Urinary retention and incontinence

URINARY SYSTEM DISORDERS ARE ONE OF THE MOST PREVALENT GROUP OF DISORDERS THAT NEEDS A THOROUGH UNDERSTANDING. THE MOST BASIC OF THEM ARE URINARY RETENTION AND INCONTINENCE. THIS PRESENTATION DEALS WITH A BRIEF OVERVIEW OF THE DESCRIPTION, CAUSES, DIAGNOSIS AND MANAGEMENT OF THESE DISORDERS IN AN ILLUSTRATED MANNER.

1. URINARY RETENTION AND INCONTINENCE GEETA JOSHI STATE COLLEGE OF NURSING

2. URINARY RETENTION I nability to void even when the urge to void is present.

3. CAUSES OF RETENTION OTHER CAUSES tumor Interference with the sphincter muscles during surgery side effect of medications

4. SYMPTOMS OF RETENTION frequency of urination, voiding small amounts Pain Palpation of a distended bladder above the symphysis pubis

5. DIAGNOSIS check for residual urine- 1.bladder scan ( The bladder scan uses ultrasound waves to identify the amount of urine remaining in the bladder. This method is preferred because it is noninvasive, decreasing the risk of urinary tract infection (UTI ).) 2. inserting an intermittent straight catheter ( can also be used to empty the bladder of the remaining urine increases the client’s chance of contracting a UTI .) The amount of urine left in the bladder, residual urine , should be less than 50 mL .

6. TREATMENT analgesics -to help the client relax. Cholinergic medications - to promote contraction of the bladder muscle, which promotes bladder emptying. Antispasmodic medications - encourage relaxation of the bladder muscle consequently decreasing the urge to void. urinary catheter may be used to empty the bladder surgery may be performed to remove any obstruction (stones, strictures, tumors, etc.).

7. URINARY INCONTINENCE involuntary loss of urine from the bladder

8. TYPES

9. STRESS INCONTINENCE Stress incontinence occurs when there is an involuntary leakage of urine due to activities that strain the pelvic floor muscles. Activities such as coughing, laughing, jogging, dancing , sneezing, lifting, and walking can all contribute to stress incontinence.

10. MANAGEMENT OF STRESS INCONTINENCE

11. Surgical procedures PURPOSE-to restore the support of the pelvic floor muscles or to reconstruct the sphincter. internal mesh support of the urethra formation of a urethral sling to elevate and compress the urethra implantation of an artificial sphincter. support prostheses and external barriers

12. URETHRAL SLING

13. INTERNAL MESH SUPPORT

14. ARTIFICIAL URETHRAL SPHICTER

15. cuff is placed around the urethra when inflated it increases pressure on the urethra and keeps it closed. patient wishes to pass urine, he presses the control pump fluid in the cuff moves into the balloon reservoir releases the pressure around the urethra, allowing the urine to flow out. cuff refills on its own with fluid from the balloon reservoir

16. Pelvic floor exercises ( Kegel exercises) PURPOSE- to strengthen the muscles, thereby preventing or minimizing stress incontinence.

17. BLADDER RETRAINING Bladder retraining begins with- assessing the client’s ability to recognize the urge to void completion of a 3-day voiding pattern history . Once a voiding pattern has been established , encourage the client to void 30 minutes before the projected time of incontinence. The schedule is extended until the client can stay dry for 2 hours, gradually increasing the time between voidings until a 3- to 4-hour schedule is achieved.

18. URGE INCONTINENCE occurs when a person is unable to suppress the sudden urge or need to urinate . The bladder muscles send strong signals to the brain indicating that it is time to void regardless of the amount of urine in the bladder . The client is unable to control the strong signals and consequently leaks urine without any warning.

19. CAUSES OF URGE INCONTINENCE irritated bladder urinary tract infections Neurologic dysfunction Uninhibited detrusor contraction

20. TREATMENT OF URGE INCONTNENCE Anticholinergic medications- to relax the smooth muscle and increase bladder capacity . Treatment of infection Increasing fluid intake- to prevent infection

21. OVERFLOW INCONTINENCE When the bladder becomes so full and distended that urine leaks out, it is called overflow incontinence .

22. CAUSES OF OVERFLOW INCONTINENCE Blocked urethra Bladder weakness Diabetes alcohol , decreased nerve function Enlarged prostate

23. TREATMENT OF OVERFLOW INCONTINENCE surgical removal of the prostate repair of genital prolapse intermittent self-catheterization

24. FUNCTIONAL INCONTINENCE Functional incontinence occurs as a result of cognitive, neurological, and behavioral malfunctions.

25. MANAGEMENT OF FUNCTIONAL INCONTINENCE behavior modifications bladder retraining programs surgical interventions absorbent padding and undergarments Diligent skin care is necessary to prevent skin breakdown indwelling catheters

26. NOCTURNAL ENURESIS Incontinence that occurs during sleep is called nocturnal enuresis . Limiting fluid intake after 6 p.m. helps the client remain continent during the night. The total fluid intake for 24 hours, however, should remain the same. The bladder should be emptied immediately before going to bed.