When we, as healthcare professionals, work with our patients, urinary incontinence is often difficult to identify because, in many cases, the patient might not report being incontinent or the condition itself might not be diagnosed.
Incontinence of bladder and/or bowel results in social isolation, embarrassment, discomfort, and the stigma surrounding incontinence often prevent those affected from discussing options with their healthcare providers, (Landefeld et al, 2008). Before discussing treatment options, however, it is important to understand the definition of urinary incontinence.
Urinary Incontinence is, essentially, an uncontrolled leakage of urine. As the sphincter muscle weakens, the bladder is unable to fully hold urine, and hence, the leakage or involuntary “mictuartion”. Aside from this basic definition, there are distinct types of urinary incontinence:
Stress incontinence – This commonly occurs in women. There is a suspected association with pregnancy and/or childbirth, and perhaps menopause. But, when one laughs, sneezes, or coughs, there is a leakage of urine. This is descriptive of stress incontinence.
Urge incontinence – Urge incontinence is also referred to as: reflex incontinence, and it is common in older adults. It usually occurs at night. It also may be a symptom of a urinary infection in the bladder or kidneys, or may result from injury, illness, or a surgery.
Overflow incontinence – When the bladder is not completely emptied, one can frequently “dribble”- this defines or describes overflow incontinence. Also, it can be an indication of nerve damage from diabetic disease or urethral blockage caused by stones, tumors, prostate enlargement (men) or birth defect (women).
Functional incontinence – In some cases, one is unable to control the bladder before reaching the bathroom. This describes functional incontinence. It is often seen in those with arthritis, Alzheimer’s dementia, or Parkinson’s disease. This condition is brought about by limitations in movement, thinking and communicating. Thus the patient often unable to control bladder before they reach the bathroom.
Mixed incontinence – Sometimes, two types of incontinence can occur together, and this depicts mixed incontinence.
Anatomic or developmental incontinece - Incontinence can also be caused by anatomic or physiologic abnormalities. In this case, the clinical notation is “anatomic or developmental incontinence”.
Temporary incontinence – Incontinence can also be caused by an underling condition or it can be the side-effect of a medication-hence the term: “temporary incontinence”—once the cause is removed, the incontinence subsides.
As nurses, working with patients who struggle with urinary or fecal incontinence, their quality of life can be improved. Nurses, who are advocates for their patients, can promote awareness and a wider view of acceptance. Consider the following care plan implementation for the patient affected by incontinence:
Assessment:
For urinary or fecal incontinence, it is important to first, take a verbal history of the patients’ accounts. A physical examination, urodynamic testing, musculature examination, and a urinalysis are all pivotal parts of the assessment piece. If one already struggles with incontinence, assess the skin around the perineum and rectum for irritation.
Planning:
When planning to care for one who is incontinent, it is important to get a subjective view of the patient’s accounts. A diary of incontinent episodes is also helpful. It is also helpful to encourage the patient to void, or to visit the restroom at scheduled intervals. Encouraging kegel exercises or working with incontinence specialists is also helpful. There is also an array of skin protection products to recommend for the patient.
Implementation:
Have the patient keep a diary of incontinent episodes, and revisit the diary with each assessment. Provide the patient with skin lotions, creams, and wipes.
Evaluation:
During the next visit, or during subsequent visits, asses the efficacy of the creams and lotions. This can involve an objective assessment of the skin and/or it can include subjective accounts from the patient. Urinary Incontinence Nursing Care Plan
When one is incontinent, self-care or caring for the patient is challenging. It can be and is often overwhelming. It is encouraging that there is an array of products available to promote soothing skin care, to protect integrity, and to protect the whole person. These are great for both the patient and the caregiver. The outlined strategies and the recommendation of such products are intended to make managing incontinence easier and less intimidating.
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