Incontinence - Urinary and Fecal

1. Incontinence - Urinary and Fecal NPN 200 Medical Surgical Nursing I

2. 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

3. 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

4. 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

5. 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)

6. Interventions • Urinary bladder 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

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

8. 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

9. Fecal Incontinence • Types • Symptomatic • 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

10. Nursing Assessment • What is the problem? • Identify bowel patterns • Identify characteristics • Color • Clarity • Consistency • Past problems • Perform physical exam • Inspect rectal area

11. 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