Module 3 Causes Of Urinary Incontinence

Transcription

1 Causes Of Urinary Incontinence V4: Last Reviewed September 2017

2 Learning Outcomes Appreciate the numerous requirements and skills necessary for the person to achieve and maintain urinary continence Discuss some of the changes that may occur in the urinary system during the normal ageing process Have a knowledge of the various causes of urinary incontinence

3 Section 1 Remaining Continent

4 Remaining Continent To remain continent people need to be able to: Recognise the need to use the toilet Be motivated to use the toilet Identify and locate an appropriate place Be able to physically get there Hold on until the toilet is reached Adjust clothing Pass urine once there (Eustice et al in Getliffe and Dolman, 2007)

5 Remaining Continent To remain continent people need to have the following in good working order: Bladder Urethral sphincter Pelvic floor Nervous system Cognition Musculoskeletal system

6 Causes of Urinary Incontinence: Factors to Consider There are so many factors that can influence the ability to achieve and maintain continence While most cases of urinary incontinence will have a physiological cause, other factors such as the environment, social and psychological influences cannot be overlooked when considering why someone has become incontinent

7 Section 2 Causes of Urinary Incontinence

8 Common Terms Nocturnal Enuresis: Involuntary loss of urine during sleep Overflow incontinence: The bladder does not empty completely and leaks urine Reflex incontinence: Involuntary loss of urine, urge to micturate is absent and causing unpredictable voiding Stress incontinence: Leakage of small amounts of urine when coughing, laughing and sneezing

9 Common Terms Trigone: Triangular area between the left and right ureteric openings and internal urethral opening Trigonitis: Inflammation of the trigone area of the bladder Urge incontinence: Urgent need to micturate followed by sudden urine leakage Urgency: Sudden urge to pass urine which is difficult to defer Urethritis: Inflammation of the urethra

10 Causes of Urinary Incontinence Age Related Psychological Behavioural Related Causes of Urinary Incontinence Social Health Related Environmental

11 Section 3 Age Related Changes

12 Age Related Changes In module one the myth that ageing and incontinence go hand in hand has been dispelled Urinary incontinence, whilst not an inevitable part of ageing, can be associated with ageing because the older person is more predisposed to physiological, pharmacological and psychological risk factors which may impact on their ability to maintain continence (Getliffe and Dolman, 2007) For many older people, maintaining continence is like walking a tightrope: the smallest of physiological or psychological change can send the person crashing down into incontinence (Nazarko, 2013, p66)

13 Age Related Changes Kidney Bladder Function Physiological effects of ageing on continence Urethra Immune System Prostate

14 Age Related Changes to the Kidney Age Related Changes Kidneys become smaller, lighter, and the number of nephrons (functioning kidney cells) is reduced. Older kidneys are less sensitive to ADH (anti-diuretic hormone) Effects On Continence Reduced ability to concentrate urine can lead to nocturia if co-existing with other cognitive or physical impairments (Nazarko, 2013) Increased night time urine production Reduced ability to concentrate urine

15 Age Related Changes to the Bladder Age Related Changes Bladder capacity reduced Amount of fibrotic tissue increases, bladder wall can become stiff and holds less There is poor contractility during voiding Reduced bladder sensitivity due to loss of sensation of the afferent nerves Effects On Continence Urgency and urge incontinence Increased residual urine (amount of urine left in the bladder after voiding) can lead to incontinence and urinary tract infections Older adults are not aware of the desire to void until their bladders are 90% full (Nazarko, 2013) If the older person has mobility or dexterity impairment this can lead to incontinence

16 Age Related Changes to the Urethra Age Related Changes The hormone oestrogen affects the female urethra. Urethral walls become less soft and tissue becomes thin after menopause, which leads to decreased urethral closing pressures. Urethra and trigone become oestrogen sensitive Effects On Continence Stress incontinence (involuntary leakage on effort or exertion) Lack of oestrogen can cause urethritis, trigonitis, atrophic vaginitis, leading to symptoms of urgency, frequency and dysuria

17 Age Related Changes to the Prostate Age Related Changes Prostatic enlargement occurs with age. Also known as BPH (benign prostatic hyperplasia). Effects On Continence May lead to incomplete bladder emptying, urethral obstruction, frequency, urgency, risk of urinary infections

18 Age Related Changes To The Immune System Age Related Changes Effects On Continence Altered immune function Increased likelihood of recurrent urinary tract infections

19 Section 4 Bladder Irritants and Behavioural Factors

20 Bladder Irritants Food and drink that can function as bladder irritants and precipitate urgency and uninhibited bladder contraction: Tea Coffee Hot chocolate Green tea Cola and other fizzy drinks Citrus fruits and juices Chocolates Tomatoes Spicy foods Sweetener substitutes that contain aspartame Alcohol acts as a sedative and a diuretic and can predispose some individuals to incontinence Taking too little fluid can cause an increase in the concentration of urine which can irritate the bladder and cause frequency, urgency and urinary tract infections (Thomson & Smith, 2002; Newman & Wein, 2005; Wyman et al, 2009).

21 Behavioural Factors High impact exercise that involves repeated sudden increases in abdominal pressure can lead to weakening of the pelvic floor musculature Smokers may develop a chronic cough which increases intra-abdominal pressure and pelvic floor weakening The incidence of urinary incontinence is higher in persons with a higher body mass index (BMI) >25kg/m2 Women with BMI >30kg/m2 are more likely to develop new onset urinary incontinence or over active bladder (Dallosso et al cited in Chirstofi and Hextall, 2007) The extra weight can cause straining, stretching and weakening of the pelvic floor muscles

22 Section 5 Health Related Causes

23 Health Related Causes Neurological Medication Genetic/ Hereditary Stool Impaction Health Related Causes Reduced Mobility Pregnancy/ Childbirth Effects of Surgery Endocrine Disorders Infection

24 Health Related Causes Continence issues can occur in individuals who suffer neurological damage or disease Neurological The particular disorder which occurs will depend on which area of the central nervous system is affected For example, lesions of the cerebral cortex may cause the cortical inhibitory control to be lost or impaired and may be associated with increased bladder activity resulting in urgency, frequency and incontinence e.g. multiple sclerosis, stroke or dementia The brain stem coordinates bladder contraction and sphincter relaxation, damage to the micturition centre in the pons can cause hesitancy and difficulty in voiding leading to overflow incontinence Damage either at or below the sacral spinal cord can cause loss of or impaired motor nerve supply to the bladder, the detrusor is unable to contract resulting in incomplete bladder emptying e.g. diabetes, pelvic surgery, post radiation treatment for prostate cancer

25 Health Related Causes Effects of Surgery Previous surgical interventions e.g. gynaecological, colorectal, neurological or urological can damage the muscles, fascia (sheath of connective tissue enclosing muscles) and pelvic nerves that support the bladder and cause urinary incontinence Pregnancy/ Childbirth Damage to the pelvic floor muscles, and/or pudendal/pelvic nerve damage during delivery, especially vaginal births can result in stress urinary incontinence

26 Health Related Causes Reduced Mobility Reduced mobility may be due to an acute event e.g. illness, accident or may be worsening of an underlying condition for example arthritis which makes it more difficult to actually reach the toilet in time Diabetes insipidus: deficiency of the anti-diuretic hormone (ADH), where urine volume cannot be Endocrine Disorders regulated and large volumes of urine can be passed daily Diabetes mellitus can cause damage to the peripheral nerves, and may also cause polydipsia (abnormal thirst) with a consequent large urinary output (polyuria)

27 Health Related Causes Medication There are numerous medications which can affect the urinary system and it is important that nurses have a basic awareness of these medications. Please refer to the reference module to see a list of the common prescribed medications that can alter bladder and urinary function. These medications may need to be adjusted or stopped and advice should be sought from your doctor. Some over the counter tablets can cause urinary symptoms too, such as decongestants and antihistamines.

28 Section 6 Recap

29 Recap As a healthcare professional caring for the person with urinary incontinence, it is important to understand the causes are multi-factorial and may be related to transient conditions such as infection, constipation or maybe long-term such as neuromuscular problems In some cases there may be more than one cause and a thorough continence assessment will help diagnose the type and cause of urinary incontinence

30 Assessment Test your knowledge of this module by using the interactive quiz in step two of the elearning tool A certificate will be available on a pass rate of 80% or over Good luck!

31 Section 7 References

32 References Christofi, N., Hextall, A. (2007). An evidence-based approach to lifestyle interventions in urogynaecology. Menopause International. 13 (4), Eustice, S., Kennedy, M., Haslam, C. (2007). Vulnerable groups. In Getliffe, K., Dolman, M. (Eds). Promoting Continence A Clinical and Research Resource. 3rd Ed. London: Bailliere Tindall. Getliffe, K., Dolman, M. (2007). Promoting Continence A Clinical and Research Resource. 3rd Ed. London: Bailliere Tindall. Nazarko, L. (2013 ) Urinary incontinence: providing respectful, dignified care. British Journal of Community Nursing. 18 (2), Newman, D.K., Wein, A.J. (2005). Overcoming Overactive Bladder. Your Complete Self-Care Guide. New Harbinger Publications: Oakland CA. Thompson, D. L., Smith, D. A. (2002). Continence Nursing: A Whole Person Approach. Holistic Nursing Practice. 16 (2): Wyman, J.F., Burgio, K. L., Newman, D.K. (2009). Practical aspects of lifestyle modifications and behavioural interventions in the treatment of overactive bladder and urgency urinary incontinence. International Journal of Clinical Practice. 63 (8):