Comprehensive Geriatric Assessment (CGA): Bowel and bladder health

The significant impact of bladder and bowel problems on wellbeing and quality of life cannot be underestimated, nor the economic and financial implications resulting from the sequela of bladder and bowel problems.

Assessment of bladder and bowel health is a crucial part of CGA and it is vitally important to address any concerns promptly, and establish ways to best manage any issues.

Common bladder health issues include:

• Incontinence
  • Can be urge, stress or mixed.
     
• Retention
  • 1 in 3 men over 65 have an issue with emptying their bladder, most commonly caused by an enlarged prostate.¹
  • Urinary retention can often be caused by constipation and as a side effect of medications e.g. opiates or those with anticholinergic effects.
     
• UTI
  • Urinary tract infections increase in prevalence with ageing,² and it is important to ensure that diagnosis is based on clinical signs and symptoms. Urine dipstick tests have a poor positive predictive value for infection in older adults and those with catheters due to the high prevalence of asymptomatic bacteriaemia, and so should be avoided. 

Common bowel health issues include:

• Constipation
  • Often due to a combination of reduced mobility, poor diet, poor fluid intake and side effects from medicines. It can also often be a result of medical conditions such as Parkinson’s disease.
     
• Diarrhoea
  • Can have a multitude of causes, including overuse of laxatives, other medications e.g. metformin, infection or other medical conditions.
     
• Incontinence
  • Can be functional or passive.
  • Due to a number of different causes and often multifactorial.³
  • Prevalence increases with age and frailty, and significantly increases within care homes with up to 60% of residents suffering from faecal incontinence.³

The management of bowel and bladder problems requires a holistic, person-centred approach during CGA to create an individualised management plan that is acceptable to patient and carer. 

Bladder and bowel problems can often be caused by medication, and medication to treat incontinence can increase the risk of adverse effects such as falls; making a full medication review an essential part of bowel and bladder assessment. link to medication section?

Some other holistic questions to consider may include:

• If the person is having to quickly get to a toilet, are they at greater risk of falls?
• Do they have postural hypotension that will increase this risk of falls?
• Is their toilet set-up safe and appropriate to allow proper toileting?
• Is the person’s incontinence affecting their ability to go out and socialise with others or attend classes/appointments?
• Could this lack of social inclusion be affecting their mental health?
• How is the patient or carer coping with the sleep disturbance from nocturia?
• What matters most to them?

This list is by no means exhaustive, and expectation and goal setting is key when formulating a management plan, with shared decision making of both patient and carers.

See also:

CGA: Medication history and review