Overview of urinary incontinence in palliative care

Urinary incontinence is highly distressing for patients with palliative care needs and their carers. It is often multifactorial; drugs, infection and general debility are common contributing factors. Urinary incontinence may also be caused by conditions unrelated to the patient’s life-limiting illness.

Types of urinary incontinence include:

• stress urinary incontinence
• urge urinary incontinence
• overflow urinary incontinence
• functional urinary incontinence.

Urinary incontinence in patients with palliative care needs is often of mixed aetiology (eg mixed urge and stress incontinence). An additional consideration in patients with chronic leakage of urine is a fistula between the renal tract and the abdominal wall, alimentary tract or vagina. Fistulae can occur after surgery or radiation therapy, or as a result of cancer or inflammation. Treatment of a fistula requires specialist advice.

Management of urinary incontinence depends on the cause and type of incontinence. Consider the potential benefits and burdens of each intervention, and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care. For some patients, management requires a multidisciplinary team including nurse continence specialists, physiotherapists and urologists.

The strategies for general management apply to all types of urinary incontinence. Specific management may be needed for stress urinary incontinence and urge urinary incontinence.