Urinary Incontinence and Nursing Care
Whats is Urinary incontinence
Urinary Incontinence (UI) is the involuntary loss of urine that creates a social or hygienic problem. It is a common health concern for women ( Sampselle et al., 1997). More than 20 million adults are estimated to have UI or Overactive Bladder (OAB).
Between 15% and 30% of adult women experience UI, and the prevalence is even greater in the elderly population. UI is present in half the older residents at nursing homes, and in 13% to 56% of home-bound elders (Anonymous, 2003).
The Agency for Healthcare Policy and Research (AHCPR) believes that UI was underreported, underdiagnosed, and undertreated in the 1990s.
Types of Incontinence
Although urinary incontinence is common, it is not a part of the normal
aging process and is therefore considered abnormal despite the large numbers of
people whose lives are affected by it.
Stress Incontinence
Stress incontinence is most common in older women. Stress incontinence occurs when urine leaks during lifting, exercise, coughing, sneezing, or laughing. Weakness of the pelvic floor allows the proximal urethra and bladder base to be pushed out of the pelvis during these periods of increased abdominal pressure, resulting in leakage.
This type of UI may also be caused by decreased estrogen levels after menopause. Overflow Incontinence is more common among older men, especially those with enlarged prostate glands, which creates constriction of the tube through which urine drains from the bladder.
This results in a constant dripping of urine and strained urination. Urge incontinence, common in elderly people, occurs when having had the urge to urinate, the ability to do so is lost, or the need to urinate comes before arriving at the bathroom.
An overactive bladder causes involuntary bladder
muscle contractions. Some medical conditions, such as stroke, multiple
sclerosis, and Parkinson's disease, can cause urge incontinence.
Functional Incontinence
Functional incontinence occurs when bladder function is normal, but the physical act of getting to a bathroom is hampered, either by cognitive impairment or physical disability.
Such conditions impair an individual's
ability to appropriately respond to their cues to void. Severe arthritis and
severe dementia are examples of hindrances which cause functional incontinence.
Mixed Incontinence
Mixed incontinence is a combination of bladder and urethral
dysfunction which causes stress and urge incontinence to occur together.
Screening for UI is appropriate at any age but is especially so for older adults. due to its increased prevalence in this population.
In fact, the at risk population weakness includes those with immobility, impaired cognition, medications, morbid obesity, environmental barriers, high impact physical activities, diabetes, stroke, estrogen depletion, and/or pelvic muscle (Dowling-Castronova, 2001 ) .
The economic costs of urinary incontinence in America have been estimated at more than $15 billion annually. There are costs other than economic as well: skin break-down and infection resulting from rashes and pressure ulcers, urinary tract infections, anxiety, depression, low self-esteem, and social isolation (Johnson, S., 2000).
In the nursing home, the economic
costs have been estimated to be close to $5 billion annually, including costs
associated with staff, laundry, and supplies. Ul may also lead to falls among
residents with nocturia, urge incontinence, and impaired balance or gait (
Ouslander &Schnelle , 1995).
Nursing and Management of Incontinence
Nursing has traditionally supported behavioral approaches to incontinence management.
Reduce Bladder Irritants
They include inhibition training (wherein the goal is to eliminate unwanted bladder contractions by decreasing the use of bladder irritants such as caffeine, alcohol, artificial sweeteners, pepper, spicy foods, etc ), active bladder relaxation (wherein movement is avoided), general relaxation.
And contracting of the pelvic muscles until the urgency sensation goes away and it becomes “safe” to go to the bathroom. The key to success is not to move when the urgency sensation occurs.
Bladder Training
With the bladder training technique, the patients are to keep a record and show some ability to control urgency. There are three components to bladder training comprehensive patient education, timed but progressively lengthened voiding intervals, and positive reinforcement ( Krissovich & Safran, 1997).
Pengelly and Booth (1980)
reported, in a prospective trial that included 12 weeks of bladder training,
that more than half of the 25 participants who completed the program were
completely cured or improved, and that none got worse.
Pelvic Muscles Rehabilitation and Exercises
Pelvic Muscle rehabilitation (Kegel exercises) involves using the pelvic floor muscles to regain control over lower urinary tract function. Pelvic muscle strengthening and active use of the pelvic muscles to prevent urge or stress incontinence are key components of this approach.
Programs of pelvic muscle exercise have proven to increase muscle strength and reduce incontinent urine loss.
Dougherty and colleagues (1993), in a study of 65 women aged 35-75 years, found significant improvement in force (25%) and duration (40%) of muscle contraction, as well as significant reduction (62%) in the amount of urine leakage and reported episodes of incontinence, after a 16-week course of pelvic muscle exercise.
Biofeedback training, which involves electronic and mechanical instruments to relay messages to patients about their physiologic conditions, is known as the most effective method of achieving pelvic muscle rehabilitation.
Other methods for augmenting pelvic muscle training include
electrical stimulation and vaginal weights. Two randomized controlled trials
using 6-week treatment periods reported 70% and 87% cure or significant
improvement rates with behavioral therapies ( Krissovich & Safran, 1997).
Importance of Treating Incontinence
The importance of treating incontinence cannot be overlooked because incontinence impacts psychologically as well as physiologically. Researchers have shown a direct relationship between incontinence and depression as patients become less involved in social activities.
Ultimately, this could lead to sadness and overwhelming despair. UI may be associated with depression, social isolation, loss of self-esteem, and altered relationships ( Castina , Boyington , & Dougherty, 2002). This negative impact may also be felt by the nursing staff and family members.
Caregivers often feel overwhelmed and frustrated as a result of the amount of time and staff required by an incontinent patient. Additionally, but often overlooked, is the economic impact resulting from early retirement or an inability to work.
Thus, urinary
incontinence can be a devastating experience, with serious psychosocial
consequences for both the affected individual and the caregiver (Yu, 1987).
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