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Prevalence and Management of Urinary Incontinence in a Brazilian Hospital: A Prospective, Descriptive Study

Empirical Studies

Prevalence and Management of Urinary Incontinence in a Brazilian Hospital: A Prospective, Descriptive Study

Index: Wound Management & Prevention 2019;65(12):12-20

Abstract

Although urinary incontinence (UI) in hospitalized patients is a frequent health problem, research on the subject is limited. Purpose: A prospective, descriptive study was conducted to evaluate the prevalence of UI, care implemented among hospitalized adult patients, and impact of UI on quality of life (QoL) in a large private institution in Brazil. Methods: All patients admitted during November 2018 who were at least 18 years of age, sufficiently conscious and oriented to answer questions, able to undergo skin inspection, and had the ability to urinate (ie, did not use an indwelling bladder catheter or have a nephrostomy, cystostomy, urostomy, or vesicostomy) were eligible to participate. Data were collected through interviews, physical examinations, chart review, and completion of the International Consultation on Incontinence Questionnaire-Short Form (ICQI-SF), a self-diagnostic, 6-item survey of UI frequency, amount of leakage, and overall impact of UI; answers for items 3 (6 answer options), 4 (4 answer options), and 5 (Likert scale ranging from 0 to 10) were considered individually and summed for a total score ranging from 0 to 21. Data were collected using paper forms and then double-entered and validated in a spreadsheet for statistical analysis. Continuous variables were described as mean/median and standard deviation. Categorical variables were described in absolute numbers and percentages. Pearson’s chi-squared test and Fischer’s exact test were used to investigate the variable statistical differences. The level of significance was 5%, and the intervals were obtained with 95% confidence. Prevalence was defined as the percentage of people with UI over the study period in all admitted patients. Results: Of the 858 eligible patients, 114 were incontinent (13.3%), but 61 were unable to answer the research questions, 2 used catheterization, and 9 refused to participate; therefore 42 patients (age 80 [range 77.6–82.3] years, 30 [71.4%] women) completed the study. All patients (100%) were managed using diapers. Twenty-one (21, 50%) were married, 24 (57.1%) were white, and 25 (59.5%) were retired. Sixteen (16, 38.1%) had urine loss several times a day, and 17 (40.5%) had urine loss in large amounts; 10 (23.8%) had incontinence-associated dermatitis. The ICQI-SF item regarding interference of urine loss in daily life had a reported mean of 4.1 ± 4.0, inferring urine loss interfered with life; mean ICQI-SF score was 12.1 ± 5.86, implying UI had a moderate impact on QoL. Conclusion: The 13.3% prevalence of UI was similar to previous studies. The absence of a protocol for incontinence management was identified. The results suggest additional, larger sample UI prevalence studies need to be conducted. 

Potential Conflicts of Interest: The content of this article was extracted from the end-of-course paper, “Prevalence and Management of Urinary Incontinence in a Brazilian Hospital,” which was presented to the Graduate Course in Stomatherapy, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil, January 11, 2019. 

Introduction

The International Continence Society1 defines urinary incontinence (UI) as any involuntary leakage of urine. Types of UI include stress UI (characterized by the loss of urine during exertion), urgency UI (urine loss associated with urgency), mixed UI (leakage is associated with urgency and exertion), nocturnal enuresis (involuntary loss of urine during sleep), continuous UI (continuous involuntary urine loss), invisible UI (the person is not aware of how UI occurred), postural UI (involuntary urine loss associated with body position), and coital incontinence (urine loss that occurs during sexual intercourse).

According to a cross-sectional study,2 UI can impact patient quality of life (QoL); its destructive consequences are related to the psychological, sexual, and social aspects of this condition and include sexual dysfunction, stress, depression, loss of self-respect and self-confidence, shame, avoidance of social events, and reduction of personal activities. The estimated cost of overactive bladder syndrome with UI in the United States was $65.9 billion in 2007, with projected costs of $82.6 billion in 2020.3

UI management includes conservative approaches such as a behavioral therapy, physical therapy, and scheduled voiding; drug therapy with antimuscarinics; surgery to improve or cure UI; restricting fluid and caffeine intake; smoking cessation; weight loss; use of containment devices or disposable pads for minor UI; pads, external devices, and catheters for moderate to severe UI; and the stimulation of the posterior tibial nerve.

A cross-sectional study5 was conducted in Brazil among 10 long-term care facilities that comprised 143 elderly people, most of them female (79.0%), average age 79.3 years old. UI prevalence was found to be 42.7%. A cross-sectional study6 conducted at the University Hospital of the University of São Paulo, Brazil, that analyzed a group of 319 patients older than 18 years of age (57.1% female, average age 47.9 years) found UI prevalence was 22.9%. 

More epidemiological studies about UI prevalence in hospital facilities in Brazil are needed. Documentation of UI is not required, and nurses usually do not include this information in their nursing assessment. The data collected from a prevalence study could support the development of a specific protocol for the care of hospitalized patients with UI. This study aims to identify the prevalence of UI in hospitalized patients and to verify what strategies were implemented for its management.

Methods

Study design and sample. This descriptive prevalence study was conducted in the medical-surgical, obstetric, intermediate, and intensive care units at a large Brazilian private hospital. Inclusion criteria stipulated patients had to have UI and be 18 years old or older, conscious and oriented to answer questions, with a clinical condition that permitted skin inspection and the ability to urinate (not use an indwelling bladder catheter or urinary diversions [nephrostomy, cystostomy, urostomy, and vesicostomy]). 

In order to calculate the sample size, the global prevalence of UI was adopted (22.9%),5 assuming a maximum error (α) of 5% and a confidence level of 95%, where z was a random variable with normal distribution (1.96), thus establishing a final sample of 303 participants.

Data collection. Data were collected from November 1 to November 30, 2018. During this period, 1003 patients were hospitalized. Research data were obtained from 3 sources: patient charts, interviews with patients, and physical examination of the participants. The physical examinations included inspection of perianal, perigenital, and adjacent area skin.

Researchers developed and used a structured questionnaire to record the data. The studied variables were age (divided into groups: <60 years, 60–79 years, and ≥80 years old), gender (female, male), profession (retired, housewife, other), marital status (married, widowed, single, divorced), self-declared race according to the Brazilian classification (white, brown, black, yellow), literacy (literate, illiterate), associated diseases (comorbidities), current medications, alcoholism (yes, no), smoking habits (yes, no), functional capacity (walked independently, motor limitation, required prosthesis/orthotics, used a wheelchair, was bedridden), dysuria (yes, no), frequent urinary infection (yes, no), diarrhea (yes, no), history of urological surgery (yes, no), type of surgery performed previously (prostatectomy, ureterolitotripsia, varicocele correction, vasectomy), previous surgical correction of UI (yes, no), number of pregnancies, number of vaginal deliveries, number of miscarriages, number of deliveries with the use of forceps, episiotomy during delivery (yes, no), laceration (yes, no), cystocele (yes, no), menopausal (yes, no), hormone replacement (yes, no), documented history of UI (yes, no), identification of UI as a risk for falling (yes, no), documented UI management (yes, no), and UI management type (intimate hygiene + use of disposable diaper, intimate hygiene + use of disposable diaper + external urinary catheter).

Skin conditions of the perianal, perigenital and adjacent area were assessed by physical examination to determine presence of incontinence-associated dermatitis (IAD). Preventive methods implemented at the facility included zinc oxide, zinc oxide + nystatin, and barrier cream.

International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Each participant completed the standard ICIQ-SF.7 The ICIQ-SF is a 6-item questionnaire used to assess the frequency, severity, and impact of UI on QoL.8 Items 1 and 2 address demographic characteristics and item 6 asks participants to describe timing of urine leakage; the 3 items are not included in the scoring. Item 3 asks about the frequency of leakage, with responses/points ranging from 0 (never) to 5 (all the time). Item 4 asks the amount of perceived leakage, with responses that include none (0 points), a small amount (2 points), a moderate amount (4 points), and a large amount (6 points). Item 5 asks participants to rate how much urine leakage interferes with daily life on a scale from 0 (not at all) to 10 (a great deal). Total scores range from 0 to 21. This instrument has been used in research and clinical practice among men and women across the world; its validity, reliability, and responsiveness were established with rigor in several data sets.7

The strategies implemented by the nurses for the management of UI and for the prevention and treatment of IAD were extracted from the patients’ records and through interviews with the patients.

Data collection and analysis. Data were collected using paper forms and then double-entered and validated in a Microsoft Excel version 2016 (16.0.6769.2017) spreadsheet. Statistical calculations were performed with the R software, Version 3.6.1 (Bell Laboratories, St. Louis, MO). The level of significance used in the statistical test decisions was 5%, and the intervals were obtained with 95% confidence.

Prevalence was defined as the percentage of people with UI over a given period in a given population. In this study, the following formula was used: 

The data referring to the variables were subjected to descriptive statistical analysis. Continuous variables were described in their measures of central tendency (mean, median) and dispersion (standard deviation). Categorical variables were described in absolute numbers and percentages. Pearson’s chi-squared test and Fischer’s exact test were used to investigate the variable statistical differences.

Ethical considerations. The research was performed respecting the international ethical parameters for research with human beings according to the Declaration of Helsinki and was approved by a Research Ethics Committee regulated by the Brazilian Council of Ethics in Research under Approval Opinion number 2.912.508. All participants provided written informed consent and told their identity and data would be kept private.

 

Results

Demographic and clinical findings. Of the 858 patients in the study population, 114 had UI; therefore the prevalence of UI was 13.3%. Of those with UI, 76 were female (66.7%). Sixty-one (61) were unable to answer the research questions, 2 used catheterization, and 9 refused to participate, leaving 42 patients with incontinence (30 women [71.4%], 12 men [28.6%]; average age 80 [range 57–92] years) in the study (see Figure). Most were retired (25, 59.5%), married (21, 50.0%), and had completed elementary education (14, 33.3%) (see Table 1). All patients denied being alcoholic, and 25 (59.5%) were smokers with a mean smoking time of 28 (range 18.5–37.5) years. 

Many patients had more than 1 disease; systemic arterial hypertension was the most frequently noted (35, 83.3%), followed by diabetes mellitus (13, 31.0%), hypercholesterolemia (10, 23.8%), hypothyroidism (7, 16.7%), obesity and heart failure (6 each, 14.3%), stroke and chronic obstructive pulmonary disease (5 each, 11.9%), cardiac arrhythmia and renal disease (4, 9.5%), Alzheimer’s Disease (3, 7.1%) and asthma, bronchitis, and depression (2 each, 4.8%).

The majority of patients used more than one class of medications. The mean number of medications used per patient was 4.6 (95% CI [4.0-5.2]); medications included hypotensive drugs (31, 73.8%), anticoagulants (27, 64.3%), antibiotics and gastric protectors (23 each, 54.8%), dyslipidemic drugs (19, 45.2%), diuretics and hypoglycemic agents (13 each, 31%), hormones (10, 23.8%), anxiolytics (9, 21.4%), antidepressants (8, 19%), anti-inflammatories (4, 9.5%), and anticholinergics (1, 2.4%).

With regard to patient mobility, 15 (35.7%) walked independently, 13 (31%) had motor limitations, 8 (19.0%) required prosthesis/orthotics, 4 (9.5%) required a wheelchair, and 2 (4.8%) were bedridden.

Seven (7) patients (16.7%) reported dysuria symptoms, 17 (40.5%) had frequent urinary infections, and 6 (14.3%) had diarrhea. Twenty-three (23) patients (54.8%) reported previous urogynecological surgery; among the 6 of the 12 men, 3 (25.0%) had a prostatectomy, 1 (8.3%) had ureterolitotripsia, 1 (8.3%])had a varicocele, and 1 (8.3%) had a vasectomy. Among the 30 women who had surgery, 10 (33.3%) reported having undergone surgery to correct UI in the past.

All female patients were postmenopausal; 7 (23.3%) had undergone hormone replacement. No rectocele uterine prolapse was found in these women; 3 (10.0%) had cystocele. None of these women underwent urological surgery during hospitalization. Other data from women regarding pregnancy and delivery can be found in Table 2

QoL analysis of the ICIQ-SF data demonstrated the effect of urine loss in daily life (average score was 4.1 ± 4.0, indicating urine loss interfered with daily life). The mean ICIQ-SF score of 12.1 ± 5.86 inferred a moderate impact on QoL. Patient responses did not include Never — urine does not leak or Leaks when you are physically active/exercising. Additional data are shown in see Table 3

Chart data. When comparing female (n = 30) and male patients (n = 12) with regard to fall risk, performance of intimate hygiene, management of UI, and actions taken to prevent IAD, only the performance of intimate hygiene was statistically different between genders (P = .049) (see Table 4).

Products used to prevent dermatitis were zinc oxide (7), zinc oxide + nystatin (6), and barrier cream (2). Products for the treatment of dermatitis were used by 8 of the patients (19%), with no statistical difference between women and men (P = .62). The products used for treatment were zinc oxide + nystatin (4), zinc oxide + nystatin + hydrocolloid powder (2), and only zinc oxide (2).

Discussion

Prevalence. The overall prevalence of UI among inpatients was 13.3% in the total study population. It is important to emphasize that all patients had urinary loss before hospitalization (ie, hospitalization was not a factor of loss of urinary control due to the deterioration of health status). UI was more predominant in women and in elderly persons (60 or older).

An overall prevalence of 13% (11.5% in men, 13.5% in women; not significantly different) also was noted for 6 hospitals in Indonesia between 2008 and 2011.9 The population of the study included children, adults, and elderly patients who underwent treatment at the pediatric, urology, obstetrics and gynecology, and geriatric outpatient clinics of those hospitals. UI prevalence in the current study was lower than the study conducted in Brazil at a university hospital, which found a prevalence of 22.9%.6 

The role of age and gender. UI is a common problem that can affect people of all age groups, but its occurrence increases as the population ages.9-11 UI prevalence also increases with age. In one review of 36 studies from 17 countries about the prevalence of UI,10 40% of women 70  years or older were affected, prevalence rates were found to be even higher in the elderly and among nursing home patients, and UI prevalence among women ranged from ~5% to 69%. Similar data were found in the study conducted in Indonesia,9 where UI prevalence among elderly persons was 22.2%. This rate was significantly higher (P <.001) than the 10.8% prevalence in persons less than 60 years old.

The association between aging and altered urinary function (ie, urgency and urinary incontinence) can be explained by the structural alterations of the detrusor, such as the development of fibrosis, reduced bladder capacity and hypersensitivity to norepinephrine, determining involuntary contractions of the muscle.12 Because UI prevalence is strongly related to the age of the woman and with the increase in mean life expectancy, overall UI prevalence in women is expected to increase in the future.10

The loss of urinary control is a significant health condition for the elderly. It is not considered a disease but rather a circumstance that physically and psychologically affects this population, with data supported by results of a national, quantitative, cross-sectional study11 conducted in a geriatric outpatient clinic in São Paulo, Brazil. In this study, among the 100 elderly patients interviewed, 65% reported UI. The results also identified that urinary tract infections, loss of mobility, and gender were factors associated with UI in elderly individuals.11

A prevalence study13 conducted in the Netherlands found UI prevalence among adults (N = 1257) was 36.8%. Women experienced UI significantly more often than men (49.0% vs. 22.6%, respectively, P <.001), and UI prevalence increased in both men and women with age (P = .003 and P <.001, respectively). In a prevalence study14 conducted in Brazil among 622 women aged 50 years or older with a mean age of 64 years, UI prevalence was 52.3%.

UI type. In addition to gender and age, prevalence is affected by UI type. In a prevalence study15 performed in western Turkey among a random sample of women and men aged ≥18 years (N = 1555; 636 men [40.9%] and 919 women [59.1%]), the most prevalent UI symptom was urgency (reported in 29.3% of the study population [20.1% of men, 35.6% of women]). The prevalence of urge, stress, and mixed UI was 6.5% (3.9% men, 8.2% women), 14.1% (3.9% men, 21.2% women) and 5.6% (0.8% men, 9.0% women), respectively.

Clinical factors. The clinical factors in the present study are similar to those described in other prevalence and incidence studies that identified that most women with UI had vaginal delivery, were menopausal, and had not undergone hormone replacement16,17; the most important factor in men was a history of urological surgery. A cross-sectional study in the Netherlands with a sample of 1257 participants13 identified that diabetes mellitus, fecal incontinence, and constipation were overall risk factors for developing UI; for women, the risk factors included obesity, vaginal hysterectomy, and vaginal delivery, and for men prostate surgery was the main risk factor. In other prevalence and incidence studies,17,18 the main risk factors associated with UI in women were increasing age, deliveries, menopause, history of gynecological surgeries, and intestinal constipation.

Functional performance/mobility. Another factor often related to UI is functional performance capacity. People with reduced mobility tend to have a higher prevalence of UI.12 In the current study, most patients presented some type of functional limitation. The same result was found in a prevalence study19 conducted with a sample of 686 elderly individuals in which the prevalence of UI was 23.2% among men and 31.1% among women, and functional limitations included walking with assistance, reported falling in the last year, and fragility. In addition, the elderly women in this sample reported negative self-perception of health, arthritis/arthrosis/rheumatism, and fragility. Both the current and previous studies suggest that the greater the degree of dependence in the elderly, the greater the prevalence of UI. 

A literature review18 revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. In men, the most important cause was prostatectomy. This result was confirmed in the current study; in the studied sample, 25.0% of the men had undergone prostatectomy. Post-prostatectomy UI is a functional complication and has a significant impact on the QoL of patients diagnosed with prostate cancer. Incontinence due to surgical intervention was demonstrated in a longitudinal cohort study20 of 211 Korean men diagnosed with prostate cancer who had undergone radical prostatectomy; urinary function and incontinence did not return to baseline for 14.2% of patients who remained incontinent 12 months after surgery.

QoL. The qualification of urinary loss and QoL in patients with incontinence were measured using the validated instrument ICIQ-SF.8 In the present study, the mean score for interference of urine loss (several times a day) in the daily life of the patients was 4.1 ± 4.0. The sum of the scores that reflects the severity of the disease had a mean of 12.1 ± 5.86 (moderate UI ). 

UI has been found to be related to QoL. A cross-sectional study21 in South Korea with a sample of 444 elderly patients evaluated UI-related QoL using the third ICIQ-SF subscale. Patients with 5 or more points were categorized as having poor QoL, while patients with 4 points or less were classified as having good QoL. Of all patients with UI, 32.5% reported poor QoL, and patients with depression were more likely to have poor QoL. In the current study, 47.7% participants were categorized as having poor QoL, considering the authors’ classification (patients with 5 or more points).

A cross-sectional study22 (N = 556 women) performed at an urogynecology outpatient unit in Brazil to compare the impact of different types of UI on QoL found women with mixed UI experienced a greater impact on QoL, concluding that all types of UI interfere both in general and specific QoL.

Assessment and documentation. In the current study, 28.6% of the patients did not have UI documented in their medical charts. In these cases, UI was identified by the nursing team by physical examinations including inspection of perianal, perigenital, and adjacent area skin conducted as part of study. Many people, especially women, wrongly assume incontinence is part of the aging process.17 They are unaware of the current treatments or do not seek help of a health care professional.

Risk factors. In the sample composed of elderly patients, it was important to evaluate how nurses treat UI and its relation to accidents related to falls, which is a multifactorial adverse event that can affect the patients. In the present study, 76.2% of medical charts lacked documentation that identified UI as a predictive factor for risk of falls. A national prospective cohort study,23 conducted in clinical units of 3 hospitals in Brazil among 221 inpatients more than 60 years old, analyzed the effect of UI as a predictor for the incidence of falls among hospitalized elderly patients. It concluded UI was a strong predictor of falls in the elderly surveyed. A methodological study24 recommended instituting prevention practices for hospitalized elderly patients with UI and/or specific risk factors. Better practices have been adopted in the facilities of the studies mentioned to optimize care quality, including the use of the John Hopkins Fall Risk Assessment Tool, in which incontinence is considered a predictive factor for falls.23,24 Strategies for preventing falls in inpatients should be based on established programs that use validated protocols to identify and implement risk reduction actions.

Management. The management of incontinence involves lifestyle changes such as losing weight; restricting water before bedtime; restricting caffeine, alcohol, and intense physical activities; and encouraging smoking cessation and pelvic floor muscle training programs including (in women with stress urinary incontinence and surgery) supervised pelvic floor exercises and the use of biofeedback.4 

In the sample studied, 33.3% of the women had previously undergone surgical procedures to cure UI. Anterior vaginal repair (anterior colporrhaphy) is an operation traditionally used for moderate or severe stress UI in women. However, a systematic review25 found insufficient data to allow the comparison of anterior vaginal repair with exercises for the pelvic floor muscles (biofeedback, electrostimulation, vaginal cone) for primary urinary stress incontinence in women.

With regard to the nurse-implemented strategies for the treatment and management of UI, a Cochrane systematic review25 highlighted care that involved nutrition, water intake, and urinary and intestinal habits, as well as urinary training exercises, hygienic habits, catheter manipulation and environmental aspects, investing in self-care, guidelines for family members and caregivers, favoring continence, and improving QoL. The current study showed UI management in hospitalized patients included hygienic care, use of containment devices (disposable diapers and urinary devices), and application of skin protectors. 

Diapers. The disposable diaper is a containment device used to absorb urinary and/or fecal flow. Guidelines26 and an observational, cross-sectional study27 note diapers should be indicated for patients with incontinence or severe mobility restrictions at hospital institutions. This product is noninvasive, and the cost is low when compared to other technologies for the management of incontinence. 

The use of disposable diapers by adults and the elderly is widespread in daily life; the risks associated with this product have not been evaluated. Results of a cross-sectional study27 indicate the indiscriminate use of diapers, often aimed at patient safety and comfort, can come with harmful risk of mobility limitation, decreased self-esteem, urinary tract infections, dermatitis, and pressure injury. The indiscriminate use of diapers was confirmed in a transversal study28 among adult inpatients (N = 228) in which 34.4% of the patients used diapers despite the fact 30.1% did not have an indication to use them. Diaper use was considered inadequate in half the patients. 

In the current study, diapers were used by 100% of the patients. It is well known that diaper use simplifies care — it avoids calls for going to the bathroom and reduces the risk of falling, especially at night. The diaper can be a good resource for incontinence management, but routine use without clinical reasoning can induce other problems, such as IAD.

Protecting the skin against moisture damage is an important component of care. Interventions to protect and prevent damage to the skin associated with moisture include the application of barrier creams, liquid polymers, and cyanoacrylates to the skin to form a protective layer; maintaining hydration; and blocking external sources of moisture and irritants. These products are recommended in a scoping review29 for patients considered to be at risk of developing IAD. No particular barrier has been found to be better than another; the performance of each product depends on the general formulation and frequency of application.

The evaluation of perianal, perigenital, and adjacent areas of skin among patients in this study found the presence of IAD in 10 patients without the presence of fungal infection. However, zinc oxide containing nystatin was the most widely used product for the prevention and treatment of IAD, followed by barrier cream and hydrocolloid powder, without differentiating among products used for skin protection and treatment of dermatitis. A review of literature30 concluded antifungals and corticosteroids can be used in the treatment phase of dermatitis, depending on its cause. Professionals should be mindful that routine use of these medications may expose patients to other risks, such as bacterial infection.

In the current study, dermatitis was present in 23.8% of the patients and occurred more frequently in women. This finding confirms the importance of adopting effective measures for the management of incontinence in addition to in-service education. In a cohort study31 among 10 713 elderly people 65 years of age and older who were newly residing in nursing homes, the incidence of dermatitis was 5.5%. The same study showed not receiving preventive interventions was a significant predictor of dermatitis. Nurses should implement care plans for patients with incontinence and specific care with professional hygiene and skin protection. 

 

Limitations

The study was conducted in 1 hospital in Brazil that did not have a specific protocol for identifying patients with incontinence; in addition, 63.1% of patients identified as incontinent did not complete the study.

The limitations described raised concerns regarding the importance of systematic actions to identify and manage UI in the hospital context, as well as the prevention and treatment of dermatitis, promotion of better-quality care and attention, reduction of complications, and direct and indirect costs of care.

The 1-month collection period was also one of the limitations of the study; the authors intend to continue the research after sharing the data with all health professionals, including the nursing team and managers of the hospital in which the study was performed. The authors intend to replicate the study in other Brazilian hospitals, considering the geographical extent of the country and its cultural diversity, in order to identify the precise situation of Brazil regarding the prevalence and management of patients with incontinence admitted to hospitals.

Conclusion

A descriptive study conducted in a Brazilian hospital involving 858 patients found an estimated UI prevalence of 13.3%. The majority of participants were women (66.7%) and elderly (97.2%), and assessment of QoL using the ICIQ-SF found severe urine loss interfered moderately in the daily life of the patients and had a subsequent effect on QoL. When comparing the female (n = 30) and male patients (n = 12) with regard to fall risk, performance of intimate hygiene, management of UI, and preventive measures taken for IAD, only performance of intimate hygiene was statistically different (P = .013). 

The data also indicated the lack of nursing documentation related to the care performed. This revealed the need to create a protocol for the management of incontinence and the resulting complications in order to improve the quality of care and implement cost reduction measures. 

The results of this study made it possible to identify the extent of UI in the hospital setting, along with gaps in its management and complication prevention. The authors hope this information will contribute to clinical research and the improvement of the quality of nursing care provided to patients with incontinence, particularly the elderly. Additional research with a larger sample size and in different institutions is warranted and being planned.