Urinary incontinence, encompassing stress, urge, and overflow types, significantly impacts patients' physical, psychological, and social wellbeing. This article provides an overview of each type, exploring their pathophysiology, risk factors, and clinical presentations. It emphasises the crucial role of nursing and discusses evidence-based management strategies, including behavioural therapies, pharmacological treatments and patient education. The article also addresses the impact of incontinence on quality of life and future directions for research and practice, advocating a multidisciplinary approach to improve patient outcomes.
Source: Horta Reis da Silva, T. British Journal of Nursing, Dec 2024; 33(22):

Urinary incontinence in older adult women: fighting a rising tide
Abstract: The world's population is rapidly ageing, with conditions such as urinary incontinence, which are especially prevalent among older adults, expected to rise in prevalence as a result. Urinary incontinence is particularly common in older women; however, despite its profound impact on every aspect of women's health and wellbeing, it is often minimised by both individual patients and the wider healthcare system. Francesca Ramadan delves into the prevalence of and psychosocial effects and patient-related factors related to urinary incontinence in older women.
Source: Ramadan, F. British Journal of Community Nursing, Dec 2024; 30(1):

The invisible disability: how to manage urinary incontinence in a neurological patient
Abstract: Urinary incontinence is a significant challenge in patients with neurological conditions, requiring a multifaceted approach to management from a broad range of healthcare professionals. It not only affects quality of life, but also is a leading cause of emergency NHS admissions. The considerable increasing cost of emergency bladder and bowel admissions has highlighted the urgent need for education in uro-neurology across the multidisciplinary team. In response, the Uro-neurology Academy was established in 2023 and hosted an initial webinar in the summer of 2023, which explored a basic approach to managing urinary incontinence in a neurological patient from a medical, nursing and allied health perspective. The webinar also provided an update on the NHS England and NHS improvement neuroscience transformation programme which outlined future commissioning models for neurology, with implications for multiple sclerosis, bladder and urology services. This article will summarise the practical guidance and key points presented by the speakers and chair.
Source: Stross, R. British Journal of Neuroscience Nursing, April 2025; 21(2):

Revolutionising treatment for urinary incontinence and enhancing intimate wellness with EMSELLA
Abstract: Older people are at an increased risk of developing skin damage related to incontinence, including pressure ulceration and incontinence-associated dermatitis (IAD). Factors exacerbating risk in older people include: a higher rate of faecal and urinary incontinence, reduced mobility, long-term conditions and changes to skin barrier function, as a result of the ageing process. Nurses have a key role to play in the assessment of continence, IAD prevention and management. This article explores nursing knowledge in relation to continence care on six inpatient wards for older people, and describes the implementation of improvement strategies, in order to reduce voidable harm.
Source: Attewell, D. Journal of Aesthetic Nursing, Apr 2025; 14(2):

The impact of urinary and bowel incontinence: psychological and physical effects and interventions
Abstract: This clinical review explores the multifaceted impact of urinary and bowel incontinence on the physical and psychological wellbeing of individuals, particularly older adults. The psychological effects, which often include anxiety, depression and social isolation, are addressed through interventions such as cognitive behavioural therapy and peer support groups, which are crucial for alleviating the emotional burden. The review also examines conservative management strategies, such as pelvic floor muscle training, bladder retraining and dietary changes, as well as discussing pharmacological treatments and surgical options for more severe cases. A key emphasis is placed on the importance of a multidisciplinary approach and incorporating the expertise of continence nurses, physiotherapists, occupational therapists and psychologists to comprehensively address patient needs.
Source: Alsararatee, Hasan H. Gastrointestinal Nursing, Nov 2024; 22 (suppl 9):

The impact of incontinence on mental health
Abstract: Bladder and bowel issues, particularly those related to continence, can significantly impact an individual's mental health. These challenges often lead to isolation, anxiety, stress, depression and social anxiety, all of which can profoundly affect a person's quality of life. Healthcare professionals are uniquely positioned to recognise these concerns and incorporate them into assessments for bladder and bowel health. By actively listening, offering empathy and guiding patients toward further support—alongside providing practical treatment and management strategies—clinicians can play a vital role in delivering comprehensive care. This article explores common bladder and bowel issues, the psychological and social challenges they present, and the difficulties both patients and healthcare professionals face in addressing and managing them.
Source: Robson, M. British Journal of Community Nursing, Apr 2025; 30(suppl 4a):

To pad or not to pad? The use of containment products in healthcare
Abstract: Containment products, commonly known as incontinence pads, are medically used in healthcare for patients with bladder and bowel symptoms. However, using them without a clinical need or selecting the wrong style or absorbency can lead to avoidable patient harm. In some cases, product formularies are developed with a greater focus on cost than clinical need, restricting access to certain styles and limiting the number of products prescribed per day. While registered healthcare professionals are accountable for assessing and prescribing containment products for patients under their care, they may not always be aware of this responsibility. Providing pads prematurely can cause unintended physical harm, and foster psychological dependence and reluctance to pursue curative treatment.
Source: Evans, T. British Journal of Community Nursing, Apr 2025; 30(suppl 4a):

A review of the role for pelvic floor physiotherapy in postmenopausal women with urinary incontinence
Abstract: Urinary incontinence is a prevalent condition affecting women. Pelvic floor physiotherapy is a specialized field of physiotherapy dedicated to assessing and treating pelvic floor muscles. This therapy has demonstrated benefits in addressing stress urinary incontinence in premenopausal women, with numerous studies supporting its efficacy in this population. However, pelvic floor physiotherapy in the treatment of postmenopausal women is less well-established, and furthermore, the types of urinary incontinence in postmenopausal women are much broader. We provide a comprehensive review of recent literature investigating the effectiveness of pelvic floor physiotherapy therapy for various conditions in postmenopausal women, including urinary incontinence, urgency urinary incontinence, pelvic organ prolapse, genitourinary syndrome of menopause, sexual dysfunction, and urinary incontinence in the context of obesity, frailty, mobility, and dementia. After evaluating the current literature, it is evident that there is insufficient data to definitively endorse or dismiss the utilization of Pelvic floor physiotherapy for treating urinary incontinence in postmenopausal women. Nevertheless, considering the low associated risks of pelvic floor physiotherapy, we advocate for the initiation of comprehensive, large-scale randomized studies aimed at evaluating its effectiveness in addressing urinary incontinence in postmenopausal women with special attention to vulnerable subgroups, including individuals who are obese, frail or experiencing cognitive impairment.
Source: Walgren, Lauren A. Post Reproductive Health, Dec 2024; 30(4): 239-245
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Key in Lock Syndrome: A Case Report of Situational Urge Incontinence
Abstract: Urgency urinary incontinence, a subtype of overactive bladder, is a common complaint in primary care. One type of urgency urinary incontinence is key in lock or latchkey syndrome, which causes patients to release urine uncontrollably because of a situational environmental trigger or triggers. This incontinence often occurs when patients visualize the door of their house or hear running water. This article presents the case of an older adult woman experiencing recurrent genitourinary infections in the setting of worsening key in lock syndrome.
Source: White, Krista A. The Journal of Nurse Practitioners, Sep 2024; 20(8):
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Reproductive history of parous women and urinary incontinence in midlife: A National Birth Cohort follow‐up study
Abstract:
Objective:
To investigate how reproductive history was associated with urinary incontinence in midlife.
Design:
A follow‐up study.
Setting:
Denmark.
Population:
A total of 39 977 mothers who participated in the Maternal Follow up (2013–2014) in the Danish National Birth Cohort. National registries provided their reproductive history.
Methods:
How parity, mode of birth and obstetric tears associated with urinary incontinence were estimated with adjusted odds ratios (OR) and 95% CI using logistic regression.
Main outcome measures:
Self‐reported urinary incontinence including subtypes stress, urge and mixed urinary incontinence.
Results:
At an average age of 44 years, the prevalence of any urinary incontinence was 32% (21% stress, 2% urge, and 8% mixed urinary incontinence). Women with two births more often had urinary incontinence than women with one birth (OR 1.20, 95% CI 1.10–1.31). Compared with women with only spontaneous births, a history of only caesarean sections was associated with much lower odds of urinary incontinence (OR 0.39, 95% CI 0.35–0.42) and a history of instrumental births with slightly lower odds (OR 0.92, 95% CI 0.86–0.98). Compared with no tear/first‐degree tear as the largest tear, episiotomy was associated with less urinary incontinence (OR 0.91, 95% CI 0.86–0.97) whereas third/fourth‐degree tears were associated with more (OR 1.14, 95% CI 1.04–1.25). Findings were mainly explained by similar associations with stress and mixed urinary incontinence.
Conclusions:
Vaginal birth was associated with a higher risk of long‐term urinary incontinence, but our results indicate that this risk may be reduced by shortening the second stage of birth.
Source: Kjeldsen, Anne C. BJOG: An International Journal of Obstetrics and Gynaecology, Oct 2024; 131(11): 1495-1505

A study to untangle the puzzle of urinary incontinence and frailty co‐occurrence among older adults: The roles of depression and activity engagement
Abstract: Aims:
To explore the co‐occurrence of urinary incontinence and frailty by testing the roles of depression and activity engagement guided by the mechanisms of common cause and interaction pathways.
Design:
A secondary analysis of a 1‐year three‐wave panel data collected from older nursing home residents in China.
Methods:
Changes in depression and activity engagement were regressed on urinary incontinence and frailty incidence underpinned by the common cause mechanism of chronic conditions co‐occurrence, and these changes were also taken as mediators linking from frailty to urinary incontinence incidence supported by the interaction pathways' mechanism.
Results:
A total of 348 older adults were included in this study, and 55.7% were women. The co‐occurrence of urinary incontinence and frailty was found in 16.7% of the participants at baseline. Older adults with sole frailty at baseline had almost twice the rate of incident urinary incontinence (32.7%) compared with those without (16.7%) over a 1‐year period. The subsample analyses showed that changes in depression and activity engagement failed to significantly predict the incidence of urinary incontinence and frailty. The mediating roles of these changes linking frailty to urinary incontinence incidence were also not statistically significant.
Conclusion:
The co‐occurrence of urinary incontinence and frailty is prevalent in older nursing home residents. Older adults with frailty at baseline are more likely to develop urinary incontinence a year later. The common cause and interaction pathways mechanisms for the co‐occurrence of urinary incontinence and frailty were not verified with changes in depression and activity engagement.
Source: Wang, C. Journal of Advanced Nursing, Nov 2024; 80(11): 4584-4592

Care Needs of Older Adults with Urinary Incontinence: A Cross-Sectional Study
Abstract: Purpose:
To explore care requirements of older adults with urinary incontinence (UI) and contributing factors.
Method:
This cross-sectional study used the Older Adults Urinary Incontinence Care Needs Inventory to survey participants with UI in three large-scale tertiary hospitals located in Guangzhou City, China, from January 2023 to November 2023. Statistical analyses, including analysis of variance, t tests, correlation analyses, and linear regression models, were conducted to assess factors influencing participants' care needs.
Results:
A total of 530 older adults with UI participated in the survey and mean standardized score for overall care needs was 78.65 (SD = 5.01), with mean scores for each dimension ranging from 70.88 (SD = 10.55) for social participation needs to 82.45 (SD = 7.11) for health education needs. Factors that were found to influence incontinence care needs in older adults included age, literacy level, number of leaks, and type of disease (F = 37.07, adjusted R2 = 0.290, p < 0.001).
Conclusion:
Comprehensive care for older adults with UI, encompassing physiological, psychological, and social aspects, is crucial. It is essential to tailor care to individual needs and characteristics, taking into account factors, such as age and education, to ensure effective care. [Journal of Gerontological Nursing, 50(5), 43–49.]
Source: Xiang, Su Y. Journal of Gerontological Nursing, May 2024; 50(5): 43-49

Managing female stress urinary incontinence in a post mesh era: What to do and when to refer
Abstract: SUI is defined by the International Continence Society as 'the complaint of any involuntary loss of urine on effort or physical exertion (eg sporting activities), or on sneezing or coughing'.2 SUI affects many domains of a person's life, and a large proportion of SUI can be improved or cured, but SUI is often under-reported secondary to incontinence-related stigma.3 Primary care providers are therefore essential in the assessment and management of SUI. Pathophysiology and assessment of SUI is related to weakness of the pelvic floor and urethral sphincter, resulting in leakage of urine with increased intra-abdominal pressure, such as that experienced during exercise, coughing and laughing. Proactive management of constipation, as well and encouraging reduced intake of alcohol and caffeine, are suggested.9 Both body mass index and waist circumference are positively associated with SUI,10 and weight reduction has been shown to lessen SUI symptoms, as well as improve postoperative outcomes in patients undergoing surgical intervention for SUI.11 The literature demonstrates that women with chronic respiratory conditions were twice as likely to develop urinary incontinence compared to the general population, so management of respiratory comorbidities is essential.12 Smoking cessation should also be recommended to relevant patients.9 Pelvic floor muscle training (PFMT) is highly effective in managing SUI and has a strong body of evidence (particularly in mild-moderate severity SUI cohorts).13-15 PFMT aims to strengthen the pelvic floor and sphincter complex and should be recommended as a first-line therapy to all patients with SUI13'14 (Table 4). PVS were performed in increasing numbers following the concerns about the use of mesh for prolapse surgery27 and have comparable clinical outcomes to synthetic slings, without mesh-specific complications (Table 5).28 Systematic reviews quote success rates between 46.9 and 90%.22,29 Burch colposuspension Burch colposuspension is a mesh-free treatment for primary SUI and involves placing sutures between the anterior vaginal wall (either side of the urethra) and Cooper's ligaments, thereby elevating the urethra and providing a support mechanism against rises in intra-abdominal pressure.
Source: McDonald, J. Australian Journal of General Practice, May 2024: 53(5): 283-288

The impact of male urinary incontinence on quality of life and sexual health
Abstract: Men with urinary incontinence problems may have a fear of urinary incontinence during sexual intercourse, which may negatively affect their sexual lives. This study aimed to determine the effect of urinary incontinence on quality of life and erectile dysfunction in men. A total of 203 men with urinary incontinence who presented to a urology outpatient clinic were assessed using a patient information form, the International Consultation on Incontinence Questionnaire‐Urinary Incontinence Short Form (ICIQ‐SF), and the International Index of Erectile Function (IIEF). The mean age was 63.48 ± 8.80 years, the mean ICIQ‐SF score was 13.45 ± 3.14 (moderate), and the IIEF erectile dysfunction score was 18.52 ± 6.48 (mild/moderate). Patient age correlated positively with the ICIQ‐SF total score (r = 0.309, p < 0.001) and negatively with the IIEF total score (r = −0.452, p < 0.001). The ICIQ‐SF score was negatively correlated with erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction scores (p < 0.001, p = 0.015, p = 0.037, p = 0.006 and p = 0.001, respectively). More severe urinary incontinence in men was associated with lower quality of life and greater erectile dysfunction. Further studies are needed to raise men's awareness of urinary incontinence.
Source: Gezginci, E. International Journal of Urological Nursing, Nov 2024; 18(3):