Urinary incontinence is the involuntary loss of urine as a result of problems controlling the bladder. Reflex Urinary Incontinence involves dysfunction of the normal neurological control mechanisms for coordination of detrusor contraction and sphincter relaxation. This is most often caused by a problem in the central nervous system. Reflex incontinence can occur as a result of stroke, Parkinson’s disease, brain tumors, spinal cord injuries or multiple sclerosis. The patient with reflex incontinence experiences periodic urination without an awareness of needing to void. Urination is constant throughout the day and night. Urine volume is consistent with each voiding. Residual urine volumes are usually less than 50 mL. Urodynamic studies will indicate detrusor contraction when bladder volume reaches a particular amount.
Other types of Urinary Incontinence:
- Impaired Urinary Elimination: Dysfunction in urinary elimination.
- Functional Urinary Incontinence: Inability of usually continent person to reach toilet in time to avoid unintentional loss of urine.
- Reflex Urinary Incontinence: Involuntary loss of urine at somewhat predictable intervals when a specific bladder volume is reached.
- Stress Urinary Incontinence: Sudden leakage of urine with activities that increase intraabdominal pressure.
- Urge Urinary Incontinence: Involuntary passage of urine occurring soon after a strong sense of urgency to void.
Here are some factors that may be related to Reflex Urinary Incontinence:
- Brain injury above level of pontine micturition center
- Radiation cystitis
- Radical pelvic surgery
- Spinal cord lesions above S2 level
Reflex Urinary Incontinence is characterized by the following signs and symptoms:
- Anticipated pattern of voiding
- Failure to initiate or inhibit voiding
- No sensation of bladder fullness
- No sensation of urge to void
Goals and Outcomes
The following are the common goals and expected outcomes for Reflex Urinary Incontinence:
- Patient establishes a regular voiding pattern.
- Patient has no episode of incontinence
The following are the comprehensive assessments for Reflex Urinary Incontinence:
|Ascertain the patient’s recognition of the need to urinate.||Patients with neurological impairments may have damaged sensory fibers, and may not have the sensation of the need to void.|
|Measure and record urine volume with each voiding.||Urine volumes are usually consistent with reflex incontinence.|
|Review the results of urodynamic studies.||A cystometrogram will measure bladder pressures and fluid volumes during filling, storage, and urination. Electromyography will record detrusor activity during voiding. Test results will indicate the point of coordination between detrusor muscle and sphincter activity.|
|Allow the patient to maintain a “bladder diary.”||Data about fluid intake and voiding pattern provides a basis for planning bladder management techniques.|
The following are the therapeutic nursing interventions for Reflex Urinary Incontinence:
|Tell the patient to limit fluid intake 2 to 3 hours prior bedtime and to void just before going to bed.||Restricting fluid intake and voiding before going to bed reduces the need to interrupt sleep for voiding.|
|Allow voiding at scheduled intervals before predictable urination.||Voiding at regular intervals, based on knowledge of the patient’s voiding pattern, lowers the possibility of uncontrolled incontinence.|
|For the male patient, acknowledge the application of an external catheter.||An external catheter attached to a gravity drainage device enables the patient to remain dry.|
|If spontaneous voiding is not possible, catheterize the patient at regular intervals.||Emptying the bladder at regular intervals will reduce incontinence episodes. The risk for infection is noteworthy with indwelling catheters.|
|Explain the importance of absorbent pads in social situations.||Absorbent pads will preserve clothing when the patient is in public. The patient needs to learn about replacing the pads at regular intervals to prevent skin irritation from exposure to urine and moisture.|
|Demonstrate to patient or caregiver intermittent catheterization.||This method drains the bladder at particular periods.|
|Work with the patient and family to establish a reasonable, manageable voiding program.||Participation in plan of care promotes additional knowledge and appropriate management.|
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Other Nursing Diagnoses
- Activity Intolerance
- Acute Confusion
- Acute Pain
- Caregiver Role Strain
- Chronic Pain
- Decreased Cardiac Output
- Deficient Fluid Volume
- Deficient Knowledge
- Disturbed Body Image
- Disturbed Thought Processes
- Excess Fluid Volume
- Imbalanced Nutrition: Less Than Body Requirements
- Imbalanced Nutrition: More Than Body Requirements
- Impaired Gas Exchange
- Impaired Oral Mucous Membrane
- Impaired Physical Mobility
- Impaired Swallowing
- Impaired Tissue (Skin) Integrity
- Impaired Urinary Elimination
- - Functional Urinary Incontinence
- - Reflex Urinary Incontinence
- - Stress Urinary Incontinence
- - Urge Urinary Incontinence
- Impaired Verbal Communication
- Ineffective Airway Clearance
- Ineffective Breathing Pattern
- Ineffective Coping
- Ineffective Therapeutic Regimen Management
- Ineffective Tissue Perfusion
- Latex Allergy Response
- Rape Trauma Syndrome
- Risk for Aspiration
- Risk for Bleeding
- Risk for Falls
- Risk for Infection
- Risk for Injury
- Risk for Unstable Blood Glucose Level
- Self-Care Deficit
- Urinary Retention
Recommended books and resources:
- Nursing Care Plans: Diagnoses, Interventions, and Outcomes
- Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
- Nursing Diagnoses 2015-17: Definitions and Classification
- Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
- Manual of Psychiatric Nursing Care Planning
- Maternal Newborn Nursing Care Plans
- Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
- Maternal Newborn Nursing Care Plans