Managing Urinary Tract Problem

Lesson-6E

Let us pray: Make the sign of the cross…In the name of

the Father, and of the Son, and of the Holy spirit. Amen
Our Father…

FOCUS on the following

objectives:

Because signs and symptoms of this disorder are vague in many

cases and non-specific in older patients you will need to do the ff:
Good assessment skills to make sure the disorder is identified
promptly.
Adapt interventions and teaching to older patients to help them
treat the problem and prevent recurrence.
 Lesson- 6E: Managing Urinary Tract Problem

Check your knowledge:

DIRECTION: Read and understand carefully the following

questions. Circle your answer.

WHAT ‘S YOUR CHOICE:

1. True or False: One of the potential complications of UI is social isolation.
a. True
b. False
2. A diagnostic test that determine or identifies any bacteria detected by urinalysis.
a. Urinalysis
b. Uroflowmetry
c. Urine culture
3. To prevent urinary incontinence at home, instruct the elderly to
a. Exercise to decrease urine stasis
b. Maintain fluid intake of 1.5 to3L/day
c. Avoid acidic
d. All of the above
4. The causes of UI include the following except;
a. Confusion
b. Depression
c. Certain medications
d. None of the above
5. Types of UI, in which the lower genitourinary tract remains intact, results from mobility
or cognitive impairment.
a. Overflow Incontinence
b. Urge Incontinence
c. Stress Incontinence
d. Functional Incontinence

Let’s move on..

Time to Explore
Activity 1

Check your own Urinary Elimination System:

Kindly mark/ check the question ask?
1. Do you have any problem in voiding? Yes ___ or No___.
2. If NO: How many times did you void in a day?
2 to 4x/day, 2- 8x/day , 3-10x/day or more than 10 /day.
3. What is the color of your urine?
crystal yellow / cloudy yellow / orange yellow
4. How many ml or what is the volume(ml) of your urine.
20cc / 30cc / 40cc / 50cc / 60cc
5. Is there any smell/ odor of your urine?

Essentials Questions? (don’t write)

1. How important is my urinary tract system? What is the role or function it
performs.
2. Does Urinary Incontinence go away?
3. Is UI a disability?

Overview: Managing Urinary Tract Problem

As the body ages, the urinary system undergoes several changes. Bladder muscles
become weaker and bladder capacity decreases; for this reason, the older adult has
more difficulty emptying his/her bladder, leaving more residual volume.
The micturition reflex is delayed. The pelvic diaphragm weakens, especially in
women who have had twins/triplets. IN aging men prostate gland commonly leads
to urinary tract problems.
 incontinence shouldn’t be treated as a normal sign of aging- it’s always a symptom
of an underlying problem. Urinary incontinence occurs twice as many women as
men, and it affects as many as 35 % on non-institutionalized adults over age 60.

Firming Up!
JUST a little DISCUSSION

A. URINARY INCONTINENCE
Loss of bladder control/ Involuntary leakage of urine.
Caused by:
Urinary tract infections, vaginal infection or irritation, constipation.
Medicines can cause bladder control problems that last a short time.
When incontinence lasts longer, it may be due to:

 Weak bladder muscles

 Overactive bladder muscles
 Weak pelvic floor muscles
 Damage to nerves that control the bladder from diseases such as multiple
sclerosis, diabetes, or Parkinson’s disease
 Blockage from an enlarged prostate in men
 Diseases such as arthritis that may make it difficult to get to the bathroom in time
 Pelvic organ prolapse, which is when pelvic organs (such as the bladder, rectum, or
uterus) shift out of their normal place into the vagina. When pelvic organs are out of
place, the bladder and urethra are not able to work normally, which may cause urine to
leak.

Most incontinence in men is related to the prostate gland. Male incontinence

may be caused by:

 Prostatitis—a painful inflammation of the prostate gland

 Injury, or damage to nerves or muscles from surgery
  An enlarged prostate gland, which can lead to Benign Prostate Hyperplasia (BPH), a condition
where the prostate grows as men age.

The condition is associated with falls, pressure injuries, social isolation, depression, and
caregiver stress; it also increases the risk of institutionalization. Or
It can also be associated with medications, treatment, and environmental factors.

Symptoms may include:

Many people experience occasional, minor leaks of urine.
Others may lose small to moderate amounts of urine more frequently.

CLASSIFICATION OF PERSISTENT INCONTINENCE

1. Urge UIncontinence
 -is a sudden strong desire to void accompanied by a leakage of urine.
 one of the most common types of UI in men, increases with age.
 Common precipitants include the sound of running water, arriving home, pulling
down clothes to void, seeing a bathroom sign, exposure to cold, drinking large
amounts of fluid, and the use of certain medications (diuretics and cholinesterase
inhibitors, for example).17 
 Urgency UI can coexist with a condition called detrusor hyperactivity with
impaired contractility, in which contractions don't fully empty the bladder, leaving
a large postvoid residual amount of urine.
2. Stress UIncontinence
 is a sudden leakage of urine associated with activity, such as laughing, sneezing,
coughing, lifting, jumping, or bending.
 results from an inefficient urethral sphincter, which leads to urine loss as a result of
exertional activity.
 This type of UI is common among women of all ages and may occur in men
following prostate surgery.19-21

3. Overflow Incontinence or Incontinence related to chronic retention of urine

 is a frequent, sometimes constant leakage of urine from a too full bladder.
 Refers to urinary leakage resulting from an overfilled and distended bladder.
 This type of UI is frequently caused by bladder outlet obstruction, making it more
prevalent among men who have hyperplasia of the prostate.
4. Mixed Incontinence
In older adults, urgency and stress UI frequently coexist. Referred to as mixed UI, this
condition has a higher incidence rate and is of greater severity among older women than
younger women.22 Management of mixed UI should begin with the most bothersome
symptom.8
5. Functional Incontinence
 occurs with an intact lower urinary tract, as the result of immobility or
cognitive impairment or
 is a result of cognitive, physical, or environmental factors that prevent a person
from voiding appropriately.12
 CONTINENCE – is a learned ability, requiring an intact genitourinary tract, competent
sphincters, adequate cognitive and physical function, motivation, and an appropriate
environment for toileting.

Causes:
Acute Incontinence
Include confusion, dehydration, medications, urethritis, and atrophic
vaginitis.
Symptomatic urinary tract infection (UTI)
Can also result from some endocrine imbalances, such as hypercalcemia and
hyperglycemia.
Restricted mobility or condition that cause urinary retention.
Or depression in older adult.
Urge Incontinence
Is the result of involuntary bladder contractions.
Irritation of the detrusor muscle (the external muscle coating the bladder)
caused by local irritating factors, such as infection, calculi, tumor, or
obstruction.
Hyperactivity of the detrusor associated with cerebrovascular accident,
suprasacral spinal disease, Parkinson’s disease, dementia, and demyelinating
disease.
Stress Incontinence
Is caused by weakened anatomic support in the pelvic floor.
Perinatal trauma, tissue weakening associated with aging, estrogen
deficiency, pudendal nerve damage, and gynecologic trauma from surgery
can cause weakening of the pelvic floor.
Medications (alpha-adrenergic blockers, analgesics, sedatives, and hypnotics
can cause bladder outlet relaxation and incontinence.
Overflow Incontinence
Caused by enlarged prostate- is blocking the urethra, diabetes and spinal cord
injuries.

Factors that increase your risk of developing urinary incontinence include:

1. Gender. 
Women are more likely to have stress incontinence. Pregnancy, childbirth, menopause and normal female
anatomy account for this difference. However, men with prostate gland problems are at increased risk of
urge and overflow incontinence.

2. Age. 
As you get older, the muscles in your bladder and urethra lose some of their strength. Changes with age
reduce how much your bladder can hold and increase the chances of involuntary urine release.
3. Being overweight. 
Extra weight increases pressure on your bladder and surrounding muscles, which weakens them and
allows urine to leak out when you cough or sneeze.
4. Smoking. 
Tobacco use may increase your risk of urinary incontinence.
5. Family history.
If a close family member has urinary incontinence, especially urge incontinence, your risk of developing
the condition is higher.
6. Other diseases. 
Neurological disease or diabetes may increase your risk of incontinence.

Complications of chronic urinary incontinence include:

Skin problems. 
Rashes, skin infections and sores can develop from constantly wet skin.
Urinary tract infections.
Incontinence increases your risk of repeated urinary tract infections.
Impacts on your personal life. 
Urinary incontinence can affect your social, work and personal relationships.

DIAGNOSTIC TEST
1. Urinalysis and urine culture
These tests show whether you have a urinary tract infection (UTI) or blood or sugar in your urine. It
can also show if a man has prostatitis.
2. Bladder stress test
It simulates the accidental release of urine that may occur when you cough, sneeze, laugh, or
exercise. Women may also get a Bonney test. It's similar to the bladder stress test, but the bladder
neck is lifted slightly with a finger or tool inserted into the vagina while the bladder stress is applied.
3. Pad test
This can help show how much urine is leaking. You are given an absorbent pad that has been
weighed. You wear the pad until urine leaks, and then you return the pad to be weighed again. The
increased weight of the pad gives an estimate of how much urine leaked.
4. X-rays or ultrasound
These are used to examine changes in the position of the bladder and urethra when you urinate,
cough, or strain.
5. Urodynamic testing
It is typically done only if surgery is being considered or if treatment has not worked for you. The
tests may include:
6. Uroflowmetry
This test measures your rate of urine flow. A low peak flow rate can be a sign of a blockage or a
weak bladder.
7. Pressure flow studies
This testing measures pressure changes in the bladder as the flow changes. It's often used when the
cause of your symptoms isn't clear. It can help show if the cause may be a blockage or a problem with
the bladder muscles or nerves.
8. Post-void residual volume
This test measures the amount of urine left after you empty your bladder.
9. Cystometry.
This is a series of tests to measure bladder pressure at different levels of fullness.
10. Electromyogram (EMG)
This test records the electrical activity of muscles.
11. Cystoscopic exam
 This is a test that allows your doctor to see inside the urinary tract by using a thin, lighted tube.
12. Cystourethrogram
This is an X-ray of your bladder and urethra while you are urinating.

Let’s go further….

Treatment/ Prevention
Treatment will depend on several factors, such as the type of incontinence, the patient’s age, general
health, and their mental state.

1. Urinary incontinence isn't always preventable. However, to help decrease your risk:
2. Maintain a healthy weight
3. Practice pelvic floor exercises or Kegel Exercise help strengthen the urinary sphincter and pelvic
floor muscles – the muscles that help control urination.
4. Bladder training
Delaying the event: The aim is to control urge. The patient learns how to delay urination
whenever there is an urge to do so. And it helps the patient gradually regain control over their
bladder.
5. Avoid bladder irritants, such as caffeine, alcohol and acidic foods
5. Eat more fiber, which can prevent constipation, a cause of urinary incontinence
6. Don't smoke, or seek help to quit smoking
7. Medication
If medications are used, this is usually in combination with other techniques or exercises.
The following medications are prescribed to treat urinary incontinence:

a. Anticholinergics -calm overactive bladders and may help patients with urge incontinence.
b. Topical estrogen may reinforce tissue in the urethra and vaginal areas and lessen some of the
symptoms.
c. Imipramine (Tofranil) is a tricyclic antidepressant.

8. Medical devices
The following medical devices are designed for females.
Urethral inserts: A woman inserts the device before activity and takes it out when she
wants to urinate.
Pessary: A rigid ring inserted into the vagina and worn all day. It helps hold the bladder
up and prevent leakage.
Radiofrequency therapy: Tissue in the lower urinary tract is heated. When it heals, it is
usually firmer, often resulting in better urinary control.
Botox (botulinum toxin type A): Injected into the bladder muscle, this can help those
with an overactive bladder.
Bulking agents: Injected into tissue around the urethra, these help keep the urethra
closed.
Sacral nerve stimulator: This is implanted under the skin of the buttock. A wire
connects it to a nerve that runs from the spinal cord to the bladder. The wire emits an
electrical pulse that stimulates the nerve, helping bladder control.
 9. Surgery
Surgery is an option if other therapies do not work. Women who plan to have children should discuss
surgical options with a doctor before making the decision.
Sling procedures: A mesh is inserted under the neck of the bladder to help support the urethra and stop
urine from leaking out.
Colposuspension: Lifting the bladder neck can help relieve stress incontinence.
Artificial sphincter: An artificial sphincter, or valve, may be inserted to control the flow
of urine from the bladder into the urethra.
10. Other options
Urinary Catheter: A tube that goes from the bladder, through the urethra, out of the body
into a bag which collects urine.
Absorbent pads: 

Power Booster

Activity 2
1. What are the other nursing interventions you can do to your elderly patient aside from
those mention above.
Give at least 5 more.
2. What is your health teaching, give at least 5.

Time to Reflect
Read and Think

Our body is composed of hundreds of systems working together to keep us healthy and
strong. One of these systems, the urinary system, operates like a plumbing system. The
kidneys, ureters, bladder, and other components work together to produce, store, and
eliminate urine from the body.1 It’s a pretty straightforward process, but is essential for our
body’s maintenance of day-to-day life.
The urinary system is an impressive machine. It works in conjunction with the body 24 hours
a day, 7 days a week. If you think you’re experiencing any problems with your urinary
system, call your urologist immediately. You need a proper diagnosis to ensure that you’re
treating the underlying cause.