Urinary Incontinence

Under supervision
Assist prof/Entesar Abd ElAlim
Cl/Shereen Mostafa
 OUT LINE

• Introduction
• Definition
• Pathophysiology
• Causes
• risk factors
• Signs and syptoms
• Types
• Complications
• Diognosis
• Medical treatment
• Surgical treatment
• Nursing management
• Prevention and Health Education
Introduction

• The International Continence Society defines urinary incontinence (UI) as the

involuntary loss of urine. In both men and women, age is a consistently
reported risk factor for UI; however, it is not considered a normal
consequence of aging. Overall, UI affects up to 30% of communitydwelling
older adults and more than 50% of nursing home residents. It is about 2–3
times more common in women than in men until 80 years of age, after which
UI rates are similar. Despite its high prevalence, up to one-half of cases may
not be reported because individuals with UI may not seek Medical
intervention. Embarrassment and the perception that UI is an expected
consequence of aging are common factors in lack of treatment. Urinary
incontinence is categorized according to pathophysiology and clinical
presentation. The four main categories are stress urinary incontinence (SUI),
urge urinary incontinence (UUI), overflow incontinence, and functional
incontinence. Mixed types of incontinence are common and may complicate
 diagnosis and treatment because of overlapping symptoms.Studies have
found that UI significantly affects psychological well-being and health care–
related quality of life. Urinary incontinence may impair sexual function,
restrict activities, interfere with interpersonalrelationships, decrease
selfesteem, increase caregiver burden, increase financial burden, and cause
anxiety or depression. It is a common precipitant of institutionalization in
older adults. Because of current demographic trends, UI is an increasingly
common medical and socioeconomic problem.

Definition
Urinary incontinence is the unintentional passing of urine or loss of bladder control

Pathophysiology

• Normal Micturition For older persons in particular, continence requires

mobility, manual dexterity, the cognitive ability to recognize and react to
bladder filling, and the motivation to stay dry. Bladder smooth muscle (the
detrusor) contracts via parasympathetic nerves from spinal cord levels S2 to
S4. Urethral sphincter mechanisms include proximal urethral smooth muscle
(which contracts with sympathetic stimulation from spinal levels T11 to L2),
distal urethral striated muscle (which contracts via cholinergic somatic
stimulation from cord levels S2 to S4), and musculofascial urethral supports.
In women, these supports form a two-layered “hammock" that supports and
compresses the urethra when abdominal pressure increases. Micturition is
coordinated by the central nervous system: Parietal lobes and thalamus
receive and coordinate detrusor afferent stimuli; frontal lobes and basal
ganglia provide signals to inhibit voiding; and the pontine micturition center
integrates these inputs into socially appropriate voiding with coordinated
 urethral relaxation and detrusor contraction until the bladder is empty. Urine
storage is under sympathetic control (inhibiting detrusor contraction and
increasing sphincter tone), and voiding is parasympathetic (detrusor
contractor and relaxation of sphincter tone). Age-Related Changes
Agerelated changes in the lower urinary tract and micturition (Table 20.1)
are found in both continent and incontinent older persons. Why some older
persons develop UI and others do not remains unclear; differences in lower
urinary tract (LUT) and non-LUT compensatory mechanisms may play a
role.

Causes of Urinary Incontinence (UI)

• Incontinence may be a temporary problem caused by a vaginal or urinary

tract infection (UTI), constipation, or certain medications, or it can be a
chronic condition.
• The most common causes of chronic incontinence include:
1. Overactive bladder muscles
2. Weakened pelvic floor muscles
3. Nerve damage that affects bladder control
4. Interstitial cystitis (chronic bladder inflammation) or other bladder
conditions
5. A disability or limitation that makes it difficult to get to the toilet quickly
6. Side effects from surgery
7. Obstruction
8. Neurological disorders such as multiple sclerosis, stroke, or Parkinson’s
disease
9. Men: an enlarged prostate, or benign prostatic hyperplasia (BPH), prostate
cancer
 10. Women: Pregnancy, childbirth, menopause, hysterectomy.

Risk Factors for Urinary Incontinence

The following factors may put you at higher risk for developing UI :

1. Being female Women experience stress incontinence twice as often as men.

2. Men, on the other hand, are at greater risk for urge and overflow incontinence.
3. Advancing age As we get older, our bladder and urinary sphincter muscles
often weaken, which may result in frequent and unexpected urges to urinate.
Even though incontinence is more common in older people, it is not
considered a normal part of aging.
4. Excess body fat Extra body fat increases the pressure on the bladder and can
lead to urine leakage during exercise or when coughing or sneezing.
5. Other chronic diseases Vascular disease, kidney disease, diabetes, prostate
cancer, Alzheimer's disease, multiple sclerosis, Parkinson's disease, and other
conditions may increase the risk of urinary incontinence
6. Smoking A chronic smoker's cough can trigger or aggravate stress
incontinence by putting pressure on the urinary sphincter.
7. High-impact sports While sports don't cause incontinence, running, jumping,
and other activities that create sudden pressure on the bladder can lead to
occasional episodes of incontinence during sports activities

Signs and Symptoms of Urinary Incontinence

The following are signs you should see a doctor:

1. Leaking urine during normal activities like lifting, bending, coughing, or

exercising
2. Sudden, strong urges to urinate; feeling like you might not make it to the toilet
in time
3. Leaking urine without feeling any warning sign or urge
4. Bed-wetting

types of urinary incontinence

1-Stress incontinence:- Urine leaks when you exert pressure on your bladder
by coughing, sneezing, laughing, exercising or lifting something heavy.

2-Urge incontinence:- You have a sudden, intense urge to urinate followed by

an involuntary loss of urine. You may need to urinate often, including throughout
the night. Urge incontinence may be caused by a minor condition, such as
infection, or a more severe condition such as a neurological disorder or diabetes. 3-
Overflow incontinence:- You experience frequent or constant dribbling of
urine due to a bladder that doesn't empty completely.
4-Functional incontinence:- A physical or mental impairment keeps you from
making it to the toilet in time. For example, if you have severe arthritis, you may
not be able to unbutton your pants quickly enough.

5- Mixed incontinence:-You experience more than one type of urinary

incontinence, this refers to a combination of stress Incontinence and urge
incontinence.

Complications
Complications of chronic urinary incontinence include:-

1. Skin problems:- Rashes, skin Infections and sores can develop from constantly
wet skin.
2. Urinary tract infections:- Incontinence increases your risk of repeated urinary
tract infections.
3. Impacts on your personal life:- Urinary Incontinence can affect your social,
work and personal relationships.

Diognosis
The doctor will ask questions about your symptoms and medical history:

1. whether the urinary incontinence happens when you cough or laugh

2. need for the toilet frequently during the day or night
3. currently taking any medicine
4. how much fluid, alcohol or caffeine you drink
Bladder diary:
 1. keep a diary of your bladder habits for at least 3 days so you can give more
information about your condition include:
2. how much fluid and types of fluid you drink
3. how often you need to pass urine and the amount of urine .

Tests and examinations

1-Physical examination

1. A physician may examine you to assess the health of your urinary system. If
you have a vagina, the doctor will do a pelvic examination, and you may be
asked to cough to see if any urine leaks.
2. The doctor may examine pelvic floor muscles that surround your bladder and
urethra. Damage to your pelvic floor muscles can lead to urinary incontinence.
3. If you're male, the doctor may check the health of your prostate gland, which
is located between the penis and bladder and surrounds the urethra ,an
enlarged prostate gland, can cause symptoms of urinary incontinence.

2-Tests:

1. Dipstick test : A sample of your urine may be tested for bacteria that cause
urinary tract infection (UTI),
2. A stick is dipped into your urine sample. It will change colour if bacteria are
present. The dipstick test can also check for blood and protein in your urine.
3. Residual urine test : It may suggest that to see how much urine is left in
your bladder after you pee.
4. Further tests if the cause is not clear.
5. Cystoscopy: to look inside your bladder and urinary tract to identify any
abnormalities .
 6. Urodynamic tests : used to check the function of your bladder and urethra.

7. measuring the pressure in your bladder.

8. measuring the pressure in your abdomen then measure the amount and flow of
urine

Medical treatment

1. Treatment will depend on several factors, such as the type of incontinence, the
patient’s age, general health, and their mental state
2. medications taken side by side with combination with other techniques or
exercises.
3. Anticholinergics calm overactive bladders and may help patients with urge
incontinence.
4. Topical estrogen.
5. Imipramine (Tofranil) is a tricyclic antidepressant.
6. Urinary Catheter: A tube that goes from the bladder, through the urethra, out of
the body into a bag which collects urine.
7. Medical devices:

1; Urethral inserts :- urinary catheter is a hollow, partially flexible tube that

collects urine from the bladder and leads to a drainage bag.

A urethral indwelling catheter is a catheter inserted through the urethra into the
bladder,

2 :Pessary :- is a device that is placed into the vagina to support the uterus or
bladder and rectum. It is a firm ring that presses against the wall of the urethra to
help decrease urine leakage
3: Radiofrequency therapy :- used by promoting submucosal collagen
denaturation in the bladder neck and throughout the lower urinary tract, causing
tissue retraction in these structures.so that can help to reduce the symptoms

4: Bulking agents: Injected into tissue around the urethra, these help keep the
urethra closed.

Surgery

If other treatments aren't working, several surgical procedures can treat the
problems that cause urinary incontinence:

1. Sling procedures. Synthetic material (mesh) or strips of your body's tissue

are used to create a pelvic sling underneath your urethra and the area of
thickened muscle where the bladder connects to the urethra (bladder neck). The
sling helps keep the urethra closed, especially when you cough or sneeze. This
procedure is used to treat stress incontinence.

2. Bladder neck suspension. This procedure is designed to provide support to

your urethra and bladder neck an area of thickened muscle where the bladder
connects to the urethra. It involves an abdominal incision, so it's done during
general or spinal anesthesia.

3. Prolapse surgery. In women who have pelvic organ prolapse and mixed
incontinence, surgery may include a combination of a sling procedure and
prolapse surgery. Repair of pelvic organ prolapse alone does not routinely
improve urinary incontinence symptoms.

4. Artificial urinary sphincter. A small, fluid-filled ring is implanted around

the bladder neck to keep the urinary sphincter shut until there's a need to
 urinate. To urinate, you press a valve implanted under your skin that causes the
ring to deflate and allows urine from your bladder to flow.

Nursing management:

1. Encourage the patient to drink 6 to 8 glasses of fluid (but not more) unless your
doctor advises you otherwise.
2. Tell the patient to limit fluid intake 2 to 3 hours before bedtime and to void just
before bedtime.
3. Reduce alcohol and caffeine intake as they act as diuretic, which makes you
urinate more often .
4. Avoid spicy and acidic foods such as curries and citrus fruits as they can irritate
the bladder and make leaks and other incontinence symptoms worse.
5. Monitor elderly patients for dehydration , It can intensify urine loss, produce
acute confusion, and increase the risk of morbidity and mortality .
6. Aid the patient with developing a bladder training program that includes
voiding at scheduled intervals, gradually increasing the time between voidings.
7. Timed voiding can be used to help a patient regain control of the bladder.
8. Educate patient about Kegel exercises.
9. Prevent constipation and avoid lifting heavy objects.
10. Manage any existing perineal skin excoriation with a vitamin-enriched cream,
followed by a moisture barrier,Moisture barrier ointments are beneficial in
protecting perineal skin from urine.
11. Eliminate environmental barriers to toileting , Help the patient remove loose
rugs from the floor and improve lighting in hallways and bathrooms.
12. Place an appropriate, safe urinary receptacle or containment device when
toileting access is limited by immobility or environmental barriers.
13. Provide privacy.
14. Assist the person to change their clothing frequently,Select loose-fitting
clothing with stretch waistbands
15. Advise the patient about the benefits of using disposable pads, pad-pant
systems, or replacement briefs specifically designed for urinary incontinenc as
indicated.
16. Encourage family members ot respond immediately to the patient’s request for
assistance with voiding.
17. Give or encourage the use of medications as ordered: Anticholinergics and
Tricyclic antidepressants
18. Note urinary elimination and incontinent patterns on a bladder log to use as a
baseline for assessment and evaluation of treatment efficacy.

Prevention and Health Education

It's not always possible to prevent urinary incontinence, but there are some steps
you can take that may help reduce the chance of it happening:

1. maintaining a healthy weight through regular exercise and healthy eating.

2. If you have to urinate frequently during the night (nocturia), try drinking less
in the hours before you go to bed. However, make sure you still drink enough
fluids during the day about 6 to 8 glasses.
3. cut down on alcohol and drinks containing caffeine, such as tea, coffee and
cola. These can cause your kidneys to produce more urine and irritate your
bladder.
4. Get more fiber into your diet, which can help prevent constipation.
5. don’t smoke – if you smoke, quit. A chronic cough because of smoking
weakens the pelvic floor and contributes to the onset of incontinence
6. Good toilet habits can help to prevent bladder and bowel problems.
 7. Go to the toilet to urinate only when your bladder is full.
8. Don’t strain to open your bowels. Regular straining can cause problems
including haemorrhoids (swollen veins in the anus), and can weaken your
pelvic floor muscles.
9. Use correct posture on the toilet (it can help you pass a bowel motion). Put
your feet on a footstool, place your elbows on your knees, bulge out your
stomach and straighten your back
10. treat urinary tract infections (UTIs) promptly – UTIs irritate the bladder
lining.
11. Seek immediate treatment if you have symptoms.

Practice pelvic floor exercises :

Kegel exercises
• Kegel Exercises can help make the muscles under the uterus, bladder, and
bowel (large intestine) stronger. They can help both men and women who have
problems with urine leakage or bowel control. You may have these problems:
1. As you get older
2. If you gain weight
3. After pregnancy and childbirth
4. After gynecologic surgery (women)
5. After prostate surgery (men)
6. People who have brain and nerve disorders may also have problems with urine
leakage or bowel control.

7. Kegel exercises can be done any time you are sitting or lying down. You can do
them when you are eating, sitting at your desk, driving, and when you are
resting or watching television.
 How to do Kegel Exercises
1) Make sure your bladder is empty, then sit or lie down.
2) Tighten your pelvic floor muscles. Hold tight and count 3 to 5 seconds.
3) Relax the muscles and count 3 to 5 seconds.
4) Repeat 10 times, 3 times a day (morning, afternoon, and night).

Reference

https://www.everydayhealth.com/urinary-incontinence/guide/

https://www.medicalnewstoday.com/articles/165408#treatment

https://www.medicalnewstoday.com/articles/165408#treatment

https://www.nhs.uk/conditions/urinary-incontinence/diagnosis/

https://eu.docworkspace.com/d/sICa56bK2AdyUuZsG?sa=00&st=0t
https://www.wps.com/d/?from=t