Urinary Incontinance
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Contributing Factors

    Excess bladder pressure
        1. from excess urine production
             a. excess water intake
             b. diuretics
             c. diabetes mellitus
        2. from excess urine retention
             a. voluntary retention (e.g., disability, inaccessibility of toilet facilities)
             b. physical obstructions (e.g., urinary stones, tumors, fecal impaction, prostatic hypertrophy)
             c. inadequate nervous stimulation of the bladder (e.g., spinal cord injury, bladder nerve damage, certain tranquilizers)
             d. weak bladder contractions (e.g., overstretched bladder from urine retention)
        3. from excess stimulation of the bladder
             a. from excess urine retention (see above)
             b. from inflammation (e.g., catheters, infection)
             c. from nerve injury causing loss of voluntary inhibitory impulses (e.g., dementias, strokes)

    Inadequate contraction of sphincter and pelvic floor muscles
        1. from sphincter and pelvic muscle weakness
             a. from physical injury (e.g., catheters, surgery)
             b. from shrinkage (e.g., low estrogen)
        2. from reduced nervous stimulation of muscles
             a. from CNS disorders (e.g., dementias, strokes)
             b. from psychological problems (e.g., depression, anxiety)

Treatments

     1. Regulate intake of fluids and diuretics (e.g., alcohol, caffeine, drugs) to reduce urine formation.
     2. Regulate all medications affecting urinary or nervous system functioning.
     3. Assure accessibility to facilities (bedpans, urinals, care-giver assistance).
     4. Urinate at scheduled times.
     5. Cure urinary tract infections to reduce bladder instability.
     6. Exercise sphincter and pelvic floor muscles to increase strength (e.g., Kagel exercises).
     7. Estrogen therapy in women to increase urethral strength.
     8. Medications to modify bladder and internal sphincter function.
     9. Surgery to remove obstructions (e.g., prostate surgery), enlarge the bladder, denervate the bladder, implant an artificial sphincter.
    10. Behavioral modification and training.
    11. Biofeedback control to (1) increase awareness of need to void and (2) gain better control of muscles.
    12. Electrical stimulators to control muscles.
    13. Absorbent pads or male condom catheters to catch urine.
    14. Skin care to avoid complications.
    15. Catheters to drain urine (last choice due to complications {e.g., infections, bladder instability}).

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© Copyright 1999 - Augustine G. DiGiovanna - All rights reserved.
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