General management of urinary incontinence in palliative care

Assess and manage factors that may be contributing to urinary incontinence, including:

• drugs that exacerbate or cause urinary incontinence—rationalise and stop if possible (for principles of rationalising drugs, see Medication rationalisation in palliative care)
• urinary tract infections—may be treated with antibiotic therapy if appropriate (see the Antibiotic guidelines)
• constipation
• faecal impaction
• excessive fluid intake, including drinks containing caffeine and alcohol.

Referral to a physiotherapist or occupational therapist for assistance with bladder training and pelvic floor exercises is helpful for some patients.

Maintaining skin integrity is vital to prevent problems (eg irritation, infection) associated with continued exposure to urine in patients with urinary incontinence. A barrier cream (eg Comfeel Barrier Cream, Sudocrem, zinc and castor oil cream) may be used with care on vulnerable skin.

Consider the use of incontinence pads, and providing other continence aids (eg commode, urinal, urinary sheath). Incontinence pads can be bought from community pharmacies and supermarkets but may be available from local community nursing or palliative care services. Funding and supply of continence aids is available for some patients; seek advice from a nurse continence specialist or palliative care specialist.

Urinary catheterisation may be necessary in the management of urinary incontinence, but it has associated morbidity and mortality. Do not use catheterisation as first-line management except for patients in the last days of life, when the benefits are more likely to outweigh the harms associated with the procedure. For further advice, see Management of long-term indwelling urinary catheters in palliative care.

Surgery may be used to manage urinary incontinence depending on the type of incontinence and the patient’s prognosis, goals of care and preferences. Referral to specialist incontinence surgical services may be required.

Additional information on managing incontinence for patients, carers and healthcare professionals is available from the Continence Foundation of Australia.