NCP Impaired Urinary Elimination - Urge Incontinence

Nursing Diagnosis: Impaired Urinary Elimination - Urge Incontinence
Stress Incontinence; Urge Incontinence; Reflex Incontinence; Functional Incontinence; Total Incontinence
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Urinary Continence
* Urinary Elimination
* Self-Care: Toileting

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Urinary Catheterization
* Urinary Catheterization: Intermittent
* Urinary Habit Training: Urinary
* Incontinence Care

NANDA Definition: Involuntary passage of urine occurring soon after a strong sense of urgency to void

There are several types of urinary incontinence; all are characterized by the involuntary passage of urine. Urinary incontinence is not a disease but rather a symptom. Incontinence occurs more among women, and the incidence increases with age, although urinary incontinence is not a given with aging. An estimated 10 million people are incontinent; billions are spent annually in the management of urinary incontinence. Micturition (urination) is a complex physiological function that relies on proper function of the bladder muscles and sphincters responding to spinal nerve impulses (S2, S3, and S4). Urinary incontinence occurs whenever the bladder, sphincter, or the nerves involved in micturition are diseased or damaged. Relaxed pelvic musculature following childbirth, postmenopausal urethral atrophy, central nervous system (CNS) diseases (e.g., Parkinson’s and cerebrovascular accident [CVA]), spinal cord lesions or injury, and postoperative injuries can result in urinary incontinence. Careful diagnosis, including urodynamic studies, should precede treatment decisions, although empiric management is common. Urinary incontinence can lead to altered skin integrity, as well as severe psychological disturbances. Incontinent individuals often withdraw from social contact, and urinary incontinence is a major determinant in the institutionalization of elderly patients. This care plan addresses five types of urinary incontinence: stress, urge, reflex, functional, and total. Education and continuity of care are addressed for each type, as well as for the problem of urinary incontinence as an entity.

* Defining Characteristics: Sudden, "unannounced" need to void
* Frequent urinary accidents associated with "not getting there in time"
* Inability to delay voiding

* Related Factors: Uninhibited bladder contraction
* Spinal cord injury
* Parkinsonism
* Multiple sclerosis
* Benign prostatic hypertrophy
* Infections
* Psychogenic

* Expected Outcomes Patient is continent of urine or verbalizes management.

Ongoing Assessment

* Ask patient to describe episodes of incontinence; note descriptions of "feeling the need suddenly [but being unable to] get to the bathroom in time." Urge incontinence occurs when the bladder muscle suddenly contracts.
* Consider age. This type of urinary incontinence is the most common type among elderly patients.
* Culture urine. Bladder infection can result in strong urge to urinate; successful management of a urinary tract infection may eliminate or improve incontinence.

Therapeutic Interventions

* Prepare patient for sphincterotomy (surgical correction) as indicated. Denervation, resulting in complete incontinence, may be undertaken (rhizotomy). Urinary diversion (ileal conduit) may be performed as a last resort.
* Facilitate access to toilet and teach patient to make scheduled trips to bathroom.

Education/Continuity of Care

* Teach use of medications that reduce or block detrusor contractions (anticholinergics). These inhibit smooth muscle contractions and may reduce episodes of incontinence.
* Educate patient in the use of biofeedback techniques. These control pelvic floor musculature.