Nursing approaches for urgency and Urge Incontinence Lucy Keedle, CNS Urology/Continence, MidCentral DHB, Palmerston North

The International Continence Society “Urgency is the complaint of a sudden compelling desire to pass urine, which is difficult to defer, usually associated with frequency and nocturia.”

Symptoms- Urinating more than eight times per day or more than once at night (urinary frequency) and a strong and sudden desire to urinate (urinary urgency).

Behavioural modification Bladder diary Flows and scans positive reinforcement, lifestyle changes containment Toileting programme Education Pelvic floor exercises Diet and fluid management Biofeedback, triggers,

Limitations of behavioural modification Motivation of patient and clinician Skill and understanding of the condition by the clinician Understanding clues Workup investigations

Investigations Urinalysis- signs of infection and haematuria Post void residual Frequency volume chart Severity of urgency Quality of life Women- vaginal state

Assessment Urinary history- duration, timing, volume, triggers, other symptoms, fluid intake, medication, previous treatments, surgery, containment Cognition Mobility dexterity

Habit changes (managing symptoms and promoting bladder health) Lifestyle modification Diet, fluid, bowel and weight management; smoking cessation Timed voiding or prompted voiding Deferment techniques

Lifestyle interventions A trial of caffeine reduction is recommended. Consider advising modification of high or low fluid intake. A body mass index greater than 30 should be advised to lose weight. Management of faecal impaction

Bladder training Bladder training/timed voiding/prompted voiding for urge incontinence Improving quality and access to toilet facilities and improving mobility, particularly in residential care, continuing care settings, schools and public places

Bladder training Reviewing existing medication as some drugs may precipitate or exacerbate incontinence e.g. diuretics, analgesics All patients should have a periodic review of their initial assessment to monitor the effectiveness of their treatment/management plan and to ensure there is adequate clinical improvement Provision of pads

Conservative management A trial of supervised pelvic floor muscle training of at least 3 months’ duration should be offered as first-line treatment Bladder training lasting for a minimum of 6 weeks should be offered as first-line treatment

Behavioural therapies timespan- If cognitively impaired, prompted and timed voiding toileting programmes are recommended as strategies for reducing leakage episodes. An anticholinergic should be offered to patients with OAB or Urge treatment if bladder training alone has been ineffective.

Urgency can be graded: (Urge Perception Score) There are 2 types of urgency: Type 1 – Sensory urgency an intensification of the normal urge (69%) Type 2 – Motor urgency/OAB that can be classified by urodynamic assessment (31%) • 0: NONE – no urgency. • 1: MILD – awareness of urgency, but it is easily tolerated and you can continue with your usual activity or tasks. • 2: MODERATE – enough urgency discomfort that it interferes with or shortens your usual • 3: SEVERE – extreme urgency discomfort that abruptly stops all activity or tasks.”