incontinence of urine


incontinence

 [in-kon´tĭ-nens] 1. inability to control excretory functions.2. immoderation or excess. adj., adj incon´tinent.bowel incontinence 1. fecal incontinence.2. a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as a state in which an individual has a change in normal bowel habits, with involuntary bowel movements.continuous incontinence continuous urinary leakage from a source other than the urethra, such as a fistula.fecal incontinence (incontinence of the feces) inability to control defecation" >defecation; both physiologic and psychological conditions can be contributing factors. Called also encopresis and bowel incontinence. See also elimination, altered" >bowel elimination, altered. Physiologic causes include neurologic sensory and motor defects such as those occurring in stroke and spinal cord injury; pathologic conditions that impair the integrity of the sphincters, such as tumors, lacerations, fistulas, and loss of sensory innervation; altered levels of consciousness; and severe diarrhea. Psychological factors include anxiety, confusion, disorientation, depression, and despair.
There is potential for physical and psychological stress when a person is unable to control his or her bowel movements. Damage to the integrity of the skin and its breakdown into ulcers" >pressure ulcers is always a possibility no matter how hard caregivers might try to keep the patient clean and dry. Psychologically the person is likely to suffer from loss of self-esteem and is certain to experience some alteration in self-image. From the time of toilet training a person is expected to be able to handle the tasks of bowel elimination. An adult who for some reason is no longer able to do this is often embarrassed by and ashamed of the inability to perform this most basic of self-care activities.Patient Care. Assessment of the problem of fecal incontinence should be extensive and thorough so that a realistic and effective plan of care can be implemented. Sometimes all that is needed is a regularly scheduled time to offer the patient a bedpan or help using a bedside commode or going to the bathroom. If diarrhea is a problem it may be that dietary intake needs changing or tube feedings are not being administered correctly. Dietary changes may also help the patient who has a stoma leading from the intestine. In cases of neurologic or neuromuscular deficit, retraining for bowel elimination is a major part of rehabilitation of the patient. Frequently, it is possible to help a patient achieve control by means of a well-planned and executed bowel training program.
Biofeedback techniques can be helpful in many cases. The person learns to maintain higher tone in the anal sphincter through use of a balloon device that provides feedback information about pressures in the rectum. With practice the person can learn better control and develop a more acute awareness of the need to defecate.functional incontinence incontinence due to impairment of physical or cognitive functioning.functional urinary incontinence a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as an inability of a usually continent person to reach the toilet in time to avoid the unintentional loss of urine. See also incontinence" >urinary incontinence.overflow incontinence (paradoxical incontinence) incontinence" >urinary incontinence due to pressure of retained urine in the bladder after the bladder has contracted to its limits; there may be a variety of presentations, including frequent or constant dribbling or symptoms similar to those of stress or incontinence" >urge incontinence.reflex incontinence the incontinence" >urinary incontinence that accompanies hyperreflexia" >detrusor hyperreflexia.reflex urinary incontinence a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as an involuntary loss of urine at somewhat predictable intervals, whenever a specific bladder volume is reached. See also incontinence" >reflex incontinence.risk for urge urinary incontinence a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as the state of being at risk for involuntary loss of urine associated with a sudden strong sensation of urinary urgency. See also incontinence" >urge urinary incontinence.severe stress urinary incontinence severe stress incontinence as a result of incompetence of the sphincter mechanism.stress incontinence incontinence" >urinary incontinence due to strain on the orifice of the bladder, as in coughing or sneezing.stress urinary incontinence a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as loss of urine of less than 50 ml when there is increased abdominal pressure. See also incontinence" >stress incontinence.total urinary incontinence a nursing diagnosis accepted by the Seventh National Conference on the Classification of Nursing Diagnoses, defined as a state in which an individual has continuous and unpredictable loss of urine; see also incontinence" >urinary incontinence.urge incontinence (urgency incontinence) urinary or fecal incontinence preceded by a sudden, uncontrollable impulse to evacuate (see also urgency). Urge incontinence of urine is a major complaint of patients with urinary tract infections" >urinary tract infections and is also present in some women two or three days before onset of the menstrual period.urge urinary incontinence a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as the involuntary passage of urine soon after feeling a strong sense of urgency to urinate; see also incontinence" >urge incontinence.urinary incontinence (incontinence of urine) loss of control of the passage of urine from the bladder; see also enuresis. It can be caused by pathologic, anatomic, or physiologic factors affecting the urinary tract, as well as by factors entirely outside it. See also elimination, altered" >urinary elimination, altered.Patient Care. The Agency for Health Care Policy and Research (AHCPR) convened an interdisciplinary, non-Federal panel of physicians, nurses, allied health care professionals, and health care consumers that has identified and published Clinical Practice Guidelines for Urinary Incontinence in Adults. Identification and documentation of urinary incontinence can be improved with more thorough medical history taking, physical examination, and record keeping. Routine tests of lower urinary tract function should be performed for initial identification of incontinence. There are also situations that require further evaluation by qualified specialists.
The guidelines provide an informed framework for selecting appropriate behavioral, pharmacologic, and surgical treatment and supportive services that can be used to treat urinary incontinence. The panel concluded that behavioral techniques such as bladder training and pelvic muscle exercises are effective, low cost interventions that can reduce incontinence significantly in varied populations. Surgery, except in very specific cases, should be considered only after behavioral and pharmacologic interventions have been tried. The panel found evidence in the literature that treatment can improve or cure urinary incontinence in most patients. The address of the AHCPR is Agency for Health Care Policy and Research, P.O. Box 8547, Silver Spring, MD 20907. They can also be called toll free at (800) 358-9295.

in·con·ti·nence of u·rine

the involuntary voiding of urine into clothing or bedclothes. A common problem in old people, especially those in long-term care facilities, which may be due to neurologic abnormalities, loss of sphincter function (especially common in multiparous women), chronic bladder outlet obstruction, or loss of cognitive functions.

incontinence

(in-kont'in-ens) [L. incontinentia, inability to retain] 1. Loss of self-control, esp. of urine, feces, or semen.2. Loss of neurological or psychological control, e.g., of habits, speech, or of the appetites for food or sex.

active incontinence

A discharge of feces and urine in the normal way at regulated intervals but involuntarily.

anal incontinence

fecal incontinence.

fecal incontinence

Failure of the anal sphincter to prevent involuntary expulsion of gas, liquid, or solids from the lower bowel. Synonym: anal incontinence See: encopresis

functional urinary incontinence

Inability of a usually continent person to reach the toilet in time to avoid unintentional loss of urine. Urinary incontinence (UI) affects about 30% of older adults living at home and about 50% of those in nursing care facilities. Women are more likely than men to develop UI. UI can result in physical problems such as skin breakdown, but it also causes emotional problems such as embarrassment, frustration, depression, and loss of self-esteem, which may lead to social isolation, loss of independence, and even institutionalization.

Patient care

Health care professionals should make questions about incontinence a routine part of taking a patient's history because the patient may be too embarrassed to report the problem without prompting. The type of episodes experienced should be documented and how long the problem has been present. Many factors may be involved, including neurologic disorders, urinary tract infection, adverse drug effects, irritants such as artificial sweeteners, caffeine, certain foods, and decreased muscle tone. Physical examination should follow up on the problem, and a urologic consultation may be warranted.

Functional UI may afflict older adults who have normal bladder control but have a difficult time getting to the toilet because of problems that interfere with mobility, e.g., arthritis, Parkinson disease, or stroke. Environmental factors (such as clutter, lack of ready access to facilities, distance to the toilet) may also play a part. Health care professionals should assess the patient’s fluid intake to be sure he or she is drinking enough and should review his or her medication regimen to determine if any of the drugs affect continence. The patient should be encouraged to use the toilet on a planned schedule (upon arising, before and after each meal and at bedtime, and as adjusted to his or her needs). For patients living independently, walkways should be kept free of clutter, and, if necessary, a commode placed closer to the person’s living space.

giggle incontinence

Involuntary passage of urine induced by laughter. The condition occurs commonly in young girls and women but tends to improve in the second or third decade of life. It is distinct from stress urinary incontinence, which usually begins after menopause. See: stress urinary incontinence

intermittent incontinence

Loss of control of the bladder upon sudden pressure or movement.

incontinence of milk

Galactorrhea.

overflow incontinence

Incontinence characterized by small frequent voidings due to leakage of small amounts of urine spilling from an overfilled bladder, or to a bladder with pathologically decreased volume.

Patient care

Overflow incontinence is more common in men than in women and requires further evaluation because it may be triggered by diabetes mellitus, multiple sclerosis, spinal injury, or benign prostatic hypertrophy. Sterile intermittent catheterization or an indwelling urinary catheter may be prescribed because retained urine can lead to infection and other complications. Male patients may benefit from alpha-adrenergic antagonists such as prazosin and terazosin, which decrease bladder outlet resistance and improve emptying. Patient, family, home health aides, and long-term-care health care assistants involved with the patient’s care should be taught about adverse reactions to these drugs, which need to be observed for and reported and include postural hypotension, palpitations, headache, nausea, and dizziness. If the patient feels dizzy while taking medications for incontinence, he or she should be advised to sit or lie down and taught to change position slowly. The patient should not drive or operate machinery of any kind until he or she knows how the drug affects his or her safety and mental alertness.

Coping strategies for overflow incontinence include allowing enough time for toileting and providing external collection devices such as a urinal or external (condom) catheter at night. Teaching the patient to perform a Credé method (applying gentle pressure above the symphysis pubis in a downward direction with the blade of the hand) may increase emptying. Assessing residual urine with a portable noninvasive bladder ultrasound scanner, and following with intermittent catheterization if the residual amount is above specified limits, can assist the patient in learning to empty the bladder.

overflow urinary incontinence

Involuntary loss of urine associated with overdistention of the bladder. See: overflow incontinence

paralytic incontinence

The constant voiding of small amounts of urine and feces owing to stroke or other central nervous system disorders.

passive incontinence

A form of urinary incontinence in which a full bladder allows urine to drip away upon pressure instead of emptying normally.

reflex urinary incontinence

An involuntary loss of urine at somewhat predictable intervals when a specific bladder volume is reached.

risk for urinary urge incontinence

Risk for involuntary loss of urine associated with a sudden, strong sensation or urinary urgency.

stress urinary incontinence

Abbreviation: SUI
Sudden leakage of urine with activities that increase intra-abdominal pressure.

Diagnosis

Direct observation of urine loss while coughing is a reliable method of establishing this diagnosis. Laughing, sneezing, lifting a heavy object, and exercising are other triggers. The urine should be cultured to rule out urinary tract infection. Ultrasound of the bladder after the patient voids establishes the residual urine volume and helps rule out retention with overflow. Stress urinary incontinence should be investigated to ensure that it is not caused by a structural abnormality.

Treatment

In addition to using devices to absorb urine that escapes, therapy consists of behavioral modification, pharmacological treatment, and surgical management. Behavioral therapy includes bladder training, timed voiding, prompted voiding, and pelvic muscle (Kegel) exercises. Pharmacotherapy includes oxybutynin hydrochloride, propantheline bromide, and imipramine hydrochloride. Surgery may restore anatomic support of the urethra or compensate for a poorly functioning urethral sphincter. The American Urological Association considers sling procedures and retropubic suspensions the most effective surgeries long term. The transvaginal tape (TVT) sling procedure is performed as outpatient surgery under local anesthesia with a small vaginal incision and two small suprapubic incisions. The sling supports the urethra during stress and the increases in intra-abdominal pressure that occur during routine activities. See: bladder drill; Kegel exercise

Patient care

The patient is taught Kegel exercises to strengthen pubococcygeal muscles and encouraged to practice the exercises at frequent intervals throughout the day, as well as during urination (by stopping and starting the urinary stream intermittently). The vulva and introitus should be kept clean and dry and free from free. Commercial barrier products should be used to protect clothing. To avoid the social isolation and depression that may result from this condition, the patient should be encouraged to continue or resume usual activities while using protective barriers. The patient's response to the exercise regimen is periodically evaluated. If conservative therapies are ineffective, surgery may be recommended to improve not only the urinary problem but also the patient’s quality of life. Postoperative precautions include: avoid lifting objects weighing 15 lb (6.8 kg) or more for 3 months; avoid driving for 1 to 2 weeks; avoid strenuous exercise (running, cycling) for 4 to 6 weeks; avoid tub baths for 4 weeks (may shower immediately); refrain from sexual intercourse for 4 weeks. Oral analgesics are prescribed for discomfort expected during the first 24 to 48 hr. Continued or increasing pain, blood in the urine, or painful or difficult urination should be reported.

total urinary incontinence

Continuous and unpredictable loss of urine.

urge urinary incontinence

Involuntary passage of urine occurring soon after a strong sense of urgency to void. Drugs that inhibit the detrusor muscle of the bladder, such as oxybutynin, can be used as treatment.

Patient care

Healthy older adults may develop urge incontinence, but it also can affect those who have suffered a stroke or who have Alzheimer disease, Parkinson disease, multiple sclerosis, or diabetes mellitus. Bladder retraining and Kegel exercises should be the first therapies for urge incontinence. The patient should maintain a regular toileting schedule, beginning with every 1 to 2 hr, then gradually increasing the time between voiding. Keeping a diary of fluid intake, urine output, and any episodes of incontinence helps the patient and the primary health care provider recognize patterns and revise the regimen as needed. The patient should carry out Kegel exercises when the urge to void starts because these exercises help strengthen perineal muscles, which may provide the patient more time to reach the toilet. Anticholinergic drugs, such as oxybutynin and tolterodine, that inhibit the detrusor muscle of the bladder can be prescribed. Patients should be aware of potential adverse effects, which include confusion, dry mouth, dry eyes, urinary retention, constipation, and blurred vision.

urinary incontinence

Abbreviation: UI
Intermittent or complete absence of ability to control loss of urine from the bladder. It is a problem that affects about 25% of women over 60 and may have significant impact on social, occupational, and psychological functioning.

Treatment

Therapy will depend upon the cause. Information on this subject may be obtained from Health for Incontinent People at 800-251-3337.

 Synonym: incontinence of urine See: Kegel exercise

incontinence of urine

Urinary incontinence.