V. Medical Management
The management of urinary incontinence falls into four broad categories: behavioral techniques, devices, medications and surgery.
The behavioral techniques include strengthening the muscle of the pelvic floor with:
• Bladder training (urinating on a schedule)
• Kegel exercise (voluntary contraction of the pelvic floor muscles)
• Regulating bowels to avoid constipation
• Quit smoking to reduce coughing and bladder irritation
• Avoid alcohol and caffeinated beverages, which can overstimulate the bladder
• Avoid foods and drinks that may irritate the bladder like spicy foods, carbonate beverages and citrus fruits and juices
• Keep blood sugars under goo control if diabetic
Devices in the forms of catheters, if the behavioral methods fail or are found unacceptable.
• Catheters must be managed with great care to avoid infection and stone formation.
• Patient can use clean intermittent catheterization for problems with emptying the bladder.
• Condom catheter may be used when men prefer a drainage system.
• Patient must be taught to take the same care to avoid infection as with other catheters.
Drugs commonly used to treat incontinence include:
• anticholinergics (calm an overactive bladder so they may be helpful for urge incontinence)
• antidepressants (it causes the bladder muscle to relax, while causing the smooth muscles at the bladder neck to contract)
• hormone replacements (are effective after menopause; a drop in estrogen can contribute to changes in the skin lining the urethra and vagina which can contribute to the development of incontinence)
• antibiotics (can be used if the incontinence is because of a UTI or an inflamed prostate gland)
VI. Nursing Diagnosis
• Impaired urinary elimination
• Deficient knowledge related to self-care and risk prevention
VII. Nursing Management
• Administer prescribed medications, which may include antibiotics for treatment of infection.
• Assess the client’s medication regimen for any drugs that could cause or contribute to incontinence.
• Discuss and prepare the client for surgical correction for stress incontinence, if indicated (e.g. vaginal repair, abdominal suspension of the bladder)
• Provide health education on measures to prevent UTIs.
• Provide pain relief.
• Promote measure to decrease physiologic and psychologic complications of urinary incontinence.
Examples:
1)Maintain skin integrity. Protect the client’s skin by keeping the perineal area drr. Change clothing and bed linens as necessary.
2)Promote measures to maintain fluid and electrolyte balance.
3)Promote measures to ensure adequate nutrition.
4)Provide an environment that promotes easy access to the bathroom, supply a bedpan or urinal within easy reach, and advise the client to select clothing that is easy to remove when using the toilet.
5)Promote client and family coping
6)Refer the client for psychological evaluation as appropriate.
• Provide bladder training, if indicated. Teach the client to do perineal and Kegel exercises to help improve muscular control, as appropriate. The exercises can be done lying, sitting, or standing as follows:
Examples:
1)Contract the perineal muscles as though stopping urination.
2)Sustain contraction for 5 to 10 seconds and release.
3)Perform 10 to 15 sets of repetitions each daily.