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URINARY ELIMINATION ( RETENTION AND INCONTINENCE)
RETENTION OF URINE: DEFINITION
Urinary retention is an accumulation of urine resulting from an inability of the bladder
to empty properly.
Inability to empty the bladder completely or incompletely.
In urinary retention the bladder is unable to respond to the maturation reflex and thus is
unable to empty.
ETIOLOGTY:
Urethral obstruction Surgical and childbirth trauma Some medication side effects (eg; antispasmodics, antidepressants, sedatives, narcotics etc..) Heavy metal poisoning (lead, mercury). Acute neurological injury causing sudden loss of mobility such as spinal shock.
SIGNS AND SYMPTOMS :
Difficulty in starting to urinate Difficulty in fully emptying the bladder Weak dribble or emptying the bladder Inability to feel when bladder is full Increased abdominal pressure Lack of urge to urinate Nocturia Strained efforts to push urine out of the bladder
INVESTIGATION :
Renal function test
Ultra sound for abdomen
X rays KUB( kidneys, ureter, bladder)
Cystoscopy
ASSESSMENT :
Perform a focused physical assessment including perineal skin integrity
Inspection , percussion and palpation of the lower abdomen for obvious bladder distention.
Determine the urinary residual volume by catheterizing the patient immediately after urination or
by obtaining a bladder ultrasound following micturition.
COMPLICATION :
Bladder damage Kidney failure Bladder stones Hydronephrosis
MANAGEMENT :
Assess the severity of retention
Provide privacy
Provide a warm bed pan or urinal
Foster the muscles relaxation by providing necessary physical support to the client and by
relieving pain
Local application of heat to the perineum and lower abdomen by pouring water or by the
application of the hot water bottles or by a sits bath can foster muscle relaxation and thereby the act of micturition.
Micturition is a conditioned response. Running water, within the hearing of the client or flushing
the toilet stimulating the micturition reflex.
Gentle massage of the lower abdomen activates micturition reflex.
Provide enough time for micturition
Reassurance and emotional support are helpful to reflex of the client
A hot enema, if permitted may relieve the retention of the urine
Give more fluids unless contraindicated. Simple diuretics such as lemon drinks, warm water are
given plenty to induce urination.
INCONTINENCE
5) Overflow incontinence: involuntary loss of urine at intervals without sensation of urge to
void It may be due to secondary effect of some drugs, fecal impaction or neurological conditions. Classification based on emptying of bladder: a. Complete : it indicates total emptying of the bladder b. Incomplete : it refers to the dribbing of the bladder without total drainage of the bladder.
PATHOPHYSIOLOGY
CLINICAL FEATURES:
Sudden urination and urinary urgency
Incontinence of the bladder occurs when those pelvic that involves in urination get traumatized , either overstretched or tear , that leads to weakness of the muscles. As time goes by, the muscles become weaker until at certain point, they cannot 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 past the urethral sphincter causing incontinence to occur.
Bladder never feels empty.
Urine dribbles even after voiding.
Frequent urination, in a day and at nighttime.
ASSESSMENT AND DIAGNOSIS:
To collect full and detailed history about the problem, previous medical and surgical history. Physical examination Abdominal roentgenogram Computerized tomography ( CT) Intravenous pyelogram ( IVP) Ultrasound Cystoscopy for to visualize the bladder. Blood test ( calcium, glucose, blood urea nitrogen, creatinine ) Urine culture –to identify infections, proteins etc To maintain the bladder diary is the recommended tool to collect information regarding UI.
MANAGEMENT:
prompted voiding : Establish a regular voiding schedule for the client. Habit training: Advice to maintain shorter voiding intervals for 2 to 3 hours. Bladder training: An exercise programme is started to strengthen the involved muscles Exercise: Increase the physical activity. This will improve the muscle tone, thus helping the client to control voiding. Teach perineal muscles and kegel exercise: periodic tightening of the perineal muscles, intentionally stopping and then starting urine stream etc…. Diet care: Suggest drinking decaffeinated tea and non-citrus fruit juices (grape, apple, etc..) Encourage to minimize fluid intake after evening meal. Skin care: The major physical problem caused by incontinence is skin irritation. The skin should be kept clean and neat. If clothing or bedding gets wet, changes them immediately.
Prevention of infection:
Teach to cleanse perineal area, wiping front to back , after each voiding or incident urine leakage. SURGICAL MANAGEMNT (surgery procedure for stress incontinence ) Colposuspension Sling surgery Vaginal mesh surgery(tape surgery) artificial urinary sphincter (surgery procedure for urge incontinence) Botulinum toxin A injection
