Types Of Urinary Incontinence PDF

10/19/23, 3:37 AM Realizeit for Student Types of Urinary Incontinence There are many types of urinary incontinence, including the following: Stress incontinence is the involuntary loss of urine through an intact urethra as a result of exertion, sneezing, coughing, or changing position (Wooldridge,...

10/19/23, 3:37 AM Realizeit for Student Types of Urinary Incontinence There are many types of urinary incontinence, including the following: Stress incontinence is the involuntary loss of urine through an intact urethra as a result of exertion, sneezing, coughing, or changing position (Wooldridge, 2017). It predominantly 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. In men, stress incontinence is often experienced after a radical prostatectomy for prostate cancer because of the loss of urethral compression that the prostate had supplied before the surgery, and possibly bladder wall irritability. Urge incontinence is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed (Wooldridge, 2017). The patient is aware of the need to void but is unable to reach a toilet in time. An uninhibited detrusor contraction is the precipitating factor. This can occur in a patient with neurologic dysfunction that impairs inhibition of bladder contraction or in a patient without overt neurologic dysfunction. Functional incontinence is the involuntary loss of urine due to physical or cognitive impairment. This occurs when the lower urinary tract function is intact but other factors, such as severe cognitive impairment (e.g., Alzheimer’s dementia), make it difficult for the patient to identify the need to void or physical impairments make it difficult or impossible for the patient to reach the toilet in time for voiding (Miller, 2019; Wooldridge, 2017). Iatrogenic incontinence is the involuntary loss of urine due to extrinsic medical factors, predominantly medications. One such example is the use of alpha-adrenergic agents to decrease blood pressure. In some people with an intact urinary system, these agents adversely affect the alpha receptors responsible for bladder neck closing pressure; the bladder neck relaxes to the point of incontinence with a minimal increase in intra-abdominal pressure, thus mimicking stress incontinence. As soon as the medication is discontinued, the apparent incontinence resolves. Mixed incontinence, which encompasses several types of urinary incontinence, is involuntary leakage associated with urgency and also with exertion, effort, sneezing, or coughing (Miller, 2019; Wooldridge, 2017). Overflow incontinence occurs when there is continual leakage of urine from an overdistended bladder (Norris, 2019). This can occur because of detrusor muscle underactivity or an outlet obstruction caused by benign prostatic hyperplasia, pelvic organ prolapse, or tumors, among other things. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcdpKuauTn1W0lrWmCsonBYnaQIwEDgwdbmVgOEy99af… 1/5 10/19/23, 3:37 AM Realizeit for Student Only with appropriate recognition of the problem, assessment, and referral for diagnostic evaluation and treatment can the outcome of incontinence be determined. All people with incontinence should be considered for evaluation and treatment. Gerontologic Considerations Although urinary incontinence is not a normal consequence of aging, age-related changes in the urinary tract do predispose the older person to incontinence. However, if nurses and other health care providers accept incontinence as an inevitable part of illness or aging or consider it irreversible and untreatable, it cannot be treated successfully. Collaborative, interdisciplinary efforts are essential in assessing and effectively treating urinary incontinence. Urinary incontinence can decrease an older person’s ability to maintain an independent lifestyle, which increases dependence on caregivers and may lead to institutionalization. Between 35% and 41% of older women have urinary incontinence (Wooldridge, 2017). Many older adults experience transient episodes of incontinence that tend to be abrupt in onset. When this occurs, the nurse should question the patient, as well as the family if possible, about the onset of symptoms and any signs or symptoms of a change in other organ systems. Acute UTI, infection elsewhere in the body, constipation, decreased fluid intake, and a change in a chronic disease pattern, such as elevated blood glucose levels in patients with diabetes or decreased estrogen levels in menopausal women, can provoke the onset of urinary incontinence. If the cause is identified and modified or eliminated early at the onset of incontinence, the incontinence itself may be eliminated. Although the bladder of the older person is more vulnerable to altered detrusor activity, age alone is not a risk factor for urinary incontinence (Miller, 2019; Wooldridge, 2017). Decreased bladder muscle tone is a normal age-related change found in older adults. This leads to decreased bladder capacity, increased residual urine (urine remaining in the bladder after voiding), and an increase in urgency. Many medications affect urinary continence in addition to causing other unwanted or unexpected effects (Miller, 2019; Wooldridge, 2017). All medications need to be assessed for potential interactions. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcdpKuauTn1W0lrWmCsonBYnaQIwEDgwdbmVgOEy99af… 2/5 10/19/23, 3:37 AM Realizeit for Student 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 (e.g., residual urine, stress maneuvers) may be used to help determine the type of urinary incontinence involved. Urodynamic tests may be performed. Urinalysis and urine culture are performed to identify infection. Urinary incontinence may be transient or reversible if the underlying cause is successfully treated and the voiding pattern reverts to normal. Medical Management Management depends on the type of urinary incontinence and its causes. Management of urinary incontinence may be behavioral, pharmacologic, or surgical. Behavioral Therapy Behavioral therapies, also known as nonpharmacologic, or conservative treatments, are the first choice to decrease or eliminate urinary incontinence. These are recommended as first-line treatment for nonneurologic causes of incontinence in adults (AUA, 2019b). In using these techniques, health care professionals help patients avoid potential adverse effects of pharmacologic or surgical interventions. Pelvic floor muscle exercises (sometimes referred to as Kegel exercises) represent the cornerstone of behavioral intervention for addressing symptoms of stress, urge, and mixed incontinence (Miller, 2019; Wooldridge, 2017). Other behavioral treatments include the use of a voiding diary, biofeedback, verbal instruction (prompted voiding), and physical therapy (AUA, 2019b; Wooldridge, 2017). https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcdpKuauTn1W0lrWmCsonBYnaQIwEDgwdbmVgOEy99af… 3/5 10/19/23, 3:37 AM Realizeit for Student Surgical Management Surgical correction may be indicated in patients who have not achieved continence using behavioral and pharmacologic therapy. Surgical options vary according to the underlying anatomy and the physiologic problem. Most procedures involve lifting and stabilizing the bladder or urethra to restore the normal urethrovesical angle or to lengthen the urethra. Women with stress incontinence may undergo an anterior vaginal repair, retropubic suspension, or needle suspension to reposition the urethra. Procedures to compress the urethra and increase resistance to urine flow include sling procedures and placement of periurethral bulking agents such as artificial collagen. Periurethral bulking is a minimally invasive procedure in which small amounts of artificial collagen are placed within the walls of the urethra to enhance the closing pressure of the urethra (Norris, 2019). This procedure takes only 10 to 20 minutes and may be performed under local anesthesia or moderate sedation. A cystoscope is inserted into the urethra. An instrument is inserted through the cystoscope to deliver a small amount of collagen into the urethral wall at locations selected by the urologist. The patient is usually discharged home after voiding. There are no restrictions following the procedure, although multiple sessions may be necessary for a cure (Norris, 2019). Collagen placement anywhere in the body is considered semipermanent because its durability averages between 12 and 24 months, until the body absorbs the material. Periurethral bulking with collagen is a relatively safe alternative to surgery. It is also an option for people who are seeking help with stress incontinence who prefer to avoid surgery and who do not have access to behavioral therapies. An artificial urinary sphincter can be used to close the urethra and promote continence. Two types of artificial sphincters are a periurethral cuff and a cuff inflation pump. Men with overflow and stress incontinence may undergo a transurethral resection to relieve symptoms of prostatic enlargement. An artificial sphincter can be used after prostatic surgery for sphincter incompetence. After surgery, periurethral bulking agents can be injected into the periurethral area to increase compression of the urethra. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcdpKuauTn1W0lrWmCsonBYnaQIwEDgwdbmVgOEy99af… 4/5 10/19/23, 3:37 AM Realizeit for Student Nursing Management The nurse may encounter the patient with incontinence either in the hospital or as an outpatient. Nursing management of the patient with urinary incontinence in any setting is based on the premise that incontinence is not inevitable with illness or aging and that it is often reversible and treatable. Patients who are incontinent and hospitalized need routine skin assessment to distinguish between incontinence-associated dermatitis (IAD) and pressure injury (Francis, 2019; Qiang, Xian, Bin, et al., 2020). When either IAD or pressure injury are identified, appropriate management techniques must be implemented to avoid complications (Francis, 2019; Qiang et al., 2020). The nursing interventions in the outpatient setting are determined in part by the type of treatment that is undertaken. For behavioral therapy to be effective, the nurse must provide support and encouragement, because it is easy for the patient to become discouraged if therapy does not quickly improve the level of continence. Patient education is important and should be provided verbally and in writing (see Chart 49-8). The patient should be educated to develop and use a log or diary to record timing of pelvic floor muscle exercises, frequency of voiding, any changes in bladder function, and any episodes of incontinence (Miller, 2019). Chart 49-8 PATIENT EDUCATION Strategies for Promoting Urinary Continence The nurse instructs the patient to: Avoid bladder irritants, such as caffeine, alcohol, and artificial sweeteners such as aspartame (NutraSweet). Avoid taking diuretic agents after 4 PM. Increase awareness of the amount and timing of all fluid intake. Perform all pelvic floor muscle exercises as prescribed, every day. Stop smoking (smokers usually cough frequently, which increases incontinence). Take steps to avoid constipation: Drink adequate fluids, eat a well-balanced diet high in fiber, exercise regularly, and take stool softeners if recommended. Void regularly, five to eight times a day (about every 2 to 3 hours): First thing in the morning Before each meal Before retiring to bed Once during the night if necessary https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IcdpKuauTn1W0lrWmCsonBYnaQIwEDgwdbmVgOEy99af… 5/5