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 CVAs, arthritis, Parkinsons
• 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, Crohns 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 enemas
• 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