An Evolutionary Concept Analysis of Urinary Incontinence

Nicole Zhang


Urol Nurs. 2018;38(6):289-295. 

In This Article

Attributes, Surrogate Terms, and Antecedents of UI


The review of the chosen sources indicated there are several attributes of UI. Rodgers (1989) defined attributes as "situations or phenomena that are encountered and are evaluated in reference to their resemblance, rather than strict correspondence to the identified concept" (p. 332). The attributes identified in the literature were used to examine the contexts in which UI exists. The first attribute is that a physiologic process has been altered. The second attribute is that by not meeting this physiological need of voiding, there is a resultant effect on the quality of life and mental and physical status of those individuals with UI. The third attribute is that UI is a social, cultural, and environmental construct, meaning it is socially and culturally shaped at both the larger societal and local levels. The fourth attribute is that an act of UI can only be involuntary. Each attribute is described in more detail below.

Altered physiologic process. To have UI, a person must have leakage of urine. This loss of urine is also in a socially unacceptable location. Leakage of urine can be the result of many physiological, psychological, and environmental issues; however, the cause of the leakage is not of concern to the definition of UI.

Quality of life. In addition to leakage of urine, there is an effect on the QoL, and mental and physical statuses of individuals with UI. UI is an issue that impacts all aspects of life for those who have the condition and may result in a decreased physiological health status. Some common causes of decreased QoL are skin breakdown and urinary tract infections (UTIs) (Landi, Sgadari, & Bernabei, 1998; Omli et al., 2010). Other psychological issues may include increased shame, embarrassment, decreased self-worth, sadness, depression, and many others (Wodchis, Hirdes, & Feeny, 2003). All of these factors can interact to decrease QoL further (Dugger, 2010; Ostaszkiewicz et al., 2012; Palmer, 2008; Robinson, 1999, 2000; Xu & Kane, 2013).

UI is an environmental, social, and cultural construct. UI and the cultural and environmental construction can operate in the broadest sense on two levels.

Larger environmental, society, and culture: Because UI is socially and culturally constructed, society determines locations where it is acceptable to urinate. For example, childhood toileting practices in China are practiced differently than elsewhere around the world. Chinese children often wear pants that expose the perineal area to allow the children to void as the urge arises. It is not uncommon to see children voiding in common areas, including streets or parks. If an adult were to partake in the same behavior, it would have social repercussions. In those with the UI and especially geriatric adults, to avoid urination in unacceptable places, absorbent products keep fluids in the vicinity of the person.

Local. In the immediate localized environment, the way UI is managed can vary depending on various perceptions of UI. This can affect the culture of a hospital unit and the organization as a whole (Jirovec, Wyman, & Wells, 1998). If the general feeling is that UI is a normal part of aging, which is repeatedly demonstrated in the literature, this is a belief that may be adopted by the person with UI affecting their desire to treat the condition (Ostaszkiewicz et al., 2012).

UI can only be involuntary. An important attribute of UI is that it must not be intentional. Voiding in socially unacceptable places knowingly is separate from UI. That is simply the case when someone makes a choice to not adhere to societal convention, but the other attributes discussed previously are absent.

Surrogate and Related Terms

Throughout the literature, several similar terms are used for UI. One term commonly used is involuntary or abnormal micturition. Micturition refers to the release of urine from the bladder (Macfarlane, 2006). Another common term referring to UI is voiding habits. Voiding habits may be proper or improper from the societal and socio-cultural perspective. A habit is something that can be adapted, changed, or in the case of UI, trained, as in the case of children. This is a major difference from the term involuntary micturition because that implies an innate process in which a person has lost control, while a habit is something one can change. It is a more optimistic usage of terminology used to label someone with UI. Related terms surrounding UI include voiding patterns, toileting, urinary habits, and urinary elimination. Most of these terms refer to voiding practices and place an emphasis on the malleability of voiding behaviors.


There are several antecedents for the development of UI. These antecedents lead to the development of UI as a condition generally and also feed into each episode of UI. Antecedents for developing UI are a physiological or environmental change, leading up to the leakage of urine. There can be some innate risk factors, such as age and gender. There are various ways that risk factors impact or produce UI. These factors are demographic factors, physical and mental health statuses, and environmental influences. Demographic factors that affect the development of UI are age, race, and gender (Boyington et al., 2007; Creason et al., 1989; Willington, 1976). Several health, psychological, and mental issues contribute or affect UI. Older adult patients who experience altered mental status have repeatedly demonstrated an increased risk for the development of UI (Jirovec & Wells, 1990). The environment may influence UI development. It has been mentioned previously that UI is socially and culturally constructed; however, the immediate environment, including staff perceptions and the physical situation of the immediate environment, also influence the development of UI (Skotnes, Hellzen, & Kuhry, 2013; Temkin-Greener, Cai, Zheng, Zhao, & Mukamel, 2012).

Antecedents directly leading to an incidence of UI are urine being produced followed by delayed or lack of communication of stimuli sent to the body to urinate. In this stage, the body has a signal. The signal may or may not be communicated for several reasons (Jeter, Faller, & Norton, 1990). The person may lack the mental faculties to do so, or the signal may not arrive or be sensed, as in some UTIs or neurogenic bladder. Next, the person fails to reach a place deemed socially and culturally appropriate for voiding.