Urinary incontinence
.
Urinary incontinence
Urinary incontinence is a condition
involuntary loss of urine from the bladder
occur.
Types of Urinary Incontinence
Stress incontinence
Urge incontinence
Functional incontinence
Iatrogenic incontinence
Mixed urinary incontinence
Stress incontinence
Stress incontinence is the involuntary loss of urine
through an intact urethra as a result of sneezing,
coughing, or changing position.
It predominantly affects women who have had
vaginal deliveries and is thought to be the result of
decreasing ligament and pelvic floor support of the
urethra and decreasing or absent estrogen levels
within the urethral walls and bladder base.
In men, stress incontinence is often experienced after
a radical prostatectomy for prostate cancer because
of the loss of urethral compression that the prostate
had supplied before the surgery, and possibly bladder
wall irritability
Urge incontinence
Urge incontinence is the involuntary loss of
urine associated with a strong urge to void
that cannot be suppressed. The patient is
aware of the need to void but is unable to
reach a toilet in time.
An uninhibited detrusor contraction is the
precipitating factor. This can occur in a
patient with neurologic dysfunction that
impairs inhibition of bladder contraction or in
a patient without overt neurologic
Functional incontinence
Functional incontinence refers to those
instances in which lower urinary tract
function is intact but other factors, such as
severe cognitive impairment (eg, Alzheimer’s
dementia or physical impairments make it
difficult or impossible for the patient to reach
the toilet in time for voiding), make it difficult
for the patient to identify the need to void
Iatrogenic incontinence
Iatrogenic incontinence refers to the
involuntary loss of urine due to extrinsic
medical factors, predominantly medications.
One such example is the use of alpha-
adrenergic agents to decrease blood pressure
Mixed urinary incontinence
Mixed urinary incontinence, which
encompasses several types of urinary
incontinence, is involuntary leakage
associated with urgency and also with
exertion, effort, sneezing, or coughing.
Risk Factors for Urinary
Incontinence
. .Diabetes mellitus
Pregnancy: vaginal Stroke
delivery, episiotomy Age-related changes in
Menopause the urinary tract
Genitourinary surgery Morbid obesity
Pelvic muscle weakness Cognitive disturbances:
Incompetent urethra dementia, Parkinson’s
due to trauma or disease
sphincter relaxation Medications: diuretics,
Immobility sedatives, hypnotics,
opioids
High-impact exercise
Caregiver or toilet
unavailable
Assessment and Diagnostic
Findings
A detailed description of the problem and a
history of medication use.
The patient’s voiding history, a diary of fluid
intake and output, and bedside tests (eg, residual
urine, stress maneuvers) may be used to help
determine the type of urinary incontinence
involved.
Urinalysis and urine culture are performed to
identify infection
Medical Management
Management depends on the type of urinary
incontinence and its causes.
Behavioral
Pharmacologic
surgical.
Behavioral Therapy
Behavioral therapies are the first choice to
decrease or eliminate urinary incontinence.
Pelvic floor muscle exercises (sometimes called
Kegel exercises) represent the cornerstone of
behavioral intervention for addressing symptoms of
stress, urge, and mixed incontinence.
use of a voiding diary, biofeedback, verbal
instruction (prompted voiding), and physical
therapy.
Pharmacologic Therapy
Anticholinergic agents inhibit bladder contraction
and are considered first-line medications for urge
incontinence.
Tricyclic antidepressant medications.
Pseudoephedrine sulfate (Sudafed), which acts on
alpha-adrenergic receptors, causing urinary
retention, may be used to treat stress incontinence
Hormone therapy (eg, estrogen) taken orally,
transdermally, or topically was once the treatment of
choice for urinary incontinence in postmenopausal
women.
Surgical Management
Urinary retention
.
Urinary retention
Urinary retention is the inability to empty
the bladder completely during attempts to
void.
Chronic urine retention often leads to
overflow incontinence (from the pressure of
the retained urine in the bladder).
Residual urine is urine that remains in the
bladder after voiding. In a healthy adult
younger than 60 years of age, complete
bladder emptying should occur with each
voiding. In adults older than 60 years of age,
50 to 100 mL of residual urine may remain
Etiology
Diabetes Some medications cause
.prostatic enlargement .urinary retention
urethral pathology Urinary retention can
(infection, tumor, occur postoperatively in
calculus) any patient, particularly
if the surgery affected
Trauma (pelvic injuries)
the perineal or anal
Pregnancy regions and resulted in
Neurologic disorders reflex spasm of the
such as stroke, spinal sphincters.
cord injury, multiple
sclerosis, or Parkinson’s
disease
Complications
Urine retention can lead to chronic infections
that if unresolved predispose the patient to
renal calculi (urolithiasis or nephrolithiasis)
Pyelonephritis
Sepsis
Hydronephrosis.
Urine leakage can lead to perineal skin
breakdown
Assessment and Diagnostic
Findings
The following questions serve as a guide in assessment:
What was the time of the last voiding, and how much urine was
voided?
Is the patient voiding small amounts of urine frequently?
Is the patient dribbling urine?
Does the patient complain of pain or discomfort in the lower
abdomen? (Discomfort may be relatively mild if the bladder distends
slowly.)
Is the pelvic area rounded and swollen (could indicate urine retention
and a distended bladder)?
Does percussion of the suprapubic region elicit dullness (possibly
indicating urine retention and a distended bladder)?
Are other indicators of urinary retention present, such as restlessness
and agitation?
Does a postvoid bladder ultrasound test reveal residual urine?
Medical management
Catheterization is used to prevent
overdistention of the bladder
Suprapubic catheter (catheter inserted
through a small abdominal incision into the
bladder)
Nursing Management
Promoting Urinary Elimination
Promoting Home and Community-Based Care
Promoting Urinary Elimination
Nursing measures to encourage normal voiding
patterns :
providing privacy
ensuring an environment and body position
conducive to voiding
assisting the patient with the use of the bathroom or
bedside commode, rather than a bedpan to provide a
more natural setting for voiding.
If his condition allows, the male patient may stand
beside the bed to use the urinal; most men find this
position more comfortable
Cont…
Additional measures include:
applying warmth to relax the sphincters (ie, sitz baths, warm
compresses to the perineum, showers)
giving the patient hot tea
Simple trigger techniques, such as turning on the water faucet
while the patient is trying to void, may also be used.
Other examples of trigger techniques are stroking the abdomen
or inner thighs, tapping above the pubic area, and dipping the
patient’s hands in warm water.
After surgery or childbirth, prescribed analgesic agents should
be administered because pain in the perineal area can make
voiding difficult.
A combination of techniques may be necessary to initiate
voiding comfortable and natural.
Catheterization
When urine cannot be eliminated naturally and
must be drained artificially, catheters may be
inserted directly into the bladder, the ureter, or
the renal pelvis
Catheters vary in size, shape, length, material,
and configuration.
A patient should be catheterized only if
necessary, because catheterization commonly
leads to UTI
Catheterization is performed to
achieve the following:
Relieve urinary tract obstruction
Assist with postoperative drainage in urologic
and other surgeries
Provide a means to monitor accurate urine
output in critically ill patients
Promote urinary drainage in patients with
neurogenic bladder dysfunction or urine
retention
Prevent urinary leakage in patients with stage
Indwelling Catheters
An indwelling catheter
also called indwelling
Foley catheter, is a
flexible tube placed in
the urethra and the
bladder to help you
urinate and collect
urine in a drainage bag.
Indwelling urinary
catheters usually
remain in place for
many days or weeks,
and are held in position
Suprapubic Catheters
Suprapubic
catheterization
allows bladder
drainage by
inserting a catheter
or tube into the
bladder through a
suprapubic (above
the pubis) incision
or puncture
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