Voiding Dysfunctions renal 2 a Flashcards
VOIDING
DYSFUNCTIONS
Urinary Incontinence
Urinary Retention
Urinary Catheterisation
Bladder Emptying
• Otherwise known as voiding, micturition, or urination. • Controlled by muscles and nerves. • Learned behaviour - not present at birth. • Muscle and nerve control
Adult Dysfunctional Voiding Patterns:
- Urinary incontinence
* Urine retention I
Urinary Incontinence (UI)
“Involuntary uncontrolled leakage of urine”
UI is normal in infants
- Reflex voiding occurs when bladder stretch receptors are activated.
- Internal sphincter prevents dribbling of urine between voids as it does in adults
Urinary Incontinence (UI) occurs
“UI occurs when bladder pressure exceeds urethral closure pressure. Anything that interferes with bladder or urethral sphincter control can result in UI.”
Causes of Urinary Incontinence (UI)
• Emotional problems • Physical pressure during and after pregnancy • Surgery • Nervous system problems • Medical conditions • Not a natural consequence of ageing
Causes can include
DRIP
D delirium, dehydration, depression R restricted mobility, rectal impaction I infection, inflammation, P polyuria, polypharmacy (
Types of Urinary Incontinence (UI)
Stress incontinence • Urge incontinence • Overflow incontinence • Reflex incontinence • Functional incontinence
Interventions for Urinary Incontinence (UI)
Lifestyle modifications - including fluid management, good bowel regimen, weight reduction, quit smoking • Scheduled voiding regimens • Pelvic floor muscle rehabilitation – exercises, vaginal muscle training, biofeedback, electrical stimulation • Anti-incontinence devices • Containment devices • Pharmacological therapy • Surgical therapy
Pelvic floor muscle (Kegel) exercises
- Pelvic floor muscles provide support for bladder and rectum
- Pelvic floor exercises:
- Otherwise known as Kegel exercises
- Series of exercises designed to build up muscles of pelvic floor
- Can be done anytime, anywhere
• Exercises consist of:
“Squeeze and lift” of pelvic floor muscles (hold for 8 seconds) then “let go”
ØRest for about 8 seconds between exercises
ØRepeat up to 8 – 12 times
ØPlan to do training 3 times a day
UI Pharmacological Therapy
Muscarinic receptor antagonist and
anticholinergic
a-adrenergic antagonists
a-adrenergic agonists
Muscarinic receptor antagonist and
anticholinergic
Oxybutynin
• Tolterodine
Reduce overactive bladder contractions in urge urinary
incontinence and overactive bladde
a-adrenergic antagonists
• Alfuzosin
• Terazosin
Reduce urethral sphincter resistance to urinary outflow
a-adrenergic agonists
• Pseudoephedrine
Increase urethral resistance
UI Surgical Therapy
Periurethral bulking
• Collagen injection
• Retropubic colposuspension or
pubovaginal slings
Urinary retention
Inability of the bladder to empty completely
Acute urinary retention
total inability to pass urine (medical emergency)
• e.g. post operative patients
Chronic urinary retention
incomplete bladder emptying despite urination
Post-void residual (PVR):
amount of urine left in the bladder after voiding (50 – 100mls)
Causes include: Urinary retention
§ Bladder outlet obstruction – prostate enlargement
§ Deficient detrusor (bladder muscle) contraction strength – neurological diseases,
diabetes mellitus, over-distention, chronic alcoholism, medications (e.g. anticholinergic
drugs)
Urinary retention
The problem – urinary retention can
chronic infection
Nursing measures to promote normal urinary elimination
§ Catheterisation
§ Drug therapy (Parasympathomimetic - Bethanecol)
