Alterations in Urinary Elimination

Alterations in urinary elimination-

  • Polyuria- Production of abnormal large amounts of urine by the kidney.polyuria can follow excessive fluid intake,a condition known as polydipsia.
  • Oliguria-Defined as low urine output usually less than 500 ml a day or 30 ml an hour.
  • Diuresis- It is the another term for production and excretion of large amounts of urine. eg- furosemide, hydrochlorothiazide
  • Anuria- Refers to a lack of urine production,with no effective urinary output.
  • Nocturia- Voiding two or more times at night.
  • Dysuria- It means voiding that is either painful or difficult.
  • Enuresis- Defined as involuntary urination in children.
  • Nocturnal enuresis- Involuntary urination during night.
  • Urinary frequency - Is voiding at frequent intervals,that is more than 4 to 6 times per day
  • Urgency - Is the sudden ,strong desire to void
     

1. Urinary incontinence

  • Urinary incontinence is the involuntary passage of urine.
  • It refers to the inability to control passage of urine.
  • It is a symptom not a disease.
  • It may be temporary or permanent.
  • Leakage may be continuous or intermittent.
  • It may be defined as the leakage of urine from the urinary bladder.

Causes-

  • UTI
  • Surgery
  • Trauma causing sphincter damage
  • STDs
  • Paralysis
  • leakage when coughing,sneezing due to increased abdominal pressure
  • Fecal impaction
  • Old age
  • Effects of certain durgs that lead to lowered voiding sensation.
  • Cognitive impairment
  • Unconsciousness

Types of incontinence and clinical manifestations

  1. Stress incontinence-Involuntary loss of urine through an intact urethra as a result of sudden increase in intra abdominal pressure. It is seen mainly in women who have had vaginal deliveries.Stress incontinence is seen when the body faces any physical stress such as when the client coughs, sneezes or faces a jerk during traveling.
  2. Urge incontinence- Involuntary loss of urine associated with a strong urge to void that cannot be suppressed.
  3. Reflex incontinence- Involuntary loss of urine due to hyper reflexia in the absence of normal sensation .
  4. Overflow incontinence(functional incontinence)- It is the involuntary loss of urine associated with over distention of the bladder.

  5. Mixed incontinence-Involuntary leakage associated with urgency and along with exertion, sneezing, and coughing.

Measures to reduce the problem of incontinence-

  • Establish a regular voiding schedule for the patient.
  • Perineal exercises- these increases the tone of muscles concerned with the micturition, in particular the perineal and abdominal muscles. Periodic tightening of the perineal muscles, intentionally stopping and then starting the urine stream etc. Can help in gaining voiding control.
  • Arrange toilet or bedpan within the easy reach of the patient.
  • Medical and surgical correction of the causative factors.
  • Bladder training program -Includes-Education of the client and support people Bladder training- which requires that the client postpone voiding,resist or inhibit the sensation of urgency and void according to a timetable rather than according to the urge to void.the goal are to gradually lengthen the Interval between urination,to stabilize the bladder and to diminish urgency
  • Habit training-(timed voiding or scheduled toileting) attempts to keep client dry by having them void at regular intervals
  • Skin care
  • Condom drainage

2. Urinary Retention

  • Urinary retention is a condition where your bladder doesn’t empty all the way or at all when you urinate.
  • The state in which one experiences incomplete emptying of the bladder.
  • When the emptying of bladder is impaired,urine accumulates and the bladder becomes over distended.
  • Over distention of the bladder causes poor contractility of detrusor muscle further impairing urination.

Cause-

  • Obstruction of urine flow-( prostate gland enlargement,pregnancy,urethral edema,surgery or diagnostic examinations Alteration in motor or sensory innervation to the detrusor muscle and internal sphincter.eg-spinal cord injury,peripheral nerve trauma,degeneration of peripheral nerves.
  • Infections- including those that affect the urinary tract directly (causing prostatitis, or urethritis) or others like genital herpes that damage the sacral nerve, which controls urinary muscles.
  • Pressure imposed- on the bladder due to pregnancy, any tumor or fecal impaction can lead to urinary retention.
  • Fluid volume deficit- When a person doesn't consume enough fluids, urinary retention may occur. As the intake is less, the urine production is less.
  • Lifestyle- Retention can occur due to changes in the lifestyles. Lack of exercise, hospitalizations, change in home etc can cause retention.
  • Medications- Certain medications suppress urine production and interfere with elimination.Drugs like antihistamines antispasmodics, opiates and tricyclic antidepressants
  • Decreased muscle tone- The muscle tone of bladder is decreased or is absent due to which the bladder cannot contract appropriately. As the bladder contractility is decreased or is absent, it causes problems in micturition.
  • Muscle bladder stimulation- is decreased due to various reasons such as paralysis, alcoholism, etc.

Types Retention of Urinary

1. Acute Urinary Retention
Acute urinary retention develops suddenly and sometimes severely. A person with acute urinary retention is unable to pee even if their bladder is full.

Symptoms of acute urinary retention are characterized by

  • A sudden inability to urinate
  • Lower abdominal pain, often sharp and severe
  • An urgent need to urinate, often painful
  • Lower abdominal swelling

2. Chronic Urinary Retention
Chronic urinary retention develops gradually and can worsen over time. People with chronic urinary retention can urinate, but they just can't empty their bladders completely.

Symptoms of chronic urinary retention can vary but may involve-

  • Frequent urination (more than eight times per day)
  • Trouble starting urination
  • A weak or intermittent urine stream
  • Discomfort with urination
  • Straining with urination
  • A feeling that you still need to urinate after peeing
  • Having to get up frequently at night to pee
  • Mild lower abdominal pain or pressure

Prevention and treatment of retention of urine-

  • Assist the patient to his or her normal position for voiding.
  • Provide privacy.
  • Offer a bedpan or urinal that is warm.a bedpan that is cold to touch may cause contraction of the perineal muscles
  • Foster the muscles relaxation by providing necessary physical support to the patient and by relieving pain.
  • Provide any assistance when the patient feels the need to void.
  • Micturition is a conditioned response.running water within the hearing of the patient or flushing the toilet stimulate the micturition reflex.
  • Provide enough time for micturition.
  • Reassurance and emotional support are helpful to reflex the patient.
  • A hot enema,if permitted may relieve the retention of the urine.
  • Give fluids freely unless contra-indicated.
  • When all these nursing interventions failed,catheterisation of the bladder is done with the doctor’s permission.
  • Certain drugs which cause contraction of the bladder may be ordered by the doctor

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