Transcript URINARY INCONTINENCE and RETENTION

URINARY INCONTINENCE
AND URINARY RETENTION
Urinary incontinence (UI)
DEFINITION
Urinary incontinence (UI): is any involuntary leakage of
urine.
Urinary incontinence in elderly patients often decreases
their ability to maintain an independent lifestyle.
Urinary incontinence affects people of all ages but is
particularly common among the elderly. urinary
incontinence is not a normal consequence of aging, agerelated changes in the urinary tract predispose the older
person to incontinence.
Risk Factors for Urinary Incontinence:
•Pregnancy: vaginal delivery.
•Genitourinary surgery.
•Pelvic muscle weakness.
•Incompetent urethra due to trauma or sphincter relaxation.
•Immobility.
•High-impact exercise.
•Diabetes mellitus.
•Medications: diuretics, sedatives.
•Age-related changes in the urinary tract.
Types of Incontinence:
Stress incontinence : is the involuntary loss of urine
through an intact urethra as a result of a sudden increase
in intra-abdominal pressure (sneezing, coughing, or
changing position).
It predominately affects women who have had vaginal
deliveries and is thought to be the result of decreasing
ligament and pelvic floor support of the urethra and
decreasing or absent estrogen levels within the urethral
walls and bladder base.
1-
2- Urge incontinence : is the involuntary loss of
urine associated with a strong urge to void that
cannot be suppressed. The patient is aware of
the need to void but is unable to reach a toilet in
time.
3- Reflex incontinence : is the involuntary loss of
urine due to hyperreflexia in the absence of
normal sensations usually associated with
voiding. This commonly occurs in patients with
spinal cord injury because they have neither
neurologically mediated motor control nor
sensory awareness of the need to void.
4- Overflow incontinence : is the involuntary loss of urine associated
with over distention of the bladder. Such over distention results from
the bladder’s inability to empty normally. Both neurologic
abnormalities (eg, spinal cord lesions) and factors that obstruct the
outflow of urine (eg, tumors, strictures, and prostatic hyperplasia) can
cause overflow incontinence
.
Assessment and Diagnostic Findings:
Once incontinence is recognized, a thorough history is necessary
This includes a detailed description of the problem and a history of
medication use. The patient’s voiding history, a diary of fluid intake
and output, and bedside tests (ie, residual urine) may be used to
help determine the type of urinary incontinence
Urinalysis and urine culture are performed to identify hematuria
(from infection, cancer, or a kidney stone), glycosuria (causes
polyuria), pyuria (urine which contains pus) , and bacteriuria
(bacteria in the urine), all of which may identify causes of urinary
incontinence.
MEDICAL MANAGEMENT
:BEHAVIORAL THERAPY :•Behavioral
therapies are always the first choice to decrease or eliminate urinary
incontinence. In using these techniques, clinicians help patients avoid potential adverse
effects of pharmacologic or surgical interventions
1- Fluid Management:• One of the most common approaches is fluid management because adequate daily
fluid intake of approximately 1,500 to 1,600 mL helps to reduce urinary urgency
related to concentrated urine production, decreases the risk of urinary tract infection,
and maintains bowel functioning.
2- Standardized Voiding Frequency:-
Timed voiding involves establishing a set voiding frequency (such as
every 2 hours if incontinent episodes tend to occur 2 or more
hours after voiding). The individual chooses to “void by the clock”
at the given interval while awake, rather than wait until a voiding
urge occurs.
3- Pelvic Muscle Exercise (PME):•
Also known as Kegel exercises, aims to strengthen the voluntary
muscles that assist in bladder and bowel continence in both men
and women.
•
Pelvic muscle exercises are helpful for women with stress, urge, or
mixed incontinence and for men who have undergone prostate
surgery.
PHARMACOLOGIC THERAPY:-
•Pharmacologic
therapy works best when used as an adjunct
to behavioral interventions.
1- Anticholinergic agents (oxybutynin [Ditropan], dicyclomine
[Antispas]) inhibit bladder contraction and are considered
first-line medications for urge incontinence.
2- Several tricyclic antidepressant medications (imipramine,
doxepin, desipramine, and nortriptyline) also decrease bladder
contractions as well as increase bladder neck resistance.
3- Estrogen (taken orally, transdermally, or topically) has been
shown to be beneficial for all types of urinary incontinence.
Estrogen decreases obstruction to urine flow by restoring the
mucosal, vascular, and muscular integrity of the urethra.
PATIENT EDUCATION Strategies for Managing Urinary Incontinence:-
•Avoid taking diuretics after 4 PM.
•Avoid bladder irritants, such as caffeine, alcohol
•Void regularly, 5 to 8 times a day (about every 2 to 3 hours)
•Perform all pelvic floor muscle exercises as prescribed, every day.
•Stop smoking (smokers usually cough frequently, which increases
incontinence).
URINARY RETENTION
definition
•Urinary retention : is the inability to empty the bladder completely
during attempts to void.
•Chronic urine retention often leads to overflow incontinence
•Residual urine : is urine that remains in the bladder after voiding.
•In a healthy adult younger than age 60, complete bladder emptying
should occur with each voiding.
•In adults older than age 60 ( 50 to 100 mL) of residual urine may
remain after each void because of the decreased contractility of the
detrusor muscle.
Pathophysiology
Urinary retention may result from urethral pathology
(infection, tumor) trauma (pelvic injuries), or neurologic
disorders such as cerebrovascular accident, spinal cord
injury, or Parkinson’s disease.
• Some medications cause urinary retention, either by
inhibiting bladder contractility or by increasing bladder
outlet resistance.
• Medications that cause retention by inhibiting bladder
contractility include anticholinergic agents (atropine
sulfate),and tricyclic antidepressant medications
• Medications that cause urine retention by increasing
bladder outlet resistance include alpha-adrenergic
agents (ephedrine sulfate, pseudoephedrine), betaadrenergic blockers (propranolol), and estrogens.
•
Assessment and Diagnostic Findings:The assessment of a patient for urinary retention is multifaceted because the signs
and symptoms may be easily overlooked. The following questions serve as a guide
in assessment:
•What was the time of the last voiding, and how much urine was excreted?
•Is the patient voiding small amounts of urine frequently?
•Does the patient complain of pain or discomfort in the lower abdomen?
•Is the pelvic area swollen?
•Does a post void bladder ultrasound test reveal residual urine?
Complications:-
•chronic infection.
•pyelonephritis
•sepsis
•
Nursing Management:•obstruction.
•Nursing measures to encourage voiding include providing privacy,
ensuring an environment and a position conducive to voiding
•Additional measures include applying warmth to relax the
sphincters (ie, sitz baths, warm compresses to the perineum,
showers), giving the patient hot tea.
•After surgery, the prescribed analgesic should be administered
because pain in the incisional area can make voiding difficult
PROMOTING HOME AND COMMUNITY-BASED CARE
In adapting the home environment to provide easy, safe
access to the bathroom, the patient may need to remove
barriers, such as throw rugs or other objects, from the route.
Leaving a light on in the bedroom and bathroom and wearing
clothing that is easy to remove when using the toilet