Urinary Incontinence

Urinary incontinence is the involuntary or uncontrolled loss of urine from the bladder sufficient to cause a social or hygienic problem. This may be caused by external urinary sphincter injury, obstetric injury, lesions of bladder neck, detrusor dysfunction, infection, neurogenic bladder, medications and neurologic abnormalities.

Risk Factors

  1. Pregnancy related (vaginal delivery, episiotomy)
  2. Menopause
  3. Caregiver or toilet unavailability
  4. Use of medications (diuretics, sedatives, opioids, hypnotics)
  5. Dementia
  6. Parkinson’s disease
  7. Genitourinary surgery
  8. Pelvic muscle weakness
  9. Diabetes milletus
  10. Immobility
  11. High impact exercise
  12. Stroke
  13. Morbid obesity

Types of Urinary Incontinence

  1. Stress incontinence – involuntary loss of urine from an intact urethra due to an increased intra- abdominal pressure (sneezing, coughing or position changes)
  2. Urge incontinence- is the involuntary loss of urine associated with a strong urge to void that cannot be suppressed
  3. Reflex incontinence- is the involuntary loss of urine as a result of hyperreflexia in the absence of normal sensations usually associated with voiding
  4. Overflow incontinence- is the involuntary loss of urine associate with the over- distention of the bladder. The over- distention results from the bladders inability to empty normally, despite frequent urine loss.
  5. Functional incontinence- refers to those instances when the lower urinary tract function is intact but the other factors such as severe cognitive impairment, makes it difficult for the patient to identify the need to void or physical impairments make it difficult or impossible to reach the loo in time.
  6. Iatrogenic incontinence- refers to the involuntary loss of urine due to extrinsic medical factors, specifically medications.

Assessment and Diagnostic Findings

  • Complete history taking is important. This includes a factual data regarding the problem medication use, the patient’s voiding history and fluid intake and output documentation.
  • Residual urine test
  • Stress maneuvers test
  • Urodynamic test
  • Urinalysis and urine culture (tests that identify hematuria, infection, cancer, kidney stoen, glycosuria, pyuria, bacteriuria)

Medical Management

  1. Behavioural therapy- this type of therapy has always been performed to decrease incidence of urinary incontinence. By the use of behavioural therapy, adverse effects of pharmacologic interventions and surgical interventions are avoided.
  2. Pharmacologic therapy- this management is a supplemental and adjunct regimen to behavioural therapy.
    • Anti- cholinergic agents inhibit bladder contractions and are considered first line medications for urge incontinence.
    • Tricyclic antidepressant decrease bladder contactions as well as increase bladder neck resistance.
    • Pseudoepinephprine are used to treat stress incontinence.
    • Estrogen decreases obstruction to urine flow by restoring the mucosal, vascular and muscular integrity of the urethra.

Surgical Management

  1. Women with stress incontinence (repair or closure of the urethra)
    • Anterior vaginal repair
    • Retropubic suspension
    • Needle suspension
    • Periurethral bulking
    • Collagen placement
    • Modified artificial sphincter
    • Electronic stimulation
  2. Men with stress incontinence
    • Transurethral resection
    • Artificial sphincter
    • Periurethral bulking

Nursing Management

  • Provide support and encouragement to improve the patient’s level of incontinence.
  • Patient education regarding bladder program is essential.
  • Monitoring and documenting the input and output.
  • Teaching patients to do Kegel’s exercises.

Byron Webb Romero, RN, MSN

Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.

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