Week 8 Nursing Flashcards
Urinary Incontinence
▪ Urinary incontinence is the involuntary loss or escape of urine.
▪ Incontinence may be temporary or permanent.
▪ Incontinence is a symptom not a disease.
▪ 37% of women have some degree of incontinence.
▪ 80% of nursing home residents are incontinent.
Types of Elimination Incontinence
▪ Stress incontinence
▪ Urge incontinence
▪ Overflow incontinence
▪ Functional incontinence
▪ Iatrogenic incontinence
▪ Mixed stress and urge incontinence
▪ Faecal incontinence
▪ Mixed urinary and faecal incontinence
Stress Incontinence
▪ The bladder neck sphincter is unable to prevent urine flow when pressure is placed upon the abdomen.
▪ More common in women due to shorter urethra:
– Pregnancy (relaxin and progesterone).
– Childbirth, menopause, surgery and obesity
Urge Incontinence
Inability to delay voiding after the sensation of bladder fullness:
– Caused by detrusor muscle instability and overactivity.
– Neurological dysfunction is the primary cause.
▪ Symptoms include an overwhelming urge to void:
– Frequency, urgency, nocturia and small voiding patterns.
Overflow Incontinence
▪ Inability to empty the bladder, resulting in over distention and frequent loss of urine.
– Outlet obstruction causes ↑ pressure and leakage of urine.
▪ Symptoms can vary but are a result of an overfull bladder:
– Straining, dribbling, poor stream, supra pubic ache and frequency.
Functional Incontinence
Resulting from physical, environmental, or psychosocial causes which decrease ability to respond to the need to void:
– Cognitive impairment (dementia and Parkinson’s disease).
– Physical disability or impaired mobility (osteoarthritis).
– Sedation (postoperative, antipsychotics and sleeping tablets).
– Depression with psychological unwillingness.
– Environmental barriers (heavy bathroom doors).
Iatrogenic Incontinence
Involuntary loss of urine due to extrinsic medical factors.
– Alpha-adrenergic blockers used to lower blood pressure (Prazosin)
– Diuretics used to promote increased urine production (Furosemide)
– Angiotensin converting enzyme inhibitors (Perindopril)
– Medications which manage complications of an enlarged prostate (Tamsulosin)
– Selective serotonin-reuptake inhibitors (Sertraline)
– Anti-cholinergic agents (Antihistamines)
– Opioid analgesia (Morphine)
Behavioural Therapy
Behavioural therapies are always the first choice to reduce episodes of urinary incontinence.
– Physiotherapy (Kegel exercises)
– Voiding diary
– Prompted voiding patterns
– Avoiding triggers
Pharmacological Therapy
Medications work well as an adjunct to behavioural therapy interventions.
– Anticholinergic agents (Oxybutynin) inhibit bladder contraction and are used for urge incontinence.
– Tricyclic anti-depressants (Amitriptyline) can decrease bladder contraction and increase bladder neck tone.
– Oestrogen restores mucosal, vascular and muscular integrity of the urethra.
– Botulinum toxin injections for overactive bladder
Surgical Management
Anterior vaginal repair and retropubic suspension.
– Lift and stabilise the bladder and lengthen the urethra to restore normal urethrovesical angle or lengthen the urethra.
▪ Periurethral bulking
– Semipermanent procedure to insert collagen into walls of the urethra.
▪ Artificial bladder sphincter insertion
– Silicone-rubber balloon placed around the bladder neck attached to a implantable pump (located in the scrotum – for men).
▪ Trans-urethral resection of prostate (TURP)
– Resection of the prostate to relieve symptoms of prostatic enlargement.
Investigations
Detailed health history assessment
▪ Voiding history
▪ Fluid intake
▪ Post-void residual volume
▪ Urinalysis
▪ Urodynamic testing
Complications
Embarrassment
▪ Social isolation
▪ Loss of employment and income
▪ Falls
▪ Perineal breakdown
▪ Cost associated with continence aids
▪ Urinary tract infections
▪ Anxiety
▪ Soiling of mattresses, carpet and clothing
▪ Sexual health decline
Nursing Management
Focusses on the premise that incontinence is not inevitable with illness or ageing and that it is often reversible.
– Support for behaviour therapy interventions to reduce patient discouragement with interventions.
– Patient teaching about bladder control program and recording of bladder habits and incontinence.
– Explanation of pharmacological interventions.
– Functional advice on continence aids, coping with social situations and managing episodes of incontinence.
– Educate about when to take diuretic medications to reduce nighttime incontinence
Pathophysiology
▪ Inflammation of the urinary epithelium usually caused by gram –ve flora from the gut.
▪ Retrograde movement of microorganisms into the urethra and bladder.
▪ Microorganisms attach themselves to the urinary epithelium and resist flushing during micturition.
▪ Inflammation occurs which stimulates stretch receptors initiating urinary tract infection symptoms
