Lecture 6 Urinary incontinence

Question 1

The _ is also referred to as the “pelvic floor muscle”.

Answer 1

Pubococcygeal muscle.

Question 2

Urge incontinence

Answer 2

1. Involuntary urinary leakage due to the inability to hold urine long enough to reach a toilet after perceiving the urge to void.
2. Results from detrusor instability or unstable bladder; the bladder muscles contract involuntarily during filling.
3. Also known as overactive bladder.

Question 3

Functional incontinence

Answer 3

1. Urination due to the inability to reach an appropriate toileting facility.
2. More likely to be an acute condition - barriers to the toilet, mobility limitations, restraints, etc.

Question 4

Stress incontinence

Answer 4

1. Leakage of urine as a result of an activity that increases abdominal pressure.
2. Most common type of incontinence in younger women.

Question 5

Mixed incontinence

Answer 5

The involuntary leakage of urine with both the sensation of urgency and activities such as coughing, sneezing, and exertion.

Question 6

The detrusor motor area in the _ controls bladder function by directing micturition centers to initiate or to delay voiding depending on the social situation.

Answer 6

Cerebral cortex.

Question 7

Pons micturition center

Answer 7

1. Located in the brainstem - provides for automatic coordinated voiding (urethral sphincter opens before bladder contracts) in response to bladder filling.
2. If the cerebral cortex (detrusor motor area) is damaged, voiding still occurs due to the action of the pons.

Question 8

Sympathetic pathways and bladder function

Answer 8

1. Tighten the bladder neck and relax the bladder muscle (detrusor).
2. Contribute to urine storage and promote continence.
3. Sympathomimetic agents such as pseudoephedrine, SNRIs, and anticholinergics cause urinary retention.

Question 9

Parasympathetic pathways and bladder function

Answer 9

1. Trigger release of neurotransmitters that cause the bladder to contract (acetylcholine).
2. Even if all cortical and pontine control is lost, parasympathetic fibers in the sacral cord will still stimulate “reflex voiding.”

Question 10

Anticholinergic drugs such as _ are commonly used to reduce urgency and frequency and promote continence.

Answer 10

Oxybutynin (Ditropan).

Question 11

The _, located at the outlet of the urethra, provides for voluntary role of the urethral sphincter muscle.

Answer 11

Pudendal nerve. (Teaching Kegel exercises will be ineffective for patients with damage to this nerve.)

Question 12

Nocturia

Answer 12

1. Getting up at least 2 times during the night to urinate.

2. The consequence of normal age-related increases in urinary output at night.

Question 13

Age-related changes affecting urinary function

Answer 13

1. Increased production of urine at night.
2. Reduced bladder capacity.
3. Reduced strength of bladder contractions.
4. Increased irritability of the detrusor muscle.
5. Delayed recognition of bladder filling.
6. Benign prostatic hyperplasia (BPH) in males; loss in estrogen in females.
7. Effects of reduced mobility and multiple medications.

Question 14

Symptoms of BPH include _

Answer 14

Hesitancy, poor urinary stream, prolonged urination time, incomplete emptying, and post-void dribbling.

Question 15

Patients with tumors, kidney stones, or other potentially serious conditions should be _

Answer 15

Referred to the appropriate specialist for further evaluation.

Question 16

_ and _ are associated with urge incontinence and mixed incontinence, but not with stress incontinence.

Answer 16

Urgency and frequency.

Question 17

Overflow incontinence

Answer 17

1. Inability to effectively empty the bladder.
2. Often associated with BPH, medication side effects, and neuropathy.
3. Most serious form of incontinence because the urine backs up in the ureters and into the kidneys.
4. Symptoms: Urinary frequency, dribbling, leakage, and nocturia.

Question 18

The type of incontinence that is characterized by urinary retention is _

Answer 18

Overflow incontinence.

Question 19

A patient complaining of trouble initiating a urine stream and constantly dribbling is suffering from _

Answer 19

Overflow incontinence.

Question 20

An elderly patient with dementia who forgets to go to the bathroom is probably suffering from _

Answer 20

Functional incontinence.

Question 21

An elderly patient whose only bathroom is located on the second floor of their home is at risk for experiencing _

Answer 21

Functional incontinence.

Question 22

A patient “losing urine” when bending over or getting up from a chair is experiencing _

Answer 22

Stress incontinence.

Question 23

Mnemonic for assessment of urinary function

Answer 23

"DIAPPERS" (two Ps):
D= Delirium
I= Infection (or irritants)
A= Atrophic vaginitis/urethritis
P= Pharmaceuticals
P= Psychological
E= Excess urine production
R= Restricted mobility
S= Stool impaction

Question 24

Alpha receptor antagonists are used for the treatment of _

Answer 24

BPH symptoms - promotes urethral relaxation and the resumption of a normal voiding pattern.

Question 25

Anticholinergics can cause _ and _

Answer 25

Urinary retention and overflow incontinence.

Question 26

Pelvic floor exercises have been shown to be very useful for women with primarily _

Answer 26

Stress incontinence.

Question 27

Management of overactive bladder is best achieved through _

Answer 27

A combination of behavioral and pharmacological therapy.

Question 28

“Freeze, squeeze, breathe”

Answer 28

These 3 steps can delay an incontinence episode for 2 minutes:

1. Stop what you’re doing - don’t move.
2. Squeeze the buttcheeks together for about 10 seconds.
3. Breathe in and out.

Question 29

_ is accomplished by gradually increasing voiding times - starting with 1 hour, but no longer than 2-4 hours.

Answer 29

Bladder retraining.

Question 30

Pessary

Answer 30

A device inserted into the vagina to provide structural support - can prevent uterine prolapse.

Question 31

Neurogenic incontinence

Answer 31

1. Incontinence caused by neurologic conditions that result in inability to sense the urge to void or an inability to control the urine flow.
2. Causes: CVA, Parkinson’s disease, multiple sclerosis, spinal cord injury, diabetic neuropathy.
3. Treatment: Toileting programs, clean intermittent catheterizations, medications to increase bladder contractions (Urecholine).

Question 32

Alpha-adrenergic blockers, such as prazosin and terazosin, relax the urethral sphincter and can have the undesirable effects of _

Answer 32

Leakage and stress incontinence.

Question 33

The primary presenting manifestation of a UTI in older adults may be _

Answer 33

A change in behavior or mental status.

Question 34

An appropriate nursing diagnosis for an assessment that reveals any risk factors for, any complaints about, or evidence of incontinence is _

Answer 34

Impaired urinary elimination.

Question 35

Incontinence that occurs because the time between the urge to void and involuntary leakage is very short is classified as _

Answer 35

Urge incontinence.