1. Incontinence - Urinary and Fecal
NPN 200
Medical Surgical Nursing I

2. Urinary Incontinence USA- 13 million (85% women)
Stress incontinence - most common type
Loss of urine when, sneezing, jogging or lifting
Common after childbirth and menopause
Urge incontinence
Inability to suppress the urge to void, may be caused by infection, stroke,, etc.
Overflow incontinence
Occurs when the muscles in the bladder do not contract and the bladder becomes distended over its capacity
Functional incontinence – lack of awareness

3. Causes of Incontinence
Medications - CNS depressants, diuretics, multiple medications
Disease – CVA’s, arthritis, Parkinson’s
Depression – decreases energy to remain continent, decreasing self worth decreases desire to remain continent
Inadequate resources – glasses, canes, may be afraid to ambulate, products to manage are costly, and no one available to help to bathroom
Drugs which may cause urinary problems
– atropine, benadryl, Theodur can cause urinary retention
- Minipress, Artane,( for parkinsons), MS, Valium, Isuprel, Neosynephrine, can cause incontinence

4. Assessment
Questions – Do you leak urine when you cough or sneeze, on the way to the bathroom, or do you wear pads, tissue or use cloths to catch leaking urine?
Have patient describe the pattern and volume of urine, and any related symptoms
May observe a stale urine odor
Assess for distention, may need post void residual, have patient cough while wearing a pad
Clean catch urine, post void residual CBC
Voiding cystogram, cystoscope , cystometry, uroflowmetry

5. Medical Treatment
Surgery to improve the tone of the sphincter, artificial sphincters, repair cystocele (anterior vaginal repair), retropubic suspension, pubovaginal sling, or other means such as collagen injections
Non-surgical management
Drug interventions
Behavioral interventions
Intermittent catheterization
Indwelling catheter
Penile clamps
Pelvic organ support devices (pessary)
Drugs – estrogen
anticholinergics (pro-banthine, ditropan, bently, detrol (cause dry mouth, may effect intraoccular pressures, and UOP) should increase fiber and fluid for BM’s
tricyclic antidepressants – trofranil, pamelor, norparmin
cholinergics – Urecholine
Beta blockers – Inderol which improves sphincter tone
Behavioral – weight reduction
exercises – Kegel’s
avoid caffeine and alcohol due to diuretic effect
Vaginal cones – apply muscle contraction with increasing weight of cones
Pessary – inserted into the vagina to give support to the pelvic organs

6. Interventions Urinary bladder training Urinary habit training
Improves bladder function by increasing the bladders ability to hold urine and the clients ability to hold urine and suppress urination
Urinary habit training
Establishes a predictable pattern of bladder emptying to prevent incontinence for patients who have urge, stress, or functional incontinence
Urinary catheterization – intermittent – regular periodic use of a catheter to empty bladder
Teach use of incontinent products
Bladder training and habit training
-Set up time to go to bathroom,
-stimulate voiding with water,
-no water after 7pm,
-encourage fluids,
-use depends until training complete,
-use external collection devices
-give positive reinforcement for work accomplished
-provide written info for visual learning
Catheterization
teach client clean intermittent catheterization
May need profhylactic antibiotic therapy for 2-3 weeks
Establish an interval of time between caths
Keep a record of schedule
Teach signs of UTI
Teach monitoring for color, odor, and clarity of urine

7. Potential Complications of Urinary Incontinence
Impaired skin integrity
Risk for infection
Social isolation
Low self esteem

8. Fecal Incontinence Less common
Caused by trauma, sphincter dysfunction, childbirth, Crohn’s disease, or diabetic neuropathy
Severe diarrhea may cause temporary incontinence
May also be R/T impaction

9. Fecal Incontinence Types Symptomatic Neurogenic Anorectal
Usually R/T colorectal disease/may have blood or mucus
Overflow
Caused by constipation, where the feces fills the entire colon
Patient passes semi-formed stool frequently
Can be seen in patients with long term laxative use
Treat by cleansing over 7-10 days, then work on constipation
Neurogenic
Patients who do not voluntarily delay defecation
Usually with dementia
Anorectal
Nerve damage which weakens muscles in the pelvic floor
Have several incontinent stools per day

10. Nursing Assessment What is the problem? Identify bowel patterns
Identify characteristics
Color
Clarity
Consistency
Past problems
Perform physical exam
Inspect rectal area
? Cramping, pain
? How often and when has BM
? tarry, yellow, green, runny, loose, sticky
? Undigested food
? If dementia, nerve damage, medications, stroke
? Diet, fluid intake, exercise, travel

11. Treatment/Interventions
Provide for regular, scheduled bowel emptying (usually 30 min after eating)
Give ordered laxatives or enema’s
Teach dietary and fluid requirements
Encourage ambulation or activity as tolerated
Cleanse and protect perineum after each BM
Use depends or fecal pouches when necessary
Always encourage patient and be prompt in attending to needs