1. Urinary incontinence in elderly

3. Outline
1- introduction
2- definition
3-Potential factors contributors urinary
incontinence
4-Classification of Urinary Incontinence

4. 5- Types of Urinary Incontinence
6- Urinary incontinence is common in elderly
7- Complication of urinary incontinence
8-Role Of the Nurse

5. Introduction
-Urinary incontinence (UI)the loss of bladder controls common
among elderly people and can have significant consequences for
those affected and their caregivers.
-This condition is associated with falls, pressure injuries, social
isolation, depression, and caregiver stress
-Prevalence rates are highest among women

6. Definition
Urinary incontinence is the involuntary loss of
urine, Urinary incontinence is a symptom and not
a disease, and is cause a social or hygienic
problem.

7. Potential Factors Contributors Urinary Incontinence
A-Physical:
 Mobility problems
 Urinary tract infections
 Obesity
 After-effects of a stroke
 Enlarged prostate gland (in men)
 Neurological conditions
 Severe constipation/impaction
 Poor fluid intake/high caffeine
 Medication ( diuretics)

8. B-Emotional
 Anxiety and stress
 Changes in lifestyle
 Worry about ‘having an accident’
 loss of self-esteem and self-confidence
 Mental health decline (dementia symptoms)

9. C-Environmental:
 Lack of easy access to a toilet
 Inadequate lighting and heating in the toilet
 Lack of handrails and aids
 Inability to get out of bed at night
 Concern about any lack of privacy/dignity
 Unsuitable clothing

10. Classification of Urinary Incontinence:
1-Transient:
The “DIAPPERS” is used to recall possible causes
1) Delirium
2) Infection – Urinary (symptomatic)
3) Atrophic urethritis/vaginitis
4) Pharmaceutical/Prostate
5) Psychological, especially depression
6) Endocrine (or excess fluid intake/output)
7) Restricted mobility
8) Stool impaction

11. 2-Persistent or Established incontinence:
If leakage persists after transient causes of incontinence have
been addressed, established incontinence due to lower urinary
tract causes must be considered

12. Types of Urinary Incontinence:

13. 1-Stress incontinence:
Is the leakage of urine during conditions that
increase intra-abdominal pressure such as exercises,
lifting heavy objects, laughing, sneezing or coughing

14. 2-Urge incontinence:
Is characterized by a sudden , unable to hold back
the urine long enough to reach a toilet .is likely to
occur after removal of indwelling Catheter.

15. 3-Overflow incontinence:
Is defined as leakage of small amount of urine from an
overly full bladder often seen in older men with benign
prostatic hyperplasia.

16. 4- Functional incontinence :
Usually occur because presence something block the
way to toilet
poor relationship between elderly and his environment

17. 5- Mixed incontinence:
Both stress and urge incontinence, usually one of the
two symptoms is more prevalent

19. Urinary incontinence is common in elderly because of:
1- Bladder capacity is decreased
2- the post void residual volume (PVR) may increase.
3- The bladder muscle shows more overactivity with
aging.
4- reduced ability to delay voiding

20. Complication of urinary incontinence:
A) Physical:
1-This area includes personal discomfort
2-Skin irritation , bed sore
3-Premature use of catheterizations
4-Increased risk of urinary tract infections
5-falls and Restricted mobility.

21. B) Psychosocial :
1-feelings of shame
2-loss of self-esteem and confidence
3-restriction of social activity
4-risk of early institutionalization
5-Isolation
6- Depression

23. Role of the nurse:
1-Assessment
History taken
-Continence (onset-duration-frequency)
-Precipitating factors (sneezing-coughing)
-Bowel habits
-Medication review: medications that affect continence as
diuretics, narcotics, ca-channel blockers.
-Psychiatric disorder

24. 2-Physical examination:
*Physical examination :is important for excluding Transient
causes.
*Neurological examination: helps identify delirium, dementia,
stroke, Parkinson's disease, spinal cord compression.
*Genital examination :should be performed for all incontinent
women , should be inspected for signs of atrophic vaginitis
*Rectal examination check for fecal impaction.

25. *Urine analysis
* Urine culture
*blood test
4-Voiding record :
This should be used for 3 to 7 days
Document the time , frequency ,duration and pattern of
incontinence

26. 5-Behavioral techniques include: bladder education/retraining, prompt
voiding, and pelvic floor muscle exercises
* Bladder training : start, the patient is given a measured amount of non-caffeinated
fluids regularly throughout the day totaling of 6-8 cups. The patient is instructed to go
to the toilet after 30 minutes
* Prompted voiding :is often used in frail or cognitively impaired patients
* pelvic floor muscle exercises or Kegel exercises :Patients are instructed
to tighten and hold the contraction for as long as 10 seconds , should be performed
30 – 50 times/day for the exercise to be effective.

27. •
6-Encourage patients to consume six to
eight cups of fluid per day and limit
intake of caffeine and alcohol .
•
7- decrease fluid intake at evening.