URINARY INCONTINENCE
Involuntary loss of urine from the bladder
Causes
·
Urinary Tract
Infections
·
Urethritis
·
Pregnancy
·
Hypercalcemia
·
Volume Overload
·
Delirium
·
Restricted Mobility
·
Psychologic Causes
There are two categories
Ø Acute
Ø Chronic
Acute:
Many factors can contribute to acute or reversible
incontinence, including polyuria, exposure to irritants, infection, urinary
retention, use of pharmaceuticals, stool impaction or constipation, atrophic
urethritis or vaginitis, restricted mobility or dexterity, psychologic
conditions, and delirium or acute confused state.
Some of these factors are readily reversible with a
lessening of symptoms.
Chronic:
Types
·
Functional
·
Overflow
·
Reflex
·
Stress
·
Urge
Functional:
·
Sudden, involuntary
loss of small amounts (<50ml) of urine that accompanies a sudden increase
intra-abdominal pressure
·
Ex: of activities that
increase intra-abdominal pressure
----
Coughing, sneezing, laughing, lifting and jumping
·
Factors associated:
ü Weakened
pelvic floor muscles (child birth)
ü High
intra-abdominal pressure (obesity, pregnancy)
ü Damage
to the bladder neck
ü Side
effects of medications
ü Direct
trauma from a fractured pelvis or genito urinary surgery
Urge Incontinence:
ü Involuntary
loss of urine after strong feeling of need to urinate
ü Unable
to perceive a full bladder and to hold urine until reaching the bathroom
ü Frequency,
Dysuria, Nocturia commonly accompany the Urge Incontinence
Factors
associated Urge Incontinence
·
UTI
·
Use of diuretics
·
Caffeine and alcohol
consumption
·
Smoking (nicotine)
·
Increased fluid intake
·
Over distended bladder
Reflex Incontinence
·
Involuntary loss of
urine that occurs at somewhat predictable intervals when a specific bladder
volume is reached
·
It is seen in clients
with:
ü neurological
impairments
ü Spinal
cord lesion
ü Cerbrovascular
accident
ü Brain
tumor
·
Bladder emptying
occurs at the sacral reflex level because of the impairment of the connection
to the cerebrum that allows voluntary inhibition of voiding
Functional Incontinence
·
Inability or
unwillingness of a person with normal bladder and sphincter control to reach
the bathroom to void
·
Environmental
barriers, disorientation, physical limitations may contribute
Total Incontinence
·
Involuntary,
unpredictable loss of urine from a non-distended bladder
·
Factors associated:
ü Specific
neurologic lesion in the brain or spinal cord
ü Traumatic
injury to the genito-urinary area
ü Congenital
malformations within the urinary tract or spinal cord
MANAGING URGE
INCONTINENCE:
Nursing interventions for clients with urinary
incontinence include
(a)
A behavior oriented
continence training program that may consist of bladder training, habit
training, prompted voiding, pelvic muscle exercises & positive
reinforcement
(b)
Meticulous skin care
(c)
Males: application of
external drainage device (condom type catheter device)
Continence (bladder)
training:- A continence training program
requires the involvement of the nurse, the client and support people.
A bladder training program may include the following:
Education of the client and support people
Bladder training, which requires that the
client postpone voiding, resists or inhibits the sensation of urgency, and void
according to a timetable rather than according to the urge to void.
ü The
goals are to gradually lengthen the intervals between urination to correct the
client's frequent urination, to stabilize the bladder, and to diminish urgency.
ü This
form of training may be used for clients who have bladder instability and urge
incontinence.
ü Delayed
voiding provides larger voided volumes and longer intervals between voiding.
Initially, voiding may be encouraged every 2 to 3 hours except during sleep and
then every 4 to 6 hours.
ü The
nurse instructs the client to practice deep, slow breathing until the urge
diminishes or disappears. This is performed every time the client has a premature
urge to void.
Habit training, also referred to as timed voiding or scheduled toileting, attempts to keep clients dry by having them
void at regular intervals. With habit training, there is no attempt to motivate
the client to delay voiding if the urge occurs. This approach can be effective
in children who are experiencing urinary dysfunction.
Biofeedback
therapy in which the child is taught to relax the pelvic floor can also
decrease incidents of wetting
Prompted
voiding supplements habit training by encouraging the client to try to use the
toilet (prompting) and reminding the client when to void.
PELVIC MUSCLE EXERCISES: Pelvic muscle exercises
(PME), or Kegel exercises, help to strengthen pelvic floor muscles and can
reduce or eliminate episodes of incontinence. The client can identify the
perineal muscles by stopping urination midstream or by tightening the anal
sphincter as if to hold a bowel movement.
CLIENT TEACHING:
First, sit or lie in a comfortable, relaxed position.
Contract your pelvic muscles whereby you pull your rectum, urethra, and vagina
up inside, and hold for a count of 3 to 5 seconds. Then relax the same muscles
for a count of 3 to 5 seconds. Initially perform each contraction 10 times,
three times daily. Gradually increase the count to a full 10 seconds for both
contraction and relaxation
PME can be performed anytime, anywhere, sitting or
standing—even when voiding.
MAINTAINING SKIN INTEGRITY:
Skin that is
continually moist becomes macerated (softened). Urine that accumulates on the
skin is converted to ammonia, which is very irritating to the skin.
Because both
skin irritation and maceration predispose the client to skin breakdown and
ulceration, the incontinent person requires meticulous skin care.
To maintain
skin integrity wash the perineal area with mild soap and water, dry gently and
provide clean dry clothing
APPLYING EXTERNAL URINARY
DRAINAGE DEVICES:
The application of a condom or
external catheter connected to a urinary drainage system can be used for
incontinent males. Use of a condom appliance is preferable to insertion of a
retention catheter because the risk of urinary tract infection is minimal.
COMMENTS