Taking a Look at Urinary Incontinence

"There’s a huge stigma around incontinence despite it being so common," she says. "I would urge anyone with symptoms to come forward as it’s more than likely that we can sort out the problem and really improve their quality of life."

This reflection case study will be discussing urinary continence management using Gibbs reflective framework (Gibbs,1988). This will include what is urinary incontinence management, the pathophysiology of urinary incontinence after stroke, how continence affect patient and current clinical practice and the role of the nurse and multi-disciplinary team within continence management. Also using the evidence based research and national guidelines.

Incontinence is one of the major problems faced by the elderly. Nurses can play a significant role in discovering continence problems (Lea R.et.al.2007). Urinary incontinence is the unintentional passing of urine. It is a very common problem and is thought to affect more than 50 million people in the developed world.(NHS.UK). To identify the problem and provide necessary treatment at the early stage, a thorough physical assessment is necessary.

Urge incontinence is defined within the context of overactive bladder syndrome. The overactive bladder is characterized by bothersome urgency (a sudden and strong desire to urinate that is not easily deferred) (Abrams et al, 2002). Overactive bladder is typically associated with frequent daytime voiding and nocturia, and approximately 37% will experience urge urinary incontinence (Stewart et al, 2003).

2011). Incontinence is defined as the complaint of any involuntary loss of urine (urine incontinence) or faecal material (faecal incontinence) or both (double incontinence) (Abrams et al. 2009). Incontinence is a widespread problem in all healthcare settings (Du Moulin et al. 2008; Macmillan et al. 2004). Figures produced by Macmillan et al. (2004) studies on the prevalence of incontinence varied but prevalence was estimated between 10% and 15% for faecal incontinence measured in community-dwelling adults and up to 46% for urinary incontinence measured in older, home-care patients in Du Moulin et al. (2008) studies results. This shows that there is a huge amount of patients at risk for IAD due to them having the risk factor of incontinence. Therefore the prevention of IAD should be paramount in the care of any patients or clients who are at risk for

One scholarly journal I found summarized the conclusion of various intervention studies for the management of incontinence and promotion of continence in care home residents. Once urinary training was implemented in a facility to analyze, incontinence rates, cost of supplies and efficiency ratios, random assignment, patterns of urinary incontinence, urological evaluations to reaffirm effectiveness and pre and post cost of hourly wet/dry checks were all documented to evaluate the program. The study ended with, “managing incontinence and promoting continence in care homes is complex, requiring time and cost-efficient management procedures to contain the problem and deliver quality, achievable care.”(Flanagan et al., 2014) The cost was a major issue that deterred many facilities from executing any sort of bladder training

It is essential for the nurse to have a proper and detailed assessment to determine the most likely cause or type of UI. One of the most basic and least invasive assessment a nurse can do is to obtain a complete history. A complete history must asked questions such as onset and duration, aggravating factors, characteristics, medical history (medical conditions and medications), associated symptoms, attempted treatments and severity (Testa, p. 83). There are also different tools that a nurse can use such as the Urogenital Inventory/ Incontinence Impact Questionnaire and Bladder Diary. Using questionnaires and bladder diary can be used in order to facilitate data gathering for people who have difficulty discussing incontinence face to face. Thorough history can provide insight and help identify potentially reversible causative factors and contributing risk factors related to UI (Mauk, p. 553). It is also important to have a detailed physical assessment, which focused on genitourinary system, abdominal, rectal and neurologic system, in order to determine the pathophysiology of voiding problems. If the nurse suspects any cognitive impairment from the initial assessment Mini Mental State Examination, Mini- Cog, and/or Confusion Assessment Method can be used to determine the severity of the cognitive impairment. It also alerts the healthcare provider for the patient’ increased risked for constant incontinence and it also determines the appropriate interventions. Having a comprehensive assessment will help the healthcare provider to diagnose and establish proper

More serious, but rarely, bladder burst will be resulted in when you are holding too long. Bladder bursting happens mostly to people who already have a damaged bladder, such as pelvic injury. Tyche Brahe, a Danish astronomer and alchemist in the 16 century, died from a bladder burst. Based on the report, “He refused to leave a banquet to relieve himself because he believed it to be a breach of etiquette, but then he found he was unable to pee at all. He descended into delirium and died soon after when his entire bladder burst” (Crew). Although there are scarce instances of bladder bursting that occur on normal people who drink too much alcohol, “the alcohol dampened the signal to their brain that is telling them they needed to pee” (Crew).

Participants completed a survey before each appointment the Incontinence severity index was used to classify the severity of incontinence. Participants were given an incontinence booklet which provided information about pelvic floor exercises, causes of incontinence and what can make incontinence worse. A three-day bladder diary was also used which recorded times and amount of urinary output. Each woman would have three individual sessions with a continence nurse where the women would go through an extensive pelvic floor assessment. This study also considered the quality of life and incontinence severity and used detailed valid measurements for each part of the study fulfilling most of its aims in regards to urinary incontinence. Ethical approval sought and obtained from human research and ethics board of the University of Newcastle.

Patients psychosocial state also needs to be taken into consideration and family involvement is important. The patient may be anxious and worried, the nurse need to maintain professional communication skills to make the care effective. Understanding the importance of neurogenic bladder problems, interventions and complications help in providing theory guided practice with effective outcome.

The NICE (2014) policy details examples of care pathways in the management of fecal incontinence, which can be viewed online as they are subject to update in response to changes in the evidence base However, in terms of chronic fecal incontinence in the elderly, it is probably more pertinent for community nurses to focus on the long term strategy recommendations: Give advice on the preservation of dignity and, where possible, independence, Offer psychological and emotional support, possibly including referral to counselors or therapists if it seems likely that people’s attitude towards their condition and their ability to manage and cope with fecal incontinence could improve with professional assistance, Perform at least a 6-monthly review

For many people, getting older can be difficult because of fear. They worry about what could happen to them or what type of diseases they might develop later on. To become a more mature adult is a stage of life that each individual will experience in a certain point. Statistics shows that eighty-eight percent of those of sixty-five years of age and older have at least one chronic health condition such as diabetes, dementia, Parkinson’s disease or cancer. (ezinearticles.com). This scholarly essay will focus mainly on urinary incontinence (UI) which is a common health problem that elderly may have.

It has some similarities with Barber, Norton, Spivak, and Mulvey (2013) study that examines current and emerging treatments for acute lower uncomplicated UTI among women. After reviewing various studies, Barber et al. came to identify that this problem is heightening and that its biological complexity makes nonpharmaceutical treatment most appropriate.

This study also enquired about other potential risk factors for urinary incontinence including history of smoking

Incontinence, the involuntary release of one’s bowels – whether urinary or fecal – has detrimental effects on relationships. Many people who suffer from it find it difficult to lead normal lives because interacting with friends and family is hard as there is a negative stigma attached to the idea of not being able to control one’s bowels. But as people age, they are more likely to experience incontinence, which leads to an increased number of older people who choose to isolate themselves.