URINARY INCONTINENCE

URINARY INCONTINENCE
Is the inability to control the release of urine from your bladder. Some people experience occasional, minor leaks or dribbles of urine. Others wet their clothes frequently. Is the involuntary loss of urine that is objectively demonstrable and a social or hygienic problem.

Risk Factors for UI

Impaired mobility Depression Delirium Alcohol Fecal impaction Stroke Endocrine disorders

Parkinsons Disease Dementia (moderate to severe)

Poorly controlled Diabetes Mellitus Hypercalcemia

PHARMACOLOGIC CAUSES
Opioids Calcium channel blockers Anti-Parkinsons drugs Anti-cholinergics Prostaglandin inhibitors

MANIFESTATION
Only leak urine occasionally Others may constantly dribble urine while still others experience a complete lack of both bladder and bowel control An urgent need to urinate resulting in the loss of urine before one arrives at the toilet overactive bladder Abdominal pressure rises when you cough, sneeze, laugh, climb stairs, or lift objects

TYPES OF URINARY INCONTINENCE

Transient UI (Acute) Established UI (Chronic)
Stress incontinence Urge incontinence Overflow incontinence Mixed incontinence Functional incontinence Total incontinence

Causes of Transient (Acute) Incontinence

D I A P P E R S Delirium Infection Atrophic Vulvovaginitis Psychological Pharmacologic agents Endocrine, excessive UO Restricted Mobility Stool impaction

Urge Incontinence
Most common Detrusor overactivity with uninhibited bladder contractions Unpredictable, abrupt urgency, frequency, variable volumes lost, PVR usually normal (Post-void residualthe volume of urine left in bladder after spontaneous voiding) Management: bladder retraining, scheduled toileting, pelvic muscle exercises (PME), pharmacologic agents This is a sudden, intense urge to urinate, followed by an involuntary loss of urine. Your bladder muscle contracts and may give you a warning of only a few seconds to a minute to reach a toilet. With urge incontinence, you may need to urinate often, including throughout the night. Urge incontinence may be caused by urinary tract infections, bladder irritants, bowel problems, Parkinson's disease, Alzheimer's disease, stroke, injury or nervous system damage associated with multiple sclerosis. If

Stress UI
2nd most common cause in aging females Impaired urethral closure due to insufficient pelvic support, sphincter opens during bladder filling Leakage occurs with intra-abdominal pressure This is loss of urine when you exert pressure stress on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. Stress incontinence occurs when the sphincter muscle of the bladder is weakened. In women, physical changes resulting from pregnancy, childbirth and

Mixed Incontinence
Features of both urge and stress incontinence. Common in older women Management: bladder retraining, pelvic muscle exercises, other pelvic muscle rehabilitative options outlined previously, pharmacologic agents. Mixed incontinence. If you experience symptoms of more than one type of urinary incontinence, such as stress incontinence and urge incontinence, you

Overflow UI
Detrusor underactivity and/or outlet obstruction Continuous small volume leakage Dribbling, weak stream, hesitancy, nocturia Outlet obstruction=2nd most common cause of UI in Males If you frequently or constantly dribble urine, you may have overflow incontinence, which is an inability to empty your bladder. Sometimes you may feel as if you never completely empty your bladder. When you try to urinate, you may produce only a weak stream of urine. This type of incontinence may occur in people with a damaged bladder, blocked urethra or nerve damage from diabetes, multiple sclerosis or spinal cord injury. In men, overflow incontinence can also be associated with prostate gland problems.

Overflow UI
Management: ObstructionTreat cause; -antagonists. Detrusor Underactivity Review meds, double voiding, intermittent self-catheterization, Credes.

Functional Incontinence
Unable or unwilling to toilet due to physical impairment, cognitive dysfunction, environmental barriers No underlying GU dysfunction Diagnosis of exclusion Many older adults, especially people in nursing homes, experience incontinence simply because a physical or mental impairment keeps them from making it to the toilet in time. For example, a person with severe arthritis may not be able to unbutton his or her pants quickly enough. This is called functional incontinence.

TOTAL INCONTINENCE
This term is sometimes used to describe continuous leaking of urine, day and night, or the periodic uncontrollable leaking of large volumes of urine.

MANAGEMENT of UI
Bladder Retraining
Urge control exercises Scheduled toileting Prompted toileting

PELVIC MUSCLE EXERCISE Dietary and fluid modification Medications to treat underlying conditions procedures and devices (pessaries, condom catheters, artificial sphincters implantation, intermittent catheterization)

Management of UI
Treat reversible cause (ie. Constipation) Review meds General measures: Behavioral interventions before pharmacologic Rx,. Avoid caffeine & ETOH, minimize evening intake, pads Occasionally, the treatment may include surgery.

Nursing Responsibilities
Explain all test and procedure to your patient. Allow him to ask questions, and answer them honestly. Provide privacy for discussion. Administer atbiotics and other medications as ordered. Orient the patient to the location of the bathroom and call devices. Provide adequate lighting in the bathroom to help him avoid mishaps during the night. If he needs help to get to the bathroom, offer it every 2hours or when he awakens.

Nursing Responsibilities
Explain bladder training routines and post the schedule. Assist the patient receiving bladder training in deep breathing exercises to delay urge to void. Give ample, positive reinforcement for all efforts toward continence. Provide frequent perineal care and watch the aging adult for skin breakdown. Wash with mild soap and water, and pat the skin to dry. Wash from the front to the back to avoid spreading contamination.

Nursing Responsibilities
Help the female patient insert pessary as ordered. If intermittent catheterization is ordered, perform it on time and document the amount of urine retured. For the post operative patient, record accurate intake and output measurements.

ROLES OF FAMILY MEMBER IN GIVING CARE TO PATIENT WITH UI

Assist older family member in going to the toilet in scheduled times of toileting. Provide support to the older person with UI.