Exploration of Nursing Care Strategies for the Management of Urinary Incontinence in Hospitalized Women

Karen A. Blanchette, BSN, RN

Disclosures

Urol Nurs. 2012;32(5):256-259. 

In This Article

Findings

The literature review re vealed five major factors that induce or exacerbate UI. These include: 1) medications that increase episodes of UI, 2) possible causes of transient UI, 3) voiding programs that decrease episodes of UI, 4) dietary bladder irritants that contribute to UI, and 5) use of indwelling urinary catheters. There is no research to suggest that any specific factor is more or less strongly correlated with the frequency of UI episodes; however, it is generally understood that the causes of UI are multifactorial (Landefeld et al., 2008).

Medications That Increase Episodes of Urinary Incontinence

It is necessary for the management of UI that nurses have a basic awareness of medications that affect the urinary system. Finkelstein (2002) identifies a myriad of medications that contribute to UI. Diuretics are commonly used antihypertension medications that increase urine volume. This increase may result in urinary frequency, urgency, and incontinence. Opioids decrease the urge to respond to bladder fullness, leading to overflow incontinence. The sedative effects of tranquilizers, antidepressants, and hypnotics impair bladder contractility, which may cause functional and overflow incontinence (Finkelstein, 2002). Benzodiazepines (anxiolytic sedatives) have been shown to increase the risk of UI among 45% of the population who take these medications (Landi et al., 2002). Other commonly used medications that have been identified as increasing the risk of UI include antihistamines, antispasmodics, antiparkinson agents, angiotensin-convertingenzyme (ACE) inhibitors, calcium channel blockers, and alpha antagonists (Thompson & Smith, 2002). It is important for nurses to have an awareness of the potential for medications to affect the urinary system. This awareness is an important step in the prevention and management of UI.

Causes of Transient Urinary Incontinence

The DIAPPERS acronym (described in Table 2) identifies potential causes of transient UI (Dowling-Castronovo, 2007; Resnick & Yalla, 1985). Delirium, an acute confused state, is transient and reversible. When in a state of delirium, a normally continent individual may experience an incontinent episode. When delirium is treated, the individual is expected to regain continence. Symptomatic infection of the urinary tract may result in urinary frequency and urgency, leading to transient incontinence. Atrophic urethritis and vaginitis are conditions affecting the genitourinary system; when treated with medications, the transient UI should be resolved. Pharmacological treatments for other health-related conditions are associated with adverse side effects that can negatively alter urinary control. The previous paragraph details medications commonly associated with UI. Psychological disorders, especially depression, are known comorbidities to UI. Endocrine disorders, such as diabetes mellitus and diabetes insipidus, in crease urine excretion and the potential for incontinent epi sodes. Restricted mobility related to psychomotor impairments as well as environmental barriers can result in transient UI. Psychomotor impairments that restrict mobility include paralysis or orthopedic fractures. Examples of environmental barriers that restrict mobility in clude physical restraints or a cluttered path to the toilet. Stool impaction can obstruct the urethra, leading to overflow incontinence and urge incontinence. Stool softeners or manual disimpaction can remove the fecal obstruction and relieve or de crease urinary incontinence. As a nurse caring for an incontinent patient in the acute care setting, it is important to understand that the causes of transient incontinence can be multi-factorial. Therefore, the nurse should have the knowledge to assess all possible causes of UI.

Voiding Programs That Decrease Episodes of Urinary Incontinence

While voiding regimens can be tailored to the individual, Hagglund (2010) suggests that timed voiding, in conjunction with additional interventions (such as prompted voiding) are most effective for minimizing episodes of UI. The implementation of timed voiding involves collaboration between the nurse and the patient to agree on predetermined times during which toileting will take place (Hagglund, 2010). Timed voiding is effective for the management of UI among cognitively intact patients who lack the urge to void as well as cognitively impaired patients who are unable to recognize or communicate the urge to void.

Prompted voiding allows patients to respond to the urge to void by independently seeking toileting assistance. With prompted voiding, the patient is encouraged to request help when the urge to void is felt. Unlike timed voiding, prompted voiding is initiated entirely by the patient. Patients receive positive reinforcement for self-prompted voiding. For patients requiring assistance initiating toileting, the nurse should offer the opportunity to toilet every two hours while the patient is awake (Roe, Milne, Ostaszkiewicz, & Wallace, 2007). If the patient's voiding schedule is determined by a voiding diary, voiding assistance should occur in accordance with the patient's schedule (Thompson & Smith, 2002). Other UI management strategies, such as pelvic muscle floor training, surgical intervention, pessaries, electrical stimulation, and habit training, have evidence to support their effectiveness; however, this exploration of managing UI is specifically focused on nursing care strategies, and therefore, does not consider these alternative strategies.

Dietary Bladder Irritants That Contribute to Urinary Incontinence

Research has shown that certain foods can irritate the bladder, leading to UI. Alterations in diet can reduce bladder irritation and minimize episodes of incontinence. Griebling (2009) identifies sugar substitutes, and spicy or acidic foods as bladder irritants. Caffeine and alcohol exacerbate urinary urgency and frequency, which can precipitate an incontinent episode (Griebling, 2009). Maintaining adequate hydration prevents electrolyte imbalances and dehydration. Increasing fluid intake has shown to decrease incontinent episodes (Bottomley, 2000).

Use of Indwelling Urinary Catheters

Indwelling urinary catheters are known to increase the risk of acquiring a urinary tract infection (UTI). According to Pratt and Pellowe (2010), the risk of acquiring a UTI increased 3% to 6% for every day an indwelling catheter is used. By the seventh to tenth day, this risk increases 50%. While the use of indwelling urinary catheters can be a necessary medical intervention, its use should be limited to patients in which the benefits outweigh the risks and should be discontinued when no longer indicated (Pratt & Pellowe, 2010). Infections increase length of stay and decrease opportunities for nurses to recognize incontinence as a problem needing appropriate management (Bradway & Hernly, 1998).

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