Urinary incontinence in older persons Flashcards
What is urinary incontinence (UI)
“A condition in which involuntary loss of urine is a medical, social or hygienic problem and is objectively demonstrable.”
Prevalence of UI
- Estimated to affect more than 3.3 million Canadians
- Affects 1 in 5 persons over the age of 65
- Women are 2X more likely to be affected
Myths of UI
- It is a normal part of aging
- It is to be expected after childbirth
- It is not treatable except by surgery
- It should be accepted and managed by using pads and/or pills
As a result, approximately half of those who suffer from UI do not consult a healthcare professional.
Mechanisms of continence
Brain
- Cortical awareness of bladder fullness is located in the post-central gyrus; initiation of micturition is located in the frontal cortex
Spinal cord
- When the bladder is distended activation of the sympathetic outflow maintains detrusor muscle relaxation and continence
- Parasympathetic nerve activation produces contraction of the detrusor muscle and relaxation of the internal sphincter to allow voiding in response to the bladder filling
Internal and external sphincter
- External sphincter under voluntary control
- Innervated by S2-4
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 the toilet or commode in a timely manner
• AND ability to suppress the urge until you get there - Motivation to maintain continence
Age-related changes in the lower urinary tract
Decreased • Bladder capacity • Sensation of filling • Speed of contraction of detrusor • Pelvic floor muscle bulk • Sphincter 'resistance' • Urinary flow rate
Increased
• Urinary frequency
• Prevalence of post-void residual volumes
• Outflow tract obstruction (male)
Types of urinary incontinence
Stress incontinence
- Urine leaks when you exert pressure on your bladder
by coughing, sneezing, laughing, exercising or lifting something heavy.
Urge incontinence
- You have a sudden, intense urge to urinate followed by an involuntary loss of urine.
- You may need to urinate often, including throughout the night.
- Urge incontinence may be caused by a minor condition, such as infection, or a more-severe condition such as a neurologic disorder or diabetes.
Overflow incontinence
- You experience frequent or constant dribbling of urine due to a bladder that doesn’t empty completely.
Functional incontinence
- A physical or mental impairment keeps you from making it to the toilet in time.
- For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.
Mixed incontinence
- You experience more than one type of urinary incontinence
Causes of incontinence: temporary UI
- Certain drinks, foods and medications may act as diuretics — stimulating your bladder and increasing your volume of urine. They include:
- Alcohol, Caffeine, Artificial sweeteners
- Heart and blood pressure medications, sedatives, and muscle relaxants
Causes of incontinence: persistent UI
- Urinary incontinence can also be a persistent condition caused by underlying physical problems or changes, including:
- Changes with age. Aging of the bladder muscle can decrease the bladder’s capacity to store urine. Also, involuntary bladder contractions become more frequent as you get older.
- Enlarged prostate. Especially in older men, incontinence often stems from enlargement of the prostate gland, a condition known as benign prostatic hyperplasia.
- Prostate cancer. In men, stress incontinence or urge incontinence can be associated with untreated prostate cancer. But more often, incontinence is a side effect of treatments for prostate cancer.
- Obstruction. A tumor anywhere along your urinary tract can block the normal flow of urine, leading to overflow incontinence. Urinary stones — hard, stone-like masses that form in the bladder — sometimes cause urine leakage.
- Neurological disorders. Multiple sclerosis, Parkinson’s disease, a stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.
Impacts of UI in OAs quality of life
Consequences of UI may affect individuals
• Physically
• Psychosocially
• Economically
UI associated with
• Depression
• Poor self-rated health
• Poor health related quality of life (HRQoL)
Urge UI is associated with: • Falls and fractures • Skin irritation and infections • Urinary tract infections (UTIs) • Pressure ulcers • Limitations of functional status
Family caregivers may suffer as well
Assessment of transient UI
• Incontinence history – onset, duration, daytime/night- time accidents, stress loss, urge loss, aware of loss, bladder diary
• Fluid intake – including caffeine, ETOH and restricted fluids
• Bowels – constipation, laxatives, diet, patterns
• Medical history – diabetes, stroke, UTI’s, ABI, dementia, PD, MS etc.
• Medication history – diuretics, antidepressants, estrogen,
sedatives, anticholinergics
• Functional abilities – access to BR, ambulation needs etc.
• Impact of cognitive impairment to be continent – ability to follow and understand prompts or cues/to interact with others/to complete self-care tasks/social awareness (including motivation to be continent)/attention deficits etc.
• Physical assessment – skin integrity, bladder distension
• Other – post-void residuals, cystoscopy
Nursing assessment: questions to ask OAs about incontinence
•Do you ever have trouble holding your urine?
•Do you ever lose urine when you don’t want to?
• Do you ever leak urine when you cough, laugh, sneeze
or exercise?
•Do you ever have difficulty getting to the bathroom? •Do you have to wear a pad to collect your urine?
- WHO helps you manage your incontinence? •WHAT makes it better/worse?
- WHERE are you when you have an episode? •WHEN did this start?
- HOW much do you lose, do you manage it?
UI interventions
Scheduled/prompted voiding
• Based on person’s bladder diary patterns
• Typically schedule voiding every 2-4 hours during waking hours
Lifestyle changes
• Do not ignore urge to void
• Drink 1.5-2L of fluid per day, before 8pm
• Eliminate or reduce caffeine and alcohol
• Education about age-related changes
Hospital interventions for UI
- Ensure toileting and mobility devices are within reach
- Provide assistance as needed
- Start with options such as bedpan/commode/urinal/protective underwear before incontinence brief
- Clear path to toilet, night light in bathroom
- Non-slip footwear
- Eyeglasses
- Identify how patient is managing at home
- Post-void residual measurement:
Post-void residual measurement
- Physician ordered
- You’re asked to urinate (void) into a container that measures urine output
- Then your doctor checks the amount of leftover urine in your bladder using a catheter or ultrasound test
- A large amount of leftover urine in your bladder may mean that you have an obstruction in your urinary tract or a problem with your bladder nerves or muscles
