Continence Care Part 4: Management of Urinary Dysfunction

1. Overview of Urinary Dysfunction

This chapter will begin by expanding on symptom identification as noted at the end of the assessment module. Evidence-based definitions will be used for the various forms of urinary incontinence, retention and other mixed-incontinence causes (i.e. neurogenic bladder vs. pelvic floor dysfunction). A more detailed description of damage to sacral and thoracic nerves, which underlie neurogenic bladder dysfunction will be carefully described as it relates to common disease states (stroke/brain injury, multiple sclerosis, SCI, Parkinson’s disease).

2. Urinary Incontinence: Multiple Etiologies and Interventions

This chapter explores the various etiologies of urinary incontinence and describes specific nursing interventions to promote continence for each. Conservative “standard” treatment will first be discussed (dietary modifications, fluid support and timing, perineal hygiene and treatment of underlying UTI). Emphasis is placed on utilizing a tracking tool (the frequency/volume-elimination chart).

3. The Overactive Bladder & Urinary Urgency

This chapter introduces symptoms of overactive bladder (OAB) and techniques to manage (bladder training, urge suppression and anticholinergic medications). Then urinary urgency symptoms will be introduced with recommendations for management. Pharmacologic and additional treatments will be briefly discussed.

4. Stress Incontinence and Pelvic Organ Disorders

Stress incontinence is described (related to pelvic organ prolapse or pelvic floor dyssynergia) with basic nursing techniques to manage symptoms. Techniques will include pelvic floor muscle exercises, leakage management, and recommendations for outpatient follow-up.

5. Functional and Mixed Incontinence

Functional incontinence is often multifactorial in cause and requires a comprehensive assessment of cognitive function, mobility, psychological motivation and proper use of devices. Interventions are more involved and require a multidisciplinary approach. Nursing interventions include timed/prompted voiding. Mixed Incontinence is also often multifactorial and may be attributed to medication side effects. Techniques to manage symptoms are similar to interventions for functional incontinence (most important is a custom, team-oriented approach).

6. Urinary Retention and Neurogenic Bladder

This chapter will describe various underlying etiologies of urinary retention as indicated by PVRs (using bladder scanning) that are consistently greater than 150cc, or if the patient reports no urge sensation to void (common with neurogenic bladder).