Clinical Practice Guidelines

AHCPR releases update to urinary incontinence guideline

The Agency for Health Care Policy and Research recently released an updated version of its clinical practice guideline on urinary incontinence (UI) first issued in March of 1992. The updated guideline has expanded sections on diagnosis and behavioral therapies, as well as a new chapter on treating chronic UI in long-term and home care settings.

Urinary incontinence is one of the primary contributing reasons that people enter nursing facilities, yet 80 percent of cases can be improved or cured by following the guideline's recommendations. Use of the guideline may help people stay at home longer and improve the quality of life for persons at home or in facilities.

Researchers estimate the Nation spends at least $16 billion a year to care for people with UI, up from $10 billion in 1990. Urinary incontinence is estimated to affect more than 13 million adults—most of them older women—but actual prevalence may be higher because it is widely underreported and underdiagnosed.

As with the first version, this updated guideline was developed by a private sector, multidisciplinary panel of clinicians and a consumer. The panel was co-chaired by Andrew J. Fantl, M.D., Professor and Vice-Chair of the Obstetrics, Gynecology, and Reproductive Medicine Department at SUNY at Stonybrook School of Medicine, and Diane Kaschak Newman, R.N.C., M.S.N., F.A.A.N., President of Access to Continence Care and Treatment, Philadelphia, PA.

Incontinence can be caused by pelvic muscle instability, as a side effect of medications or caffeine, or other conditions such as a urinary tract infection or constipation. It also can be caused by not being able to reach the bathroom in time due to a lack of mobility. Many younger women experience incontinence after childbirth but don't report it because they are embarrassed or feel it is an inevitable result of the birthing process. Older men with prostate problems or recovering from prostate surgery often suffer from incontinence but are more likely to ask for and receive help for the condition.

According to the guideline panel co-chairs, surveys have shown that women tend to accept incontinence as their personal burden, while men understand that UI is not normal and should be treated. They point out that clinicians need to ask women about incontinence and treat it aggressively.

The guideline is written for the primary care provider and covers various types of incontinence, provides a framework for selecting appropriate behavioral, pharmacologic, and surgical treatments, and evaluates the use of alternative treatments such as catheters and bladder support devices.

AHCPR is working collaboratively with the American Medical Directors Association (AMDA) and the American Health Care Association (AHCA) to develop new materials to increase caregivers' understanding of UI. The caregiver guide will be written specifically for certified nursing assistants in nursing facilities and home health aides. A companion piece will be written for directors of nursing to help them train caregivers. The new materials will be available later this summer.

The American Medical Directors Association is a national professional organization representing physicians who practice in long-term care facilities as medical directors or attending physicians. The American Health Care Association is a federation of 51 State associations representing more than 11,000 long-term care facilities nationwide, caring for more than 1 million elderly, chronically ill, and convalescent Americans.

A quick reference guide for clinicians, Managing Acute and Chronic Urinary Incontinence (AHCPR Publication No. 96-0686), and a consumer guide, Understanding Incontinence, in English (AHCPR Publication No. 96-0684) or Spanish (AHCPR Publication No. 96-0685), are available from AHCPR.

Single and bulk copies of the complete clinical practice guideline, Urinary Incontinence in Adults: Acute and Chronic Management, are available from the Superintendent of Documents, U.S. Government Printing Office (stock number 017-026-00155-7; $6 per copy). Bulk copies of the quick reference guide (stock number 017-026-00156-5, $27 per pack of 20) and the consumer guide (English only; stock number 017-026-00157-3, $10 per pack of 20) also are available from GPO. To order, call the GPO order desk at (202) 512-1800 (credit card and deposit account orders only) or write to Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15205-7954.

Select for the UI guideline, quick reference guide, and English and Spanish consumer guides.

Editor's Note: As explained in Administrator testifies in support of AHCPR's FY 97 budget, AHCPR has implemented a new policy on clinical practice guidelines. AHCPR will no longer be directly involved in guideline development but will work as a "science partner" with private-sector groups to supply the scientific evidence they need to develop their own clinical practice guidelines.]

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