Incontinence: Types, Treatments, and Care
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josegarc2311Incontinence: Types, Treatments, and Care
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josegarc2311Chapter 14
Incontinence
Lesson 14.1
1. Describe the scope and consequences of
incontinence.
2. Identify common therapeutic measures used for
the patient with incontinence.
3. List the types of urinary and fecal incontinence.
4. Explain the pathophysiology and treatment of
specific types of incontinence.
5. Recognize nursing assessment data needed to
assist in the evaluation and treatment of
incontinence.
6. Assist in developing a nursing care plan for the
patient with incontinence.
2
Urinary Incontinence
Involuntary passage of urine (urinary
incontinence) or feces (fecal
incontinence)
Prevalence and costs
3
Therapeutic Measures for
Urinary Incontinence
Bladder training
Habit training
Prompted voiding
Pelvic muscle rehabilitation
Urge suppression
4
Drug Therapy for Urinary
Incontinence
Anticholinergics
Smooth muscle relaxants
Calcium channel blockers
Tricyclic antidepressant agents
Nonsteroidal antiinflammatory drugs
Alpha-adrenergic agonists
Estrogen
5
Urine Collection Devices
External
Indwelling catheters
Intermittent self-catheterization
Garments and pads for incontinence
Penile clamp
6
Pelvic Organ Support Devices
Pessary
Bladder neck support prosthesis
7
Surgical Treatment for Urinary
Incontinence
Surgical procedures
Remove obstructions
Treat severe detrusor overactivity
Implant an artificial sphincter
Reposition the sphincter unit
Improve perineal support
Inject substances that increase urethral compression
Implantation of electrodes
Retropubic urethropexies and pubovaginal
slings
Artificial sphincter
8
Types of Urinary Incontinence
Stress incontinence
Urge incontinence
Mixed incontinence
Overflow incontinence
Functional incontinence
9
Physiology of Urination
Urination or micturition
Normal voiding requires healthy bladder
muscles, a patent urethra, normal
transmission of nerve impulses, and
mental alertness
Alterations in any of these factors may
result in incontinence
10
Urinary Incontinence: Diagnostic
Tests and Procedures
Clean-catch urinalysis with culture and sensitivity
testing usually ordered to assess for infection
A blood sample collected to measure blood urea
nitrogen, creatinine, glucose, and calcium
Imaging procedures
Urodynamic testing
Uroflowmetry
Cystometry
Provocative stress testing
Cystoscopy
Postvoid residual volume
11
Health History: Patient With
Urinary Incontinence
Reason for seeking care
Medical history
Review of systems
Functional assessment
12
Physical Examination of Patient
With Urinary Incontinence
Measurement of vital signs and height and weight
Be alert for fever, tachycardia, and weight gain
Level of awareness and appropriateness of
responses
Inspect the skin for edema
Palpate the abdomen for masses, tenderness,
fullness, or distention
Inspect the female perineum for redness or
irritation
Assess the environment, including toilet
accessibility, grab bars, lighting, and availability
of toileting options
13
Interventions for Urinary
Incontinence
General strategies for bladder health
promotion
Inadequate knowledge
Decreased socialization
Impaired self-concept
Potential for skin breakdown
Potential for urinary infection
14
Question 1
What percentage of men over age 60
experience urinary incontinence?
A. 13%
B. 17%
C. 21%
D. 25%
15
Question 2
When ______ mL of urine collect in the
bladder, stretch and tension receptors are
stimulated, causing the bladder to
contract, and the internal sphincter to
relax, sending a message to the brain of
the need to void.
A. 100-150
B. 200-250
C. 300-350
D. 400-450
16
Bowel Incontinence
Less common than urinary incontinence
Believed to affect 20% of community
dwelling older persons and 50% of long-
term care residents
17
Common Therapeutic Measures
for Bowel Incontinence
Enemas
Pouches
Drug therapy
Biofeedback
Dietary changes
18
Types of Bowel Incontinence
Overflow incontinence
Neurogenic incontinence
Anorectal incontinence
19
Physiology of Defecation
The muscles of the pelvic floor and the
external sphincter are under voluntary control
The bowel has its own nerve network that
stimulates peristalsis when it is distended
The fecal mass enters the rectum by mass
movement
Feces in the rectum creates a desire to
defecate
Defecation occurs when the anal sphincter
relaxes and the rectum contracts
20
Diagnostic Tests and Procedures
Evaluation of fecal incontinence may
include
Assessment of rectal sphincter tone
Laboratory examination of a stool specimen
for blood or pathogens
Endoscopic or radiologic procedures to
detect underlying problems
21
Health History: Patient With
Bowel Incontinence
Reason for seeking care
Bowel pattern
Characteristics of stools
Medical history
Review of systems
Functional assessment
Physical examination
22
Interventions for Bowel
Incontinence
Loss of bowel control
Potential for skin breakdown
Impaired self-concept
23