urinary incontinenc Flashcards
What is Urinary Incontinence?
Involuntary leak of urine More common in older adults Not natural consequence of aging Impacts quality of life Loss of independence
D.R.I.P.
D – delirium, dehydration, depression R – restricted mobility, rectal impaction I – infection, inflammation P – polyuria (excessive urination) ▪ polypharmacy (5 or more medicines/day
Assessments urinary incontinenceve
Perineal skin: signs of erosion or rashes from urine
Medications
Pelvic organ prolapse (POP)
Strength of Pelvic Floor muscles
Bladder diary for 2-3 days
▪ timing, volume, leaking, nocturia
Urine analysis – UTI, Diabetes
Flow tests – post void residual (PVR)
Urodynamics when indicated – SI, OAB, obstruction
Ultra sound - upper urinary tract involvement
▪ Kidney, ureters, bladder and prostate
Urinary Incontinence
Types
Functional incontinence Stress incontinence Urge incontinence Overflow incontinence Mixed incontinence
Urinary Incontinence
Treatment
Behavioural therapy
Pharmacology therapy
Neuromodulation
Surgical therapy
Functional Incontinence
Cognitive: dementia Functional: mobility Environmental factors Balance and mobility Normal functioning bladder Unable to access toilet Episodes of urinary incontinence Modify environment and care plan Facilitate regular, easy access to the toilet Normal functioning bladder Unable to access toilet Episodes of urinary incontinence Modify environment and care plan Facilitate regular, easy access to the toilet
Interventions urinary incontinence
Safety: better lighting removal of scatter rugs clothing alterations Timed voiding, mobility or toilet equipment
Hospitalised Patients
Prevent incontinence:
▪ Answer call bells quickly ▪ Frequent toilet rounds ▪ Assist to toilet or bed pans ▪ Perineal care after bedpans ▪ Encourage fluids
Stress Incontinence
Sudden increase of intra-abdominal pressure
Causes involuntary passage of urine
Coughing, laughing or sneezing
Physical activities - heavy lifting and exercising
Leakage in small amounts, may not be daily
Causes of Stress Incontinence
Women with relaxed PF muscles from childbirth Urethra atrophy - oestrogen decreases in women as they age Prostate surgery for BPH or prostate cancer
Treatments stress incontinence
Pelvic Floor exercises – Kegel exercises
Lifestyle Changes - weight loss if obese
Urethral inserts, patches, oestrogen cream
Pseudoephedrine (Sudafed) – urinary retention
Pessaries and bladder neck support prosthesis for prolapses
External condom catheters, penile clamps
Absorbent products – reusable/disposable pads/underwear
Surgery for Stress Incontinence
Artificial Urinary Sphincter
Bulking Agent
Urethral Sling Women
Urethral Sling Men
Urge Incontinence
Urinary urgency followed by involuntary urination
Occurs randomly
Over active bladder symptoms: urgency and frequency
Frequent periodic leaking in lager amounts
Nocturnal frequency and incontinence are common
Causes of urge incontinence
Uncontrolled contraction or overactivity of detrusor
muscle
CNS disorders: Alzheimer’s, Parkinson’s disease, MS
Bladder disorders: cancer, radiation effects or interstitial
cystitis
Bladder outlet obstruction e.g. enlarged prostat
Behavioural Interventions
urge incontinence
Bladder Retraining Timed voiding 2 - 3hrly Prompted voiding: carer Urge control strategies ▪ Relaxation/distraction Psychologist Fluid management Decrease dietary irritants: ▪ caffeine, citrus juices Keep bowels regular: ▪ fibre, fluids and aperients