Urinary Incontinence

Definition

Urinary Incontinence

Types

1. Stress incontinence

2. Urge Incontinence

3. Overflow incontinence

4. Mixed incontinence

5. Functional incontinence

6. Transient causes

7. Permanent causes

Stress Incontinence

Definition/Cause/Manifestations

Definition: Involuntary loss of urine during activities that increase abdominal and detrusor pressure

Cause: Weakening of bladder neck supports

Intrinsic sphincter deficiency caused by such congenital conditions

Anatomic damage of the urethral sphincter

Manifestations: Urine loss with physical exertion, cough, sneeze, or exercise

Small amounts of urine are lost

Normal voiding <8 time a day, < 2 times a night

Post void residual < 50ml

Hypermobility of the urethra or bladder neck with valsalva maneuvers

Urge Incontinence

Definition/Cause/Manifestations

Definition: Involuntary loss of urine associated with a strong desire to urinate

Cause: Unknown

Manifestations: Abrupt and strong urge to void

May have loss of large amounts of urine with each occurrence

Overflow Incontinence

Definition/Cause/Manifestations

Definition: Involuntary loss of urine associated with overdistension of the bladder when the bladder's capacity has reached its maximum

Causes: Diabetic neuropathy

Enlarged prostate, large genital prolapse

Abnormal contraction of the skeletal muscle

Manifestations: Bladder distention, often up to the level of the umbilicus

Constant dribbling of urine

Mixed Incontinence

Definition/Cause/Manifestation

Definition: Combination of stress, urge, and overflow incontinence

Cause: As with each separate disorder

Manifestations: As with each separate disorder

Functional Incontinence

Definition/Manifestations

Definition: Leakage of urine caused by factors other than disease of the lower urinary tract

Manifestations: Quantity and timing of urine leakage vary

Urinalysis-rule out infection

If RBC's, WBC's, leukocyte  esterase, or nitrites are found further culturing is needed

-An infection is treated before further assessment of incontinence

Urography-used to locate the kidneys and ureters.

Voiding cystourethrogram (VCUG)-assesses the size, shape, support, and function of the bladder

-Problems identified by this test include obstruction and post-void residual.

Ultrasonographic bladder scanner-assess post-void residual

• Age
• If female, menopausal status
• Neurologic disease
• Parkinson disease 
• Dementia
• Multiple sclerosis
• Stroke
• Spinal injury 
• Diabetes mellitus
• Child birth
• Urologic procedures
• Prescribed and over-the-counter drugs
• Bowel patterns
• Stress/anxiety level

• Leakage
• Frequency
• Urgency
• Nocturia
• Sensation of full bladder before leakage

• Maintain a normal body weight to reduce the pressure on the bladder
• Do not try to control incontinence by limiting fluid intake
• If a catheter is in the bladder, follow the instruction given about maintaining the sterile drainage system
• If discharged with with a suprapubic catheter in the bladder, inspect the entry site for the tube daily, clean the skin around the opening gently with warm soap and water,and place a sterile gauze dressing on the skin around the tube. Report redness, swelling, drainage, or fever
• Do not put anything in the vagina
• Do not have sexual intercourse until after the 6-week post operative checkup
• Do not lift of carry anything heavier than 5 pounds or participate in any strenuous exercise until physician gives clearance

Interventions Urinary Incontinence

Urinary bladder training

Urinary bladder training

• Determine ability to recognize urge to void
• Keep a continence specification record for 3 days to establish voiding pattern
• Establish interval of initial toileting schedule, based on voiding pattern
• Establish beginning and ending time for toileting schedule, if not for 24 hours
• Establish interval for toileting of not less than 1 hour and preferably not less than 2 hours
• Toilet patient or remind patient to void at prescribed intervals
• Provide privacy for toileting
• Use power of suggestion to assist patient to void
• Avoid leaving patient on toilet for more than 5 minutes
• Reduce toileting interval by one-half hour if there are more than three incontinence episodes in 24 hours
• Increase toileting interval by 1 hour if patient has no incontinence episodes for 3 days until optimal 4-hour interval is achieved
• Teach the patient to consciously hold urine until the scheduled toileting time
• Discuss daily record of continence with patient to provide reinforcement

Urinary Incontinence Interventions

Urinary Habit training

• Keep a continence specification record for 3 days to establish voiding pattern
• Establish interval of initial toileting schedule, based on voiding pattern and usual routine
• Establish beginning and ending time for the toileting schedule
• Establish interval for toileting of preferably not less than 2 hours
• Assist patient to toilet and prompt to void at prescribed intervals
• Provide privacy for toileting
• Use power of suggestion to assist patient to void
• Avoid leaving patient on toilet for more than 5 min
• Reduce toileting interval by on-half hour if there are more than two incontinence episodes in 24 hours
• Increase the toileting interval by on-half hour if patient has no incontinence episodes in 48 hours until optimal 4-hour interval is achieved
• discuss daily record of continence with staff to provide reinforcement and encourage compliance with toileting schedule
• Maintain scheduled toileting to assist in establishing and maintaining voiding habit
• Give positive feedback or positive reinforcement

patient will describe the type of urinary incontinence experienced

Demonstrate knowledge of proper use of medications and correct procedures for self-cauterization's, use of artificial sphincter, or care of an indwelling urinary catheter

Demonstrate effective use of the selected exercise or bladder-training program

Select and use incontinence devices and products

Have a reduction in the number of incontinence episodes

Action: Reduces incontinence, by improving vaginal and urethral blood flow and tone

Nursing Interventions: Teach patients to notify provider if they experience any unusual vaginal bleeding 

teach to avoid smoking while on the drugs and to report calf pain or swelling

Anticholinergic

Action: Reduce incontinence by causing bladder muscle relaxation and suppressing the urge to void

Nursing Interventions: Ask about glaucoma

Tricyclic antipepressant

Action: Have anticholinergic actions and also black acetylcholine receptors. Relieve urinary incontinence

Nursing Interventions: Warm patient not to take medication with other tricyclic antidepressants or MAO inhibitors

Stress Urinary Incontinence

Interventions

• Pelvic floor exercise therapy for women-strengthens the muscles of the pelvic floor which increases the ability to start and stop the urine stream or passage of flatus
• Nutrition therapy-weight reduction because incontinence is made worse by increased abdominal pressure from obesity
• Drug therapy-used to improve urethral resistance
• Vaginal cone therapy-helpful in strengthening the pelvic muscles
• Electrical stimulation devices-strengthen urethral contractions
• Surgical management-vaginal, abdominal or retropubic surgeries
• Behavior modifications
• Psychotherapy

Urge Urinary Incontinence

Interventions

• Behavioral intervention-bladder training, habit training, exercise therapy, and electrical stimulation
• Drug therapy-relax smooth muscle and increase the bladder's capacity 
• Nutrition therapy-help avoid fluid overload on the bladder and allow urine to collect at a steady pace, avoid foods that have bladder stimulating or diuretic effects
• Bladder training-the patient learns to control the bladder
• Habit training-increases awareness of need to void
• Exercise Therapy-helps overcome abnormal detrusor contractions 
• Electrical stimulation-treat urge and stress incontinence

Reflex Urinary Incontinence

Interventions

• Drug Therapy-increases bladder pressure
• Bladder compression-promotes bladder emptying 
• Intermittent self-catheterization-helps empty bladder

Functional Urinary Incontinence

Interventions

• Applied devices-helps maintain the correct position of the bladder
• Containment-Collect urine and keep skin and clothing dry
• Catheterization-controls incontinence