2. INTRODUCTION
Incontinence is defined as the involuntary loss of
urine and stool that is objectively demonstrable and is
a social or hygienic problem.
It’s affects an individuals physical, physiological and
social well being and is associated with a significant
reduction in quality of life.
Incontinence is of two types –
Urinary incontinence
Fecal incontinence
3.
4. URINARY INCONTINENCE
ANATOMY OF URINARY INCONTINENCE -
The Urinary System also known as the Renal System or Urinary Tract.
Urinary System consist of …..
a) Two Kidney
b) Two Ureter
c) Urinary Bladder and
d) Urethra
The purpose of the Urinary System is to eliminate waste from the body,
regulate blood volume and blood pressure, control levels of electrolyte and
metabolites and regulate blood Ph.
5. KIDNEY - Kidney are two in number, located in left and
right retroperitoneal space(behind the peritoneum). Kidney
are bean shaped organ and as filter to blood to create urine
and situated between last thoracic and 3rd lumbar vertebrae.
URETER - Ureter is a tube like structure attach to kidney
and carries the urine to the bladder.
URINARY BLADDER - It is a muscular sac in the pelvis. The
bladder structure the urine, allowing urination to be infrequent
and controlled.
6. URETHRA - Urethra is the last part of the Urinary System
and it eliminate the urine outside from the body.
7. DEFINITION - Urinary Incontinence is define as the unintentional loss of
urine or inability of the bladder to hold the urine due to loss of voluntary
control over the urinary sphincter resulting in involuntary passage of urine.
CAUSE -
Due to UTI (URINARY TRACT INFECTION)
Prostate cancer in male
Hysterectomy in female
Due to neurological disease. Ex- Stroke
Ageing of bladder muscle
Vaginal delivery can weaken the muscle needed for bladder control.
8. SYMPTOM -
Problem of controlling the urine.
Involuntary leakage of urine specially when you cough or sneeze.
Frequent and sudden moderate amount of urine.
RISK FACTOR -
Menopause
Age related change in the urinary tract.
Pregnancy and high impact exercise.
Being overweight and other disease.
10. FACTOR INFLUENCING URINATION
AGE - In the case of infants and children they lack the voluntary
control over the bladder , because they don’t have well developed
urinary system but adult individuals have voluntary control over the
micturition.
DIET/FLUID INTAKE - Food and fluids that are rich in caffeine and
alcohol increase the urinary output.
EXERCISE - It enhance the muscle tone which leads to the gall
bladder contraction and healthy elimination.
MEDICATION - Certain medication like Diuretics increase the
urinary output.
11. CONTINUE….
ENVIRONMENT - Client’s experience incontinence generally
during winter time as compared to summer time.
PSYCHOLOGICAL FACTOR - Anxiety and emotional stress
increase frequency of urination.
DISEASE CONDITION - Many disease affect the ability to
micturate. Ex... Diabetes mellitus.
OTHER CONDITION - In case of the pregnancy due to increase
in the size of uterus, can exert pressure on the bladder.
12. PATHOPHYSIOLOGY OF URINARY INCONTINENCE
Incontinence of the bladder occur when those pelvic muscle that involve in
urination get traumatized, either overstretched or tear, that leads to
weakness of the muscle.
As the goes by the muscle become weaker until at certain point, they can
not support the bladder anymore.
When there is high pressure from the abdominal such as coughing,
sneezing, lifting or pushing heavy things, the bladder forces urine to pass
the urethral sphincter causing incontinence to occur.
13. CLINICAL MANIFESTATION –
1. SENSORY SIGN –
• Order of urine of feces in the room
• Soiling of undergarments or bed linen
• Irritation of perineal area
• Accidents while engaged in physical activity, sneezing
2. EMOTIONAL SIGN –
• Anger
• Decline in social activity
• Desire for attention
14. DIAGNOSTIC EVALUATION –
• Physical Examination – no identify pelvic muscle prolapse
• Urinalysis and urine culture – no identify infection
• Spinal MRI
• Ultrasonography
• Cystrourethrography
• Vaginal and examination pad test
15. ASSESSMENT –
• Carefully assess environmental factors for their potential impact on the urinary
incontinence
• Dietary habits such as excess caffeine intake or insufficient fluid intake.
• Physical examination and specific diagnostic test also aid in identifying urinary
incontinence
• The PVR (Post Void Residual) can be measured by the use of portable ultrasound
device that scan the bladder.
16. MANAGEMENT ….
MEDICAL MANAGEMENT –
PESSARY - It is a prosthetic device that can be inserted into vagina to
support its internal structure, often used in case of urinary incontinence
and a vaginal or pelvic organ prolapse
Urinary Seal – Strong flexible adhesive creates a positive seal with urinal.
It is made up of flexible PVC and move with urinal.
Urinary Insert – Small plugs inserted in urethra to prevent urinary
incontinence.
Condom Catheter – It fits over the penis or vagina. It is connected to
urobag for urine.
17.
18. Urinary Catheter and Urobag – Urinary catheter is a hollow flexible to be
inserted into the bladder through urethra and connected to urobag, it
collects urine.
Pharmacology Therapy – Anti-cholinergic agents like oxybutynin
dicyclomine.
To inhibit detrusor muscle contraction
Tricyclic antidepressant like Imipramine or doxepin
Estrogen
Calcium channel blockers
19. MANAGEMENT….
SURGICAL MANAGEMENT –
• Surgical procedure involves lifting and stabilizing bladder or urethra vesicle angle.
• Periurethral bulking is also done and in this agent like artificial collagen is injected in
urethral wall to close urethral opening to prevent avoiding.
NURSING MANAGEMENT –
• A number of measure can be employed to help reduce the problem of incontinence.
• Formulate a schedule and definite timing for the patient and try to empty the bladder. Use
toilet or commode and use or not to void.
• Instruct the patient to drink a measure amount of fluid at regular intervals.
20. PERINEAL EXERCISE –
• These increase the tone of perineal and abdominal muscle periodic tightening of the
perineal muscle intentionally shopping and then starting the urine stream etc. can help in
gaining voiding control.
• Arrange for the toilets or bedpan within easy reach of the patient as delay in responding is a
common cause of incontinence.
BLADDER TRAINING PROGRAMME –
• An exercise programme started to strong then the involved muscle. The patient is placed on
the commode or toilet every 2 hrs depending on the frequency of micturition the interval are
lengthened as the programme.
• Skin care should be done to prevent infection.
21. COMPLICATIONS –
• Skin Problem – Rashes ,skin, infections, sores can develop
from constantly wet skin
• Urinary Tract Infection – Incontinence increase risk of
repeated urinary infection
• Impact on personal life – Urinary incontinence can affect
social work and personal relationships.
22. 1. NURSING DIAGNOSIS –
RISK FOR FLUID VOLUME DEFICIT RELATED TO ALTERED URINARY
OUTPUT
INTERVENTIONS –
• Weigh patient daily
• Take accurate input and output measurements
• Place all parenteral therapy on an infusion pump
• Monitor amount and characteristics of urine
• Auscultate heart and lung sounds every shift
23. 2. NURSING DIAGNOSIS –
IMPAIRED SKIN INTEGRITY RELATED TO CONSTANTLY WETTING OF SKIN
INTERVENTIONS –
• Demonstrate good skin hygiene example wash thoroughly and pat dry carefully
• Instruct family to maintain clean dry clothes preferably cotton fabric.
• Educate patient about proper skin care.
24. 3. NURSING DIAGNOSIS –
ACTIVITY INTOLERANCE RELATED TO INVOLUNTARY PASSAGE OF URINE
INTERVENTIONS –
• Assess the time and amount of micturition
• Instruct patient to use the toilet at specific time
• Teach bladder control exercise example kegal exercise
• Encourage patient to participate in activities of daily living
• Provide appreciation and positive reinforcement to the patient
25. 4. NURSING DIAGNOSIS –
DEFICIT KNOWLEDGE RELATED TO UNFAMILIARITY WITH THE NATURE AND
TREATMENT OF URINARY INCONTINENCE
INTERVENTIONS –
• Asses the clients knowledge level
• Encourage patient to ask queries and doubts related to disease condition
• Listen patiently to all questions
• Provide appropriate information regarding the treatment regimen.
26. 5. NURSING DIAGNOSIS –
FEAR AND ANXIETY REALATED TO DISEASE CONDITION
INTERVENTIONS –
• Patient listen to all concerns of the patient
• Encourage to ask questions & queries from the patient and relatives
• Explain the disease condition and treatment regimen to the patient
• Make sure all doubt are cleared and patient feels calm and confident
27. PATIENT TEACHING……
Nurse need to educate the patient and relatives about –
• Limit/control water intake.
• Checking drinking habits.
• Eat, fruits, vegetables and whole grains daily to prevent constipation.
• Stop smoking, because nicotine irritates the bladder.
• Urinate every 3 to 6 hrs to retain bladder.
• Person should perform kegal exercise
• Care of skin – skin should be kept and clean to prevent infection.
• Maintain body weight – Observe people have risk advised to take healthy diet and regular
exercise.
29. FAECAL INCONTINENCE
DEFINITION –
• Faecal incontinence is defined as the inability to defer the elimination of liquid or solid
stool until there is a socially acceptable time and place to do so.
• Minor incontinence - it is the inadvertent escape of flatus or partial soiling of
undergarments with liquid stool.
• Major incontinence – it is the involuntary excretion of faeces.
Prevalence of faecal incontinence in elderly –
• After age of 65yrs –
• 15% in community dwelling women
• 45% in nursing home residents.
• Many patients are embarrassed and do not report their physician.
30. ANATOMY OF FECAL INCONTINENCE
THE RECTUM – It is a hollow muscular tube , 12 to 15cm long , composed of a
continuous layer of longitudinal smooth muscle that interlaces with the underlying
circular smooth muscle.
THE ANAL CANAL – The length of the anal canal is about 4cm (3-5cm) with two third
of this being above the pectinate line and one third below it.
• The rectum contains three distinctive semilunar mucosal folds, which help to
maintain its capacitance.
• The rectum can accommodate up to 300ml without any significant increase in
intraluminal pressure.
• The anal mucosal folds, together with expansive anal vascular cushions, provide a
seal.
31. RISK FACTOR –
• Age, depression, dementia, neurological disease, immobility
• Constipation
• Female sex, vaginal parity and a history of operative vaginal
delivery
• Women with pelvic floor dysfunction( urinary incontinence
and/ or pelvic organ prolapse).
32. ETIOLOGY –
• Structural abnormality
• Change faecal volume and consistency
• Altered mental control
• Neurological disease
33. CLINICAL ASSESSMENT –
• Stool diary and clinicals feature –
• This history should initially focus on whether facial incontinence is truly
present and its severity.
• True incontinence must be differentiated from frequency and urgency
without loss of bowel contents, which can occur in the setting of
inflammatory disease, irritable bowel syndrome, and pelvic irradiation.
34. PATHOPHYSIOLOGY –
• Faecal incontinence results from conditions that interrupt or disrupt
the structure or function of the anorectal unit.
• Common causes include and sphincter weakness neuropathies
both peripheral and generalised, disorder diarrhoea, facial
impaction with overflow and behaviour disorder.
35. TREATMENT -
• Diet and Lifestyle
• Control faecal impaction
• Bowel Training
• Anal sphincter and pelvic floor exercise
• Biofeedback
• Anal continence plug
36. 1. NURSING DIAGNOSIS –
ALTERED BOWEL ELIMINATION PATTERN RELATED TO LACK OF
VOLUNTARY SPHINCTER CONTROL AS EVIDENCED BY PATIENT’S INABILITY
TO CONTROL PASSAGE OF STOOL
INTERVENTIONS –
• Asses the bowel pattern of the patient
• Identify the causes behind altered bowel elimination pattern
• Try to understand the modification of behaviour of the patient
• Administer medications as prescribed by the physician
37. 2. NURSING DIAGNOSIS –
IMBALANCED NUTRITION LESS THAN BODY REQUIREMENT
RELATED TO DIETARY RESTRICTION
INTERVENTIONS-
• Assess the nutritional status of the patient.
• Check his dietary habits.
• Calorie and high fibre diet has to be provided,
38. 3. NURSING DIAGNOSIS –
RISK FOR IMPAIRED SKIN INTEGRITY RELATED TO INVOLUNTARY PASSAGE OF FECES
INTERVENTION –
• Assess the hygienic condition of the patient’s skin
• Maintain the hygiene and cleanliness around patient
• Frequent assessment can detect sign and symptoms of possible infection
39. PATIENT TEACHING –
• Limit/ control food intake
• Checking eating habits
• Eat fruits, vegetables and whole grains to prevent constipation
• Do squatting to strengthen the muscle
• Preventing UTI
• Maintain body weight
• Care of skin
