An Evolutionary Concept Analysis of Urinary Incontinence

Nicole Zhang

Disclosures

Urol Nurs. 2018;38(6):289-295. 

In This Article

Definition of Urinary Incontinence

Incontinence is used scientifically as a matter of addressing the physiological situation. However, incontinence is also used in casual conversation to describe an uncontrolled physiological process. The Merriam-Webster Dictionary (n.d.) definition of incontinence is "lacking self-restraint, uncontrolled." Additionally, some synonyms include unbridled and ungovernable (Merriam-Webster Dictionary, n.d.). The current definition may be perceived negatively, and as a result, patients may have negative associations with this label.

Willington (1976) stated that "in medical circles (the word incontinence) conjures frustration, disgust and even despair. It has the stigmata of failure, resulting as it does from the restricted sense of a negative term" (p. 1). In further discussion of definition of the term, Willington (1976) stated that a quick look in the Oxford Dictionary shows that incontinence means a lack of moral control, and for most elderly, it is still understood in this way.

UI has been used in several contexts. Definitions can be considered in six different categories: broad definitions, scientific definition, definitions relating to desirability, as accidental occurrence, not only leakage of urine but as a problem with demonstrable effects, and as the answer to a diagnostic question. Several broad definitions are commonly used in the literature relating to UI. One definition is "involuntary loss of urine" (Newman, 2002, p. 85). A similar definition was given by the ICS as "involuntary leakage of urine" (Abrams et al., 2002, p. 117). The notable difference in these definitions is the usage of the word leakage as opposed to loss. These broad definitions do not attempt to give a measurable component of UI or to touch on the effects of UI on the person involved.

In the literature, UI may be defined and characterized by degree and number of episodes. This terminology is used in the MDS 3.0, which labels patients as always continent, occasionally incontinent (less than seven episodes), frequently incontinent (seven or more episodes of UI, with at least one episode of continent voiding), or always incontinent (no episodes of continence) (Centers for Medicare and Medicaid Services, 2017).

Another type of definition found in the literature relates to UI and desirability. One definition was "passing of urine into an undesirable place, or when micturition occurs in a socially unacceptable site" (Willington, 1976, p. 2). This definition is important because this is one of the few definitions of UI that mentions the social and cultural relevance of UI. However, this definition does not mention whether the act is involuntary or not. It can be assumed that the voluntary act of urinating in an unacceptable location would not be called incontinence, thus resulting in strong repercussions socially.

The accidental nature of UI is commonly reported, as seen in Burgio, Matthews, and Engel's (1991) description of UI as "accidental loss of urine" (p. 1256). The idea of UI is important to address because the idea of UI as an accident implies the individual has some form of control over the action, which may not be the case. It also implies a degree of normalcy because accidents happen and do not cause alarm or raise a red flag.

Another approach to define UI is an interactive form between the individual and caregiver or provider. In this way, UI has been thought of as an answer of 'yes' to the question: "Does urine ever come away unexpectedly and without your being able to stop it and get you wet?" (Brocklehurst, Fry, Griffiths, & Kalton, 1971, p. 583). The idea of a thorough assessment and interactive process of diagnosis is important. However, this definition implies an individual being able to respond to the question and does not address all important components of UI.

Finally, UI has also been defined as more than the leakage of urine, with demonstrable effects to the incontinent individual. Included in some definitions, UI is defined as involuntary leakage of urine that impacts the life of those with this condition (Bates et al., 1979; National Institutes of Health [NIH], 1988). These definitions bring a very interesting and important component of UI to the forefront. The first important nuance is that not only is there physiological process, but this problem has holistic effects. Secondly, this sheds light on ideas and perceptions of UI. It is important to consider perceptions caregivers and medical professionals have regarding UI. These perceptions can impact the psycho-social components of UI. Potentially, based on one's perception of the illness, the way the illness is defined could be altered situationally.

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