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Urinary Incontinence Nursing Management

Urinary incontinence is an uncontrolled leakage of urine. Pathology speaking, the inability to hold urine in the bladder is either caused by the weakened, or the lost of voluntary control over the urinary sphincter. This involuntary micturation commonly occurs as a distressing problem for the patient and its caregivers—which may considerably affect the quality of life. Urinary incontinence is a treatable condition that needs medical attention to prevent the occurrence of underlying complications.

Mayo Clinic categorized urinary incontinence with the following types and definitions:

  1. Stress incontinence  –  occurs while lifting, exercising, laughing, sneezing and coughing which commonly occurs in women, and presumptively the effect of pregnancy and childbirth; and/or hormonal imbalance during menopausal stage.
  2.  Urge incontinence – defined as an oversensitive bladder causing the urge to urinate when sleeping, drinking or listening to running water. Also termed as reflex incontinence, spastic bladder and overactive bladder. This condition is usually nocturnal and common in older adults. It also may be a symptom of a urinary infection in the bladder or kidneys, or may result from injury, illness or surgery.
  3.  Overflow incontinence – happen when the bladder is not completely emptied causing frequent dribbling urination. It can be an indication of nerve damage from diabetic disease or urethral blockage caused by stones, tumors, prostate enlargement (men) or birth defect (women).
  4.  Functional incontinence – this condition is brought about by limitations in movement, thinking and communicating—thus the patient often unable to control bladder before they reach the bathroom. Commonly observe in older patients with Parkinson’s disease, Alzheimer’s disease and arthritis.
  5.  Mixed incontinence – two types of incontinence that occurs concurrently, usually stress incontinence and urge incontinence which is commonly found in women.
  6. Anatomic or developmental abnormalities – incontinence that is caused by anatomic and/or neurologic abnormalities.
  7. Temporary incontinence – usually occur from an underlying specific condition (constipation, UTI) or side-effect of treatment or medications.
  8. Bed-wettingnocturnal enuresis is common in children and normal until 5 years old. This condition is the result of delayed neurological control of the bladder, an inherited disorder.

Urinary Incontinence Nursing Care Plan

Doenges, Moorhouse & Curr (2008); Smeltzer & Bare (2004)*

Urinary incontinence is a medical condition with implication that extends beyond physical manifestations. This condition often has serious effects on the lives of many individuals who suffer from embarrassment, stigma, physical discomfort and social isolation—that façade barriers to seek medical attention. Studies have shown that it is difficult to identify high risk or affected individuals because most cases are not reported and not diagnosed (Landefeld et al, 2008).

Tannenbaum et al (2010), reported that interactive continence workshops promote self-management and consultation seeking among older women with incontinence. Through the joint effort and cooperation from the victims of urinary incontinence, their caregivers and medical practitioners (nurses and doctors), we can improve symptoms and prognosis—thus, improving the quality of life. Awareness and health promotion is a must in creating a wider public acceptance—to unlock a new perspective in the nursing management of urinary incontinence.

References:

  • Doenges, M.E., Moorhouse, M.F. & Curr, A.C. (2008). Nurses Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales, 11th ed.Philadelphia: F.A. Davis Company. Kessler, T.M. (2008).
  • Diagnosis of Urinary Incontinence. Journal of the American Medical Association, 300(3), 283. Landefeld, C.S. et al. (2008).
  • National Institutes of Health State-of-the-Science Statement: Prevention of Fecal and Urinary Incontinence in Adults. Annals of Internal Medicine, 148(6). Mayo Clinic.
  • http://www.mayoclinic.org/urinary-incontinence/types.html Rogers, R.G. (2008). Urinary Stress Incontinence in Women. The New England Journal of Medicine, 358, 1029–1036.
  • Shamliyan, T.A. et al. (2008). Systematic Review: Randomized, Controlled Trials of Nonsurgical Treatments for Urinary Incontinence in Women. Annals of Internal Medicine, 148, 459–473. Smeltzer, S.C. & Bare, B.G. (2004).
  • Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 10th Ed. PA: Lippincott Williams & Wilkins. Tannenbaum, C. et al. (2010).
  • Lessons Learned: Impact of a Continence Promotion Activity for Older Community-Dwelling Women. Neurology and Urodynamics, 29, 540–544.
She is currently working as a medical-surgical nurse at Ministry of Health, Sultanate of Oman. A writer, blogger, researcher, correspondent and publication consultant for nursing journal and health-related educational websites. Her field of specialization focused on Intensive Care and Emergency Management. She is now taking up MAN major in Adult Health Nursing at the University of the Philippines Open University. A nursing professor for 8 years in the Philippines and served as a staff nurse at UST hospital. A caring and devoted nurse who introduced a “Pinay Nightingale” in the land of the pharaohs. A nurse by profession, an educator by devotion and a writer / researcher by passion.