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

2. 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.”

3. 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).

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

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

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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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.

14. 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.”