ELIMINATION

(URINALLY)

A.C LUDZU
 OBJECTIVES
• Describe the act of urination
• Describe factors affecting urination
• Describe the alterations in urinally elimination
 THE ACT OF URINATION
• Several brain structures influence bladder
function
• These structures suppress contraction of
bladder’s destrusor muscle until a person
wishes to urinate or void
• Once urination occurs, the response is
contraction of the bladder and coordinated
relaxation of the pelvic floor muscles
 THE ACT OF URINATION cont’d
• The bladder holds as much as 600mls of urine.
• The desire to urinate can be sensed when the
bladder contains a smaller amount of urine
(150-200 mls in adults and 50-200 mls in a
child).
• The bladder walls stretch with the increasing
volume in turn this sends sensory impulses to
the micturation centre in the sacral spinal cord
 THE ACT OF URINATION cont’d
• the impulses from the micturation centre
stimulate the bladder muscle to contract
rhythimically.
• The internal urethral sphincter also relaxes so
that urine may enter the urethra, although
voiding does not yet occur.
• As the bladder contracts, nerve impulses travel
up the spinal cord to the brain
• A person is thus conscious of the need to urinate
 THE ACT OF URINATION cont’d
• Older children and adults can respond to or ignore
this urge, thus making urination under voluntary
control.
• If the person chooses not to urinate, the external
urinary sphincter remains contracted and the
micturition reflex is inhibited.
• However if the person is ready to urinate, the
external sphincter relaxes, the micturition reflex
stimulates the bladder muscles to contract and
urination occurs
 FACTORS AFFECTING URINATION
• Many factors influence the volume and quality
of urine and the client’s ability to urinate
• Some pathophysiological conditions may be
acute and reversible whereas others may be
chronic and irreversible
 FACTORS AFFECTING URINATION
CONTINUED
1. DISEASE CONDITIONS
– Disease may primarily affect the renal function,
and these are generalised as pre-renal, renal and
post renal.
– Pre-renal diseases decrease blood flow to the
kidneys- leads to oliguria or anuria
– Renal diseases occur due to direct injury to kidney
structures
 FACTORS AFFECTING URINATION
CONTINUED
– Post renal diseases results from obstruction in the
collecting system anywhere from the
calyces(drainage structures within the kidney) to
the urethral meatus (that is outside the kidney but
within the urinally system)
– Several diseases can affect the ability to micturate
in many ways eg diabetis mellitus
 FACTORS AFFECTING URINATION
CONTINUED

2. GROWTH AND DEVELOPMENT

• Infants and young children cannot effectively
concentrate urine. Their urine thus appears
light yellow or clear
• In relation to their small body size they excrete
large volumes of urine.
 FACTORS AFFECTING URINATION
CONTINUED
• For example a 6 months old infant who weighs 6 to 8 kgs
excretes 400-500mls of urine daily.
• A child cannot control micturation of voluntarily until 18 to
24 months
• A child must be able to recognise the feeling of bladder
fullness, to hold urine for 1-2 hours and to communicate
the sense of urgency to the adult.
• A child may not gain full control of micturation until age 4
to 5. Day time control is easier to accomplish than night
time control and occurs earlier in the child’s development,
usually by 2 years of age
 FACTORS AFFECTING URINATION
CONTINUED
3. PSYCHOLOGICAL FACTORS
– Anxiety and emotional stress may cause a sense of
urgency and increased frequency of urination.
– An anxious person may have the urgency to void
even few minutes after voiding
– Anxiety may also prevent a person from being able
to urinate completely.
• Emotional tension makes it difficult to relax the
abdominal and perineal muscles. If external urethral
sphincter is not completely relaxed, voiding may be
incomplete, and urine is retained.
 FACTORS AFFECTING URINATION
CONTINUED
– Attempting to void in public restroom may result
in temporary inability void.
• Privacy and adequate time to void are usually
important to most people.
• Some people need distractions (e.g reading) to relax.
 FACTORS AFFECTING URINATION
CONTINUED
4. MUSCLE TONE
– Weak abdominal and pelvic floor muscles impair
bladder contractions and control of the external
urethral sphincter
– Poor control of micturation can result from:
• Muscle wasting caused by prolonged immobility
• Stretching of muscles during child birth
• Menopausal muscle atrophy
• Damage to muscles from trauma
 FACTORS AFFECTING URINATION
CONTINUED
5. FLUID BALANCE
• The kidneys maintain a sensitive balance
between retention and excretion of fluids.
• If fluids and concentration of electrolytes and
solutes are in equilibrium, an increase in fluid
intake causes a causes an increase in urine
production.
• Ingested fluids increase the body’s circulating
plasma and more urine is produced.
 FACTORS AFFECTING URINATION
CONTINUED
6. SURGICAL PROCEDURES
– The surgical patient is usually in altered state
before surgery due to the disease process or
preoperative fasting which aggravates reduction in
urine output
– Anaesthetic and narcotic analgesics may slow
glomerular filtration rate, reducing urine output
– Surgery of lower abdominal and pelvic structures
can impair urination because of local trauma to
surrounding tissues.
 FACTORS AFFECTING URINATION
CONTINUED
7. MEDICATIONS
• Diuretics prevent reabsorption of water and
certain electrolytes to increase urine output
• Some drugs promotes retention of urine such
as anticholinergics example atropine,
antihistamines, anti-hypertensives example
Aldomet,
ALTERATIONS IN URINARY ELIMINATIONS

• Clients with urinally problems most commonly

have disturbances in the act of micturition that
involve a failure to store urine or a failure to empty
urine
• These disturbances result from impaired bladder
function, obstruction to urine out flow, or inability
to voluntarily control micturition
• Some clients may have permanent or temporary
changes in the normal pathway or urinary
excretion.
 1. Urinary retention
• Is the marked accumulation of urine in the
bladder as a result of the inability of the
bladder to empty
• Urine continues to collect in the bladder ,
stretching its walls, causing feelings of pressure,
discomfort, tenderness over the symphysis
pubis, restlessness, and diaphoresis (sweating)
• The alert client has severe pain as the bladder
distends beyond its normal capacity
 Urinary retention continued
• In severe urinally retention, the bladder may
hold as much as 2000-3000mls or urine.
• Retention occurs as a result of:
– Urethral obstruction due to pregnancy
– Surgical trauma
– Medication side effects
– anxiety
 2. Lower urinary tract infections
• Bacteria in the urine (bacteriuria) may lead to the
spread of organisms into the blood stream and
kidneys leading to sepsis.
• Micro organinsms most commonly enter the
urinally tract through the ascending urethral route.
• Women are more susceptible to infection because
of the proximity of the anus to the urethral meatus
and because of the short urethra
 Lower urinary tract infections cont’d
• Older adults with progressive underlying
disease or decreased immunity are at risk.
• In men prostatic secretions that contain an
antibacterial substance and the length of
urethral meatus reduce the susceptibility to
infections
• In a healthy person with good bladder
function organisms are flushed out during
voiding
 Lower urinary tract infections cont’d
• The most common cause of UTIs are
– the introduction of instruments into the urinally
tract eg urinally catheter,
– poor personal hygiene(common in women)
• Inadequate hand wshing
• Failure to wipe from front to back after voiding or
defecating and
• Frequent sexual intercourse expose women to
infections especially with multiple parteners
• Clients with UTI’s have
– Pain or burning during urination (dysuria) as urine
flows past inflammed tissues
– Fever, chills
– Nausea and vomiting
– Malaise develops as infections worsens
– Frequent and urgent need to void (caused by
inflammed bladder).
 3. Urinally incontinence
• Is the involuntary loss of urine
• It can be temporary or permanent
• The client can no longer control the act of
micturition
• Leakage of urine may be continous or
intermitent
• It may develop in people of all ages but is
more common in older adults
 Urinally incontinence cont’d
• Continued episodes of incontinence create a
potential for skin breakdown (acidic character
of urine is irritating to the skin)
– The immobilised client who has frequent
incontinence is especially at risk for pressure
ulcers.