Factors Influencing Urinary Elimination

Polyuria-Increased frequency of micturition
Oliguria-Urine output is less than 30 mL/hr or urine output 100-500 ml/day
Anuria-Absence of urine output or <50 mL/day
Hematuria-blood (RBC) in urine
Pyuria-Pus cells in urine

Volume- An amount of 1000-2000 ml of urine excreted in 24 hour.
Color- The normal urine is pale yellow or amber in color.when the quantity of urine is increased,the color becomes pale yellow and when the quantity of urine decreased,the color becomes deep yellow
Appearance-The normal urine is clear with no deposit.
Odour- The normal urine has an aromatic odour
Reaction- Reaction of normal urine is slightly acidic
Specific gravity- it varies from 1.016 - 1.025 with a normal fluid intake.

Factors Influencing Urinary Elimination

The urine output depends majorly on the age of a person. The amount of urine excreted is different for differe age groups. For instance, infants and adults have different urine output.

A. Developmental Factors

Infants- usually amount of voiding is 15 to 60 ml a day after birth,increasing to 250-500 ml a day.An infant may urinate as often as 20 times a day.it is colorless and odour less and has a specific gravity of 1.008.infants are born without urinary control.
Preschoolers- Pre-schoolers is able to take responsibility for independent toileting. Enuresis-involuntary passage of urine Nocturnal enuresis or bed wetting is the involuntary passing of urine during sleep.
School Age Children- Their elimination system reaches maturity
Older adults- The excretory function of kidneys diminishes with age.due to decreased kidney’s filtering ability,decreased muscle tone and contractility of detrusor muscle,decreased reabsorptive and secretory capabilities

All these conditions can be improved using behavioral training, habit training and by providing easy approac the commode, bathroom, etc.
For the older adults, surgeries can be suggested by the doctor, or medications can be prescribed
The safety of the room should be maintained.
Provision of assistive devices, such as walker, canes, etc.

B. Psychological Factors-

Anxiety and emotional stress may cause a sense of urgency and increased frequency of urination.anxiety can prevent a person from being able to urinate complety .
Privacy , normal positions,sufficient time can stimulate the micturition reflex.

C. Fluid intake-

If fluid intake is greatly increased,frequency of voiding increases.if fluid intake is decreased,frequency of voiding decreases.ingestion of certain fluids directly affects urine production and excretion .eg:coffee,tea,cola drinks

D. Food intake-

Increase urine production and elimination if foods high in fluid content.eg:fruits,vegetables.
Foods and fluids high is sodium retains water,decrease urine production and elimination.eg:potato chips,pickles
Change the color of the urine:eg beetroots cause urine to appear red.

E. Body position-

Eg:some men find it difficulty to empty their bladder fully into urinal while lying flat in bed

F. Medications-

Many medications such as antidiuretics or diuretics can interfere with the process of volding.

Eg-cholinergics,diuretics cause urinary elimination Anticholinergics,opioid analgesics cause urinary retention Some medicine cause change in color of urine.eg- Red—methyldopa To brown or black-levodopa,ferrous sulphate,ferrous gluconate

G. Muscle tone and activity-

Regular exercise increases muscle tone and metabolic rate. Good muscle tone is necessary to maintain stretch and contractility of muscle tone.

H. Pathological conditions-

Some diseases and pathologies can affect the formation and excretion urine. Eg: Diabetic mellitus,multiple sclerosis,Parkinson’s disease –possible loss of bladder tone. Benign prostatic hyperplasia-may cause urinary retention and incontinence.
Cognitive impairments such as Alzheimer’s disease-lose the ability to sense a full bladder or unable to recall the procedure for voiding
Diabetes insipidus-increases urine production
Neurogenic bladder-The client doesnot perceive bladder fullness and is unable to control the urinary sphincter.

I. Diagnostic procedures-

Eg-Urethra may swell following cystoscopy Surgical procedures on any part of urinary tract may result in post-operative bleeding
A restriction in fluid intake commonly lowers urine output. Surgery of lower abdomen and pelvic structures sometimes impairs urination because of local trauma to surrounding tissue.

J. Socio-cultural factors- Certain life-style behaviours can affect urinary elimination by delaying voiding due to ignoring the urge to void because of: Insufficient time,unavailability of toilet facilities,lack of privacy,inability to assume a normal position Delay in voiding can stretch and weaken the detrusor muscle lead to incomplete emptying of the bladder,residual urine left in the bladder and bladder infection