Urinary Incontinence Flashcards
What is urinary incontinence?
A condition in which involuntary loss of urine is a medical, social, or hygienic problem and is objectively demonstrable (Canadian Continence Foundation, 2007)
Approx. how many Canadians are affected by UI?
3.3 million
How many persons over the age of 65 live with UI?
1/5
Which gender is more likely to be affected by UI?
Women are 2x more likely than men
(T/F) UI is a normal part of aging
F
(T/F) UI is expected after childbirth
F
(T/F) UI is treatable in ways other than surgery
T
(T/F) UI should be accepted and managed by using pads/pills
F
(T/F) Approximately half of those who suffer from UI do not consult a HC professional
T
What is the brain’s role in maintaining continence?
- Cortical awareness of bladder fullness is located in the post-central gyrus
- Initiation of micturition is in the pre-central gyrus
- Voluntary control of micturition is located in the frontal cortex
What is the spinal cord’s role in maintaining continence?
- When the bladder is distended, activation of sympathetic outflow (T11-L2) maintains DETRUSOR MUSCLE relaxation, and continence
- Parasympathetic nerve activation (S2-4) contracts detrusor muscle and relaxes INTERNAL SPHINCTER to allow voiding
What are the 5 requirements of continence?
- Intact lower urinary tract function
- Intact brain and spinal cord
- Cognitive ability to recognize urge to void
- Functional ability to get to toilet on time (and suppress urge until you get there)
- Motivation to maintain continence
What are some age-related changes in the lower urinary tracts?
- Dec. bladder capacity
- Dec. sensation of bladder filling
- Dec. speed of contraction of detrusor muscle
- Dec. pelvic floor muscle
- Dec. sphincter resistance
- Dec. urinary flow rate
- ^ urinary frequency
- ^ post-void residual volume
- outflow tract obstruction (men)
What is stress incontinence?
Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising, or lifting something heavy
What is urge incontinence?
Sudden intense urge to pee followed by involuntary void. May have need to urinate often/ during the night. May be caused by minor condition (infection) or severe condition (neurologic disorder/ diabetes)
What is overflow incontinence?
Frequent or constant dribbling of urine due to bladder that doesn’t empty completely.
What is functional incontinence?
Physical/mental impairment keeps you from making it to the toilet in time. E.g.: severe arthritis inhibits you from unbuttoning pants quickly
What is mixed incontinence?
Experiencing more than one type urinary incontinence
What are some causes of temporary urinary incontinence?
Certain drinks/foods/meds that act as diuretics and ^ urine volume (caffeine, alcohol, artificial sweeteners, BP meds, sedatives, muscle relaxers)
What are some causes of persistent urinary incontinence?
Underlying physical problems or changes including:
- changes in age (dec. bladder muscle’s ability to store urine)
- enlarged prostate (benign prostatic hyperplasia)
- prostate cancer (often a side effect of prostate cancer treatment)
- obstruction (tumors block normal urine flow/ urine stones sometimes cause urine leakage)
- neurological disorders (MS, parkinson’s, a stroke, a brain tumour, spinal injury, can interfere with nerve signals involved in bladder control)
In general, in which 3 ways does UI impact OA’s quality of life?
UI is associated with depression, poor self-rated health, and poor health-related quality of life.
What are the consequences of urge UI on quality of life?
Urge UI is associated with:
- falls and fractures
- skin irritation and infections
- UTIs
- pressure ulcers
- limits in functional status
- emotional toll on family caregivers
Outline the steps of an assessment of transient UI.
Incontinence history (onset, duration, time of day, aware of loss, stress loss, urge loss, bladder diary) Fluid intake (including caffeine, alcohol, restricted fluids) Bowels (constipation, laxatives, diet, patterns) Medical history (diabetes, stroke, UTI, ABI (blood flow), dementia, peritoneal dialysis, etc) Functional abilities Physical assessment (skin integrity, bladder distension) Other (post void residuals, cytoscopy)
In a nursing assessment of UI, what are questions to ask an older adult to identify the presence of UI?
Do you ever have trouble holding your urine?
Do you ever lose urine even when you don’t want to?
Do you ever leak urine when you cough, sneeze, laugh, or exercise?
Do you ever have difficulty getting to the bathroom?
Do you ever have to wear a pad to collect your urine?
In a nursing assessment, what are some associated questions to ask the older adult? (5 W’s) What type of questions should you avoid?
Avoid “WHY” questions.
Who helps you manage your continence? What makes it better/worse? Where are you when you have an episode? When did this start? How much do you lose, and how do you manage it?
Identify and describe the everyday interventions that can be implemented for UI.
Scheduled/ prompted voiding:
- based on bladder diary patterns
- e.g.: void every 2-4hr during waking hrs
Lifestyle changes:
- do not ignore urges
- 1.5-2L fluid a day before 8pm
- eliminate or reduce caffeine/alcohol
- education about age-related changes
What are in-hospital interventions for UI?
- ensure toileting and mobility devices are within reach
- provide assistance as needed
- start with bedpan/commode/urinal/protective underwear BEFORE brief
- clear path to toilet overnight (nightlight, nonslip footwear, eyeglasses in reach)
- identify how pt manages at home
What is post-void residual management?
(physician-ordered)
Pt voids into container measuring urine output. Dr uses catheter or ultrasound to see the amount of leftover urine in bladder. Excess residual urine may indicate obstruction in urinary tract or problem with bladder nerves/ muscles
What are the 4 containment products discussed in the slideshow?
Incontinence briefs (do not say diapers) - pull-up type promotes independence
Condom catheters (male patients)
Intermittent Catheterization (for urinary retention)
Barrier creams (for skin integrity)
