Incontinence - Urinary and Fecal NPN 200 Medical Surgical Nursing I

Urinary Incontinence USA- 13 million (85% women) Stress incontinence - most common type Loss of urine when, sneezing, jogging or lifting Common after childbirth and menopause Urge incontinence Inability to suppress the urge to void, may be caused by infection, stroke,, etc. Overflow incontinence Occurs when the muscles in the bladder do not contract and the bladder becomes distended over its capacity Functional incontinence – lack of awareness

Causes of Incontinence Medications - CNS depressants, diuretics, multiple medications Disease – CVA’s, arthritis, Parkinson’s Depression – decreases energy to remain continent, decreasing self worth decreases desire to remain continent Inadequate resources – glasses, canes, may be afraid to ambulate, products to manage are costly, and no one available to help to bathroom Drugs which may cause urinary problems – atropine, benadryl, Theodur can cause urinary retention - Minipress, Artane,( for parkinsons), MS, Valium, Isuprel, Neosynephrine, can cause incontinence

Assessment Questions – Do you leak urine when you cough or sneeze, on the way to the bathroom, or do you wear pads, tissue or use cloths to catch leaking urine? Have patient describe the pattern and volume of urine, and any related symptoms May observe a stale urine odor Assess for distention, may need post void residual, have patient cough while wearing a pad Clean catch urine, post void residual CBC Voiding cystogram, cystoscope , cystometry, uroflowmetry

Medical Treatment Surgery to improve the tone of the sphincter, artificial sphincters, repair cystocele (anterior vaginal repair), retropubic suspension, pubovaginal sling, or other means such as collagen injections Non-surgical management Drug interventions Behavioral interventions Intermittent catheterization Indwelling catheter Penile clamps Pelvic organ support devices (pessary) Drugs – estrogen anticholinergics (pro-banthine, ditropan, bently, detrol (cause dry mouth, may effect intraoccular pressures, and UOP) should increase fiber and fluid for BM’s tricyclic antidepressants – trofranil, pamelor, norparmin cholinergics – Urecholine Beta blockers – Inderol which improves sphincter tone Behavioral – weight reduction exercises – Kegel’s avoid caffeine and alcohol due to diuretic effect Vaginal cones – apply muscle contraction with increasing weight of cones Pessary – inserted into the vagina to give support to the pelvic organs

Interventions Urinary bladder training Urinary habit training Improves bladder function by increasing the bladders ability to hold urine and the clients ability to hold urine and suppress urination Urinary habit training Establishes a predictable pattern of bladder emptying to prevent incontinence for patients who have urge, stress, or functional incontinence Urinary catheterization – intermittent – regular periodic use of a catheter to empty bladder Teach use of incontinent products Bladder training and habit training -Set up time to go to bathroom, -stimulate voiding with water, -no water after 7pm, -encourage fluids, -use depends until training complete, -use external collection devices -give positive reinforcement for work accomplished -provide written info for visual learning Catheterization teach client clean intermittent catheterization May need profhylactic antibiotic therapy for 2-3 weeks Establish an interval of time between caths Keep a record of schedule Teach signs of UTI Teach monitoring for color, odor, and clarity of urine

Potential Complications of Urinary Incontinence Impaired skin integrity Risk for infection Social isolation Low self esteem

Fecal Incontinence Less common Caused by trauma, sphincter dysfunction, childbirth, Crohn’s disease, or diabetic neuropathy Severe diarrhea may cause temporary incontinence May also be R/T impaction

Fecal Incontinence Types Symptomatic Neurogenic Anorectal Usually R/T colorectal disease/may have blood or mucus Overflow Caused by constipation, where the feces fills the entire colon Patient passes semi-formed stool frequently Can be seen in patients with long term laxative use Treat by cleansing over 7-10 days, then work on constipation Neurogenic Patients who do not voluntarily delay defecation Usually with dementia Anorectal Nerve damage which weakens muscles in the pelvic floor Have several incontinent stools per day

Nursing Assessment What is the problem? Identify bowel patterns Identify characteristics Color Clarity Consistency Past problems Perform physical exam Inspect rectal area ? Cramping, pain ? How often and when has BM ? tarry, yellow, green, runny, loose, sticky ? Undigested food ? If dementia, nerve damage, medications, stroke ? Diet, fluid intake, exercise, travel

Treatment/Interventions Provide for regular, scheduled bowel emptying (usually 30 min after eating) Give ordered laxatives or enema’s Teach dietary and fluid requirements Encourage ambulation or activity as tolerated Cleanse and protect perineum after each BM Use depends or fecal pouches when necessary Always encourage patient and be prompt in attending to needs