LESSON PLAN ON

URINARY INCONTINENCE

EXTERNAL EXAMINER INTERNAL EXAMINER

STUDENT TEACHER OBJECTIVES:

By the end if the session the students will be able to

 Develop the skills in introducing the topic from the general to specific
 Develop the skills in organizing the content
 Develop the skills in explaining the topic
 Select, prepare and display appropriate A.V Aids
 Develop the skills in questioning the group
 Develop the skills in motivating the students for learning
 OBJECTIVES

General objective:

By the end of the session the group will be able to gain the in-depth knowledge regarding urinary incontinence

Specific objectives:

 Define the urinary incontinence

 Enlist the types of urinary incontinence
 Discuss the pathophysiology of urinary incontinence
 Explain the diagnostic evaluations
 Discuss the management
 Describe the surgical procedures
 Explain the nursing management.
Objectives Time Content Teaching/ A.V Aids Evaluation
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 URINARY INCONTINENCE
Introduction Lecture cum Power
1min Introduction:
about the Discussion point.
Urinary incontinence (UI) is an involuntary
urinary
incontinence. leakage of urine. Approximately 17 million people in
the United States suffer from UI. The prevalence is
30% to 40% among young adult to middle-aged
women, and increases to 30% to 50% in older women.
In contrast, the incidence of UI in men tends to be
considerably lower, ranging from 1% to 5% in young
adult men and increasing to 9% to 34% in older men.31
Although incontinence is more prevalent among older
women and older men, it is not a natural consequence
of aging. UI has traditionally been viewed as a social or
hygienic problem, but it also has a major effect on
quality of life and contributes to serious health
problems, especially in older adults.

Objectives Time Content Teaching/ A.V Aids Evaluation

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 Activities
Define the 2min Definition:
definition.
Loss of bladder control, carrying from a slight Lecture cum Power
Discussion point Can you
loss of urine after sneezing, coughing or laughing, to
define the
complete inability to control urination
urinary
According to Brunner
incontinence?
Urinary incontinence also know as involuntary
urination, is any uncontrolled leakage of urine
Enlist the types. 12min According to Lewis
Lecture cum Leaflets
Can you list
Types Of Incontinence Discussion
out the types?
Stress Incontinence
Sudden increase in intra-abdominal pressure causes
involuntary passage of urine
 Can occur during coughing, laughing, sneezing,
or physical activities such as heavy lifting,
exercising,
 Leakage usually is in small amounts may not be
daily
Objectives Time Content Teaching/Learning A.V Aids Evaluation
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CAUSES
 Found most commonly in women with relaxed
pelvic floor musculature, due to Explain the
 Delivery causes and
 Instrumental delivery
treatment?
 Multiple pregnancies
 Urethra atrophy due to
 Decreased oestrogen
 In males due to
 Prostate surgery for BPH and prostate
cancer

Treatment

 Pelvic floor exercises, weight loss if patient is

obese
 Cessation of smoking
 Application of topical oestrogen products

Urge Incontinence
Condition occurs randomly when involuntary urination
Objectives Time Content Teaching/Learning A.V Aids Evaluation
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is preceded by urinary urgency
 Seen with overactive bladder symptoms of
urgency and frequency
 Leakage is periodic but frequent and usually in
large amounts
 Nocturnal frequency and incontinence are
common

Causes
 Condition is caused by uncontrolled contraction
or over activity of detrusor muscles
 Bladder escape central inhibition and contracts
reflexively
 Conditions include
 Central nervous system disorders (e.g.
Cerebrovascular diseases, Alzheimer’s disease,
brain tumours, Parkinson’s disease)
 Bladder disorders (e.g. carcinoma in situ,
radiation effects, interstitial cystitis)
 Interference with spinal inhibitory pathways (e.g.
malignant growth in spinal cord, spondylosis)
Objectives Time Content Teaching/ A.V Aids Evaluation
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 Bladder outlet obstruction or conditions of
unknown etiology

Treatment
 Treatment of underlying cause
 Biobehavioural interventions including bladder
retraining with urge suppression, decrease in
dietary irritants, bowel regularity, and pelvic
floor muscles exercises
 Anticholinergics drugs (e.g. oxybutynin,
tolterodine, solifenacin, dacrifenancin,
imipramine [at bed time], calcium channel
blockers)
 Containment devices (e.g. external condom
catheters)
  Vaginal oestrogen cream

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  Absorbent products

Overflow Incontinence
Condition occurs when the pressure of urine in overfull Lecture cum Power

bladder overcomes sphincter control Discussion point

Explain the
 Leakage of small amount of urine is frequent overflow
throughout the day and night type of
 Urination may occur frequently in small amounts urinary
 Bladder remains distended and is usually incontinence
palpable ?

Causes

 Disorders is caused by bladder or ureteral outlet

 Obstruction (bladder neck obstruction, ureteral
stricture, pelvic organ prolapse)

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  Under activity of detrusor muscles caused by
myogenic or neurogenic factors (e.g. herniated
disc, diabetic neuropathy)
 May also occur after anaesthesia and surgery (e.g.
haemorrhoidectomy, herniorrhaphy, cystoscopy)
 Neurogenic bladder (flaccid type)

Treatment
 Urinary catherization to decompress bladder
implementation of crede or Valsalva manoeuvre
 Alpha adrenergic blocker (doxazosin, terazosin,
tamsulosin, alfuzosin)
 5- alpha reductase inhibitors (e.g. finasteride- to
decrease outlet resistance, bethanechol
(urecholine)- to enhance bladder contractions)
 Intravaginal device such as pessary to support

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 Learning
Activities
 Prolapse
 Intermittent catheriaztion
 Surgery to correct underlying problem

Reflex Incontinence
Condition occurs when no warning or stress precedes
periodic involuntary urination
 Urination is frequent, is moderate in volume, and
occurs equally during the day and night

Causes
 Spinal cord lesion above S2 interferes with central
nervous system inhibition
 Disorders results in detrusor hyperreflexia and
interferes with pathways coordinating detrusor
contraction and sphincter relaxation
Objectives Time Content Teaching/Learning A.V Aids Evaluation
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Treatment
 Treatment of underlying cause
 Bladder decompression to prevent ureteral
reflux and hydronephrosis
 Intermittent self catherization
 Diazepam, or baclofen- to relax external
sphincter
 Prophylactic antibiotics
 Surgical sphincterotomy

Incontinence After Trauma Or Surgery

 In women,
 Vesicovaginal or
 Urethrovaginal fistula may occur
Objectives Time Content Teaching/Learning A.V Aids Evaluation
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 In men
 Alteration in continence control involves
proximal urethral sphincter (bladder neck and
prostatic urethra) and
 Distal urethral sphincter (external striated
muscles)

Causes
 Fistulas may occur during pregnancy
 Afterdelivery of baby
 As a result of hysterectomy
 Invasive cancer of cervix
 After radiation therapy
 Incontinence is a postoperative complication of
 Transurethral
 Perineal or
Objectives Time Content Teaching/ A.V Aids Evaluation
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 Retropubic prostatectomy

Treatment
 Surgery to correct fistula
 Urinary diversion surgery to bypass urethra and
bladder
 External condom catheter
Leaflets
 Penile clamp
Lecture cum Describe the
 Placement of artificial implantable sphincter Discussion functional

Functional Incontinence incontinence?

Loss of urine resulting from cognitive, functional or

environmental factors
Causes
 Older adults often have problems that effect
balance and mobility
Objectives Time Content Teaching/ A.V.Aids Evaluation
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Discuss the 3min Management
management Modifications of environment or care plan that facilitates
Lecture cum Can you
regular, easy access to toilet and promotes patient safety
Discussion explain
(e.g. better lighting, removal of scatter rugs, ambulatory
regarding the
assistance equipment, clothing alterations, timed voiding,
management
Power
different toileting equipment) of urinary
point
Etiology incontinence
 Incontinence may be temporary problem caused by ?

 Vaginal or urinary tract infection

 Constipation
 Most common causes include
 Overactive bladder muscles
 Weakened pelvic floor muscles
 For some enlarged prostate
 Nerve damage that affects bladder control

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 Risk Factors
 Female gender- women experience stress
incontinence twice as often as men
 Advancing age
 Excess fat
 Smoking
 High impact sports
Discuss the 2min
pathophysiology Pathophysiology Lecture method Chart

when bladder pressure exceeds urethral closure pressure

Anything that interferes with bladder or urethral sphincter

control can result in UI.

Urinary leakage accompanied by both urgency and

increased intra-abdominal pressure

Objectives Time Content Teaching/ A.V.Aids Evaluation

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 Urinary leakage preceded Episodic involuntary
urinary
by a sudden urge to void. leakage with sudden increase
intra-abdominal.
Clinical Manifestations
 Leakage of urine in everyday activities
 Feeling a strong, sudden urge to urinate
 Leaking urine without any warning to urge
 Being unable to reach a toilet in time
Explain the
 Wetting of bed during sleep Lecture cum Power- Can you
diagnostic
2min Discussion point explain the
evaluations Diagnostic Evaluations
diagnostic
History Collection evaluations?
 Collect history about timing and pattern of
voiding
 Ask about stress incontinence

Objectives Time Content Teaching/ A.V.Aids Evaluation

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 Physical Examination
 Examination is tailored somewhat in each
case ,check for obesity which may influence
the pattern of voiding
 Patient should provide a urine sample for
urine sample and culture

Cytometer and urethral pressure

Management
Behavioural Techniques
Bladder Control Training: it involves learning to delay
urination after get urge to go patient may start by trying to
void off for 10 minutes
 The goal is to lengthen the time between
trips to the toilet
 It should for 3 to 12weeks

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 Scheduled Toilet Trips:
 Going to toilet according to the clock rather than
waiting for the need to go

Pelvic Floor Muscle:

 This are designed to strengthen the urinary
sphincter and pelvic floor muscle
 These exercise include repeated contraction of
isolated muscles which is very effective in stress
incontinence

Vaginal Cone Therapy:

 It is suitable for women. This technique involves
the use of set of small vaginal cones .patient simply
involves the use of small plastic cone in the vagina
where it is held in by a mild reflex contraction
 This should be performed twice a day for 15-20min

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 for 4 to 6 weeks

Drug Therapy:
Anti Cholinergic Agents: oxybutynin, solifenacin
This agents inhibits ACH to the cholinergic receptors thus
suppresses involuntary bladder contraction
Anti Spasmodic: flavoxate, dicyclomine
It helps to relax the bladder muscle
Topical Oestrogen:
Applying low dose of topical oestrogen may reduce List the
incontinence surgical
Alpha Adrenergic Blocker procedures?
It is to decrease bladder over activity
Describe the 1min Lecture cum
surgical Surgical Management Discussion Flip
procedures charts
Artificial Urinary Sphincter:
This small device is mainly useful for men who have
weakened

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  urinary sphincter from the treatment of prostate
cancer
 Doughnut shaped device is implanted around the
neck of bladder
 This device is made from silicone and has three
compartments that are implanted into the patient
 The cuff is the portion that provides circular
compression of the urethra and prevents the leakage
of urine
 A small fluid filled pressure regulating balloon is
placed in the abdomen and a small pump is placed
in the scrotum to be controlled by the patient
 When patient needs to urinate he presses the scrotal
pump which releases the fluid back to the
abdominal balloon opening the urethra and
allowing the a patient to void

Objectives Time Content Teaching/ A.V.Aids Evaluation

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 Sling Procedure
 Retro Pubic Colposuspension and pubovaginal
sling placement appear to be most effective.
Typically, both procedures are performed through
low transverse incisions.

Complications

 Complications are specific to the retropubic

suspensions include
 Postoperative voiding dysfunction,
 Urgency, and
 Vaginal prolapse.

Sub urethral sling

 Placement of a sub urethral sling, using the
person’s own fascia, cadaveric fascia, or a synthetic
material, is also used to correct stress UI in women.

Objectives Time Content Teaching/ A.V.Aids Evaluation

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 Complications
 Complications include
 Vascular and bowel injury,
 Urinary retention,
 Mesh or sling erosion,
 Infection,
 Urgency, and
 Bladder perforation.
 Sub urethral slings have success rates comparable
to those of colposuspensions or slings and are
associated with shorter recovery periods.
3min
 An artificial urethral sphincter can be used in men
with intrinsic sphincter deficiency and severe stress
explain the
Explain the
UI. Lecture cum Power nursing
Nursing Nursing Management Discussion point management?
management Assessment
Monitor urine elimination including consistency, odour,
Objectives Time Content Teaching/ A.V.Aids Evaluation
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volume, and colour.
Nursing Diagnosis
 Urinary incontinence related to weak pelvic floor
muscle as evidence by inability to reach toilet in
time to avoid urine loss
 Impaired skin integrity related to constant contact
of urine with Perineal tissue as evidenced by
redness over Perineal area
 Fatigue related to sleep deprivation as evidenced by
inability to maintain usual daily activities
 Disturbed body image related to altered voiding
pattern as evidenced by withdrawal
 Disturbed thought process related to emotional
changes as evidenced by inappropriate social
behaviour.
Objectives Time Content Teaching/ A.V.Aids Evaluation
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Interventions
Urinary incontinence
 Assess the voiding pattern, type of incontinence,
frequency, severity of leakage
 Plan the pattern of urination
 Ask the patient to limit fluid intake 2 to 3 hours
before bed time
 Limit the intake of caffeine beverages
 Educate pelvic floor exercises

Impaired skin integrity

 Assess the skin turgor, integrity, and the color of
the skin
 Avoid excessive moisture near the Perineal area
 Advice patient to wear loose cotton clothes
 Advice patient to use cotton pads
Objectives Time Content Teaching/ A.V.Aids Evaluation
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Disturbed body image
 Assess the meaning of change to the patient
including future expectations and impact of cultural
and religious beliefs
 Evaluate the patients behavior regarding the actual
or perceived change in body function
 Acknowledge and accept expression of feeling and
frustration and hostility
 Set limits for the maladaptive behavior
 Encourage family interaction with each other and
with rehabilitation team

Disturbed thought process

 Identify factors prexent like malnutrition, sleep or
sensory deprivation or chronic mental illness
 Review laboratory values for abnormalities
  Perform periodic neurological assessment.

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 Summary
Today we have discussed regarding definition,
types, causes, pathophysiology, clinical manifestations,
diagnosis, and treatment of urinary incontinence.

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 Conclusion
Nurses need to have adequate theoretical knowledge
about the causes, signs and symptoms of disease
conditions in order to apply the knowledge appropriately
in the clinical setting, in order to uplift the standards of
the profession.

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 Bibliography
1. Toratora text book of Anatomy and physiology,
volume –II, 7th edition, page no. 1144-1169
2. Lewis, textbook of medical surgical nursing,
volume-I, 3rd edition, Elsevier publication, page
no. 1375-1383
3. Suzanne C Smeltzer’s, textbook of medical
surgical nursing, 7th edition, Lippincott publication,
page no. 350-364
4. Brunner and Suddharth, text book of medical
surgical nursing, 11th edition, Lippincott
publication, page no. 2052-2061

5. NET REFERENCE
6. www. Wikipedia. Com