Stress Urinary Incontinence occurs when the bladder leaks urine during physical activity or exertion. It may happen when a person coughs, lifts something heavy, changes positions, or exercise. Stress incontinence is much more common in women than men. The predisposing factors for women include pregnancy, obesity, decreased estrogen levels linked with menopause, and surgery involving the lower abdominal area. Men may develop stress incontinence following surgical treatment for benign prostatic hyperplasia or prostate cancer. These factors contribute to a decrease in muscle tone at the urethrovesical junction. When muscles that control the ability to hold urine get weak or do not work, they no longer give support for the urinary sphincter. The urinary sphincter cannot remain constricted with increasing abdominal pressure. Coughing, sneezing, laughing, exercising, lifting heavy objects, jumping, running, and straining with defecation are examples of activities that increase intraabdominal pressure and lead to stress incontinence. The amount of urine lost may vary from a few drops to 100 mL or more. A person with stress incontinence may feel embarrassed, isolate self, or limit work and social life, especially exercise and leisure activities. With treatment, the person may likely be able to manage stress incontinence and improve overall well-being.
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 Stress Urinary Incontinence:
- Diabetic neuropathy
- Multiple vaginal deliveries
- Pelvic surgery
- Radial prostatectomy
- Trauma to pelvic area
Stress Urinary Incontinence is characterized by the following signs and symptoms:
- Observed or patient reports of involuntary leakage of small amounts of urine with activities associated with exertion and/or increased intraabdominal pressure
- Observed or patient reports of involuntary leakage of small amounts of urine in the absence of detrusor contraction or an overdistended bladder.
Goals and Outcomes
The following are the common goals and expected outcomes for Stress Urinary Incontinence:
- Patient has no episodes of incontinence.
- Patient implements activities to increase abdominal and pelvic floor muscle tone.
The following are the comprehensive assessments for Stress Urinary Incontinence:
|Interview patient about involuntary loss of urine during coughing, laughing, sneezing, lifting, or exercising.||A weak sphincter/relaxed pelvic floor muscles allow urine to pass involuntarily when intraabdominal pressure increases.|
|Examine patient’s menstrual history.||Postmenopausal hypoestrogenism contributes to relaxation of the urethra.|
|Determine patient’s parity.||Pregnancy and vaginal births weaken pelvic muscle. The weakness increases with multiple pregnancies.|
|Know patient’s previous surgical procedures.||In men, transurethral resection of the prostate gland can result in urinary incontinence.|
|Examine the perineal area for evidence of pelvic relaxation:||The presence of these conditions can lead to incontinence due to poor muscular control,|
The following are the therapeutic nursing interventions for Stress Urinary Incontinence:
|Encourage the patient to maintain adequate fluid intake.||Patients usually limit fluid intake to reduce incontinence episodes.|
|Encourage weight loss if patient is obese.||Obesity is associated with increased intra-abdominal pressure on the urinary bladder.|
|Give or promote the use of medication as ordered:||These medications increase bladder sphincter tone and improve pelvic muscle tone.|
|Prepare the patient for surgery (Marshall-Marchetti-Krantz, Burch’s colposuspension, and sling procedures) as indicated.||Many surgical procedures are done to control stress incontinence. These procedures provide support to the bladder and urinary sphincter.|
|Allow patient to know more about Kegel exercises.||Kegel exercises are done to strengthen the muscles of the pelvic floor and can be followed with a minimum of exertion. The repetitious tightening and relaxation of these muscles (10 repetitions four or five times per day) aid some patients regain continence. Kegel exercises may be used in combination with biofeedback to enhance a positive outcome.|
|Allow the patient to use transcutaneous electrical nerve stimulation (TENS), as indicated.||This device improved pelvic floor tone and inhibits the micturition reflex.|
|Educate female patients about the use of vaginal pessary (a device reserved for nonsurgical candidates).||A pessary works by elevating the bladder neck, thereby increasing urethral assistance.|
|Refer the patient for biofeedback training.||Biofeedback techniques combined with electromyography or pressure manometry aid the patient learn to contract pelvic floor muscles and control incontinence.|
|Advise the patient about the benefits of using disposable or reusable insert pads, pad-pant systems, or replacement briefs specifically designed for urinary incontinence (or double urinary and fecal incontinence) as indicated.||Most absorptive products utilized by community-dwelling elders are not designed to absorb urine, prevent odor, and protect the perineal skin. Substitution of disposable or reusable absorptive devices particularly created to contain urine or double incontinence is more useful and efficient than household products, especially in moderate to severe cases.|
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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