Discussion Post on Urinary Incontinence

Discussion Post on Urinary Incontinence

A nurse practitioner (NP) is having a conversation with a 70-year-old patient who is concerned about a problem she finds embarrassing to discuss with her physician. She reports experiencing increasing issues with urinary incontinence, particularly when she coughs or sneezes. There is no accompanying fever, chills, or pain during urination, and she wonders if this is a normal part of aging.

Etiology of Incontinence in Older Adults

Urinary incontinence is a common issue in the elderly, and it is not solely a result of aging. In frail older adults, urinary incontinence is often attributed to a combination of factors affecting the lower urinary tract (Enberg and Li, 2017). Frailty and urinary incontinence are considered geriatric syndromes, typically observed in individuals aged 65 and older. Frailty can negatively impact normal lower urinary tract (LUT) function, affecting the ability to maintain continence. Common causes of LUT issues leading to urinary incontinence, unrelated to age-induced changes, include medications, medical illnesses, neurologic/psychiatric disorders, functional impairment, disorders of the LUT or surrounding structures, and environmental factors (Enberg and Li, 2017).

Types of Urinary Incontinence

Urinary incontinence in the aging adult can manifest in different ways. There are three primary types: urgency incontinence, stress incontinence, and mixed incontinence (Vaughn & Markland, 2020). Urgency incontinence is characterized by a sudden need to urinate, while stress incontinence involves urine leakage when pressure is exerted on the bladder, such as during coughing or sneezing. Mixed incontinence is a combination of both urgency and stress incontinence. Stress incontinence is often linked to factors like the integrity of the urethra, urethral closure pressure, and the support of bladder muscles and connective tissues (Minassian et al., 2017).

Potential Causes of Urgency Incontinence

Urgency incontinence’s exact cause is still under investigation, with theories suggesting neurogenic, epithelial, and myogenic factors (Minassian et al., 2017). Neurogenic theory implies a loss of central nervous system control over continence, leading to involuntary contractions of the bladder muscle. Epithelial hypersensitivity theory points to chemical sensitizers affecting bladder stability. Myogenic theory suggests that pelvic floor support may fail due to various factors, including exhaustion, birth injury, genetics, or environmental influences (Minassian et al., 2017).

Delusional Disorders Pakistani Female With Delusional Thought Processes

Impact and Management

Urinary incontinence can have a significant impact on the quality of life for elderly individuals. It can lead to skin issues, urinary tract infections, falls, and emotional challenges (McDaniel et al., 2020). Management and intervention strategies are crucial, including education for healthcare providers on evidence-based practices (McDaniel et al., 2020).

In summary, urinary incontinence in older adults is a complex issue with various causes and types. It is not solely a result of aging, and healthcare providers must consider multiple factors when assessing and managing this condition.

References:

– Enberg, B., & Li, J. (2017). Urinary Incontinence in Frail Older Adults.
– Vaughn, C. P., & Markland, A. D. (2020). Urinary incontinence in women. Annals of Internal Medicine, 172(3), ITC17 – ITC32.

– Minassian, V. A., Bazi, T., & Stewart, W. F. (2017). Clinical epidemiological insights into urinary incontinence. International Urogynecology Journal, 28(5), 687 – 969.

– McDaniel, C., Ratnani, I., Fatima, S., Abid, H. M., & Surani, S. (2020). Urinary Incontinence in Older Adults Takes Collaborative Nursing Efforts to Improve. Cureus, 12(7), 9161.

– Mayo Clinic. (2020a). Stress incontinence. Retrieved from https://www.mayoclinic.org/diseases-conditions/stress-incontinence/symptoms-causes/syc-20355727

– Mayo Clinic. (2020b). Overactive bladder. Retrieved from https://www.mayoclinic.org/diseases-conditions/overactive-bladder/symptoms-causes/syc-20355715

– NIH. (2017). Urinary Incontinence in Older Adults. Retrieved from https://www.nia.nih.gov/health/urinary-incontinence-older-adults

Urinary Incompetence discussion post

A nurse practitioner (NP) is talking with a 70-year-old patient who asks if she could discuss a problem that she is embarrassed to talk about with her physician. She states she has been having increasing problems with incontinence. Every time she coughs or sneezes, she notices a loss of urine. She has not had any fever or chills or pain with urination. She asks the Nursing Practitioner if this is just a sign of getting older?

1. Discuss the etiology associated with incontinence in the aging adult.

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to grading rubric for online discussion urinary incontinence discussion post.

 

• • Urinary Incontinence in Frail Older Adults, Enberg and Li (2017) stated “in the frail elderly population, urinary incontinence is generally caused by a combination of factors affecting the lower urinary tract” (p. 119). Enberg and Li (2017) documented the co-existence of frailty and UI and described them as “geriatric syndromes” seen in individuals 65 years of age and older. Normal LUT function was documented as being adversely affected by frailty, Enberg and Li (2017) further stated frailty adversely affects “many functional requirements needed to maintain continence” (p. 220). Common causes of LUT, which subsequently contribute to urinary incontinence, that are unrelated to age-induced changes are medications, medical illness, neurologic/psychiatric disorders, functional impairment, disorder of the LUT or surrounding structures, and environmental issues (Enberg and Li, 2017, p. 121).
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  • Steven Bartos posted Mar 3, 2021 4:28 PM
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  •             Urinary incontinence (UI) is a loss of bladder control that is common in the aging adult. The three most common types of UI include urgency incontinence, stress incontinence, and mixed incontinence. Urgency incontinence is a loss of urine related to an increased need to urinate. Stress incontinence is a loss of urine as a result of coughing, sneezing, lifting, or laughing. Mixed incontinence is a combination of the two (Vaughn & Markland, 2020) urinary incontinence discussion post. Research has found that stress incontinence is mostly related to the integrity of the urethra and the maximum urethral closure pressure. It is also related to the support of the bladder muscles and the supporting connective tissue laxity. Mixed incontinence doesn’t have a clear pathophysiology, as it is difficult to distinguish between urine loss from urgency versus stress (Minassian et al., 2017).ReferencesVaughn, C.P., & Markland, A.D. (2020). Urinary incontinency in women. Annals of Internal Medicine, 172(3), ITC17 – ITC32. https://dx.doi.org/10.7326/AITC202002040less1 UnreadUnread4 ViewsViews
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  • Minassian, V.A., Bazi, T., & Stewart, W.F. (2017). Clinical epidemiological insights into urinary incontinency. International Urogynecology Journal, 28(5), 687 – 969. https://dx.doi.org/10.1007/s00192-017-3314-7
  • It seems that in the example of the 70 year old female, she may be having an experience of stress or mixed incontinence. Her urethra or bladder may be compromised by the normal aging process related to urinary urgency, and sneezing or coughing may be causing incontinence as a result of the stress to her system.
  •             The etiology of urgency incontinence is still being understood through research; however, most individuals have idiopathic urgency UI or overactive bladder syndrome. Several theories have been proposed, such as neurogenic, epithelial, and myogenic. Neurogenic theory describes UI as a loss of central nervous system control over the continence stemming from the micturition center of the brain, which normally would suppress the urge to urinate when a full bladder is present. As a result, involuntary overreactive contractions of the bladder muscle, known as detrusor hyperreflexia, causes the UI. Examples of disorders that would cause this CNS malfunction include stroke, traumatic brain injury, dementia, and brain tumors. The epithelial hypersensitivity theory suggests that chemo-sensitizing agents leads to bladder instability. The myogenic theory proposes that the pelvic floor might fail to support urethra continence as a result of exhaustion, birth injury, genetic or environmental factors (Minassian et al., 2017).
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  • Jazmin Jerez-Rivera posted Mar 2, 2021 11:11 AM
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  • Incontinence is quite common in the elderly population and many feel it is a normal part of aging. However, many are reluctant to bring it up and symptoms can progress over time. Research by Shaw & Wagg suggests “Physiological, pathological and functional changes can result in a loss of continence” (2017, p. 1). Muscles in the bladder contract during urination allowing flow through the urethra (NIH, 2017). Sphincter muscles found in the urethra then relax to pass urine from the body. Bladder incontinence can be the result of weak bladder muscles, weak pelvic floor muscles, nerve damage that controls the bladder, pelvic prolapse and even some diseases (NIH, 2017).ReferencesNational Institute of Health. (2017) Urinary Incontinence in Older Adults. Retrieved from https://www.nia.nih.gov/health/urinary-incontinence-older-adultsless1 UnreadUnread4 ViewsViews
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  • Shaw, C., & Wagg, A. (2017). Urinary incontinence in older adults. Medicine, 45(1), 23-27
  • Huether, S. E., McCance, K. L., Brashers, V. L. (2020). Understanding Pathophysiology (7 Ed.).  Elsevier.
  • The patient seems to display symptoms of stress incontinence. This type of incontinence occurs when there is increased pressure in the abdomen usually while laughing, coughing, or sneezing (Huether et. al. 2020). Other types of incontinence include urge incontinence which is the strong desire to void. Overflow incontinence is loss of urine due to an overdistended bladder (Huether et. al., 2020). Mixed incontinence is a pattern of both stress and urge incontinence. Functional incontinence can be caused by physical impairment and immobility or cognitive impairment (Shaw & Wagg, 2017).
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  • Eleany Yasein posted Mar 3, 2021 5:41 PM
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  • Urinary incontinence is a major problem seen in elderly population (above age 65), it is an involuntary leakage of urine (McDaniel, Ratnani, Fatima, Abid, & Surani, 2020). Urinary incontinence is caused due to physiological, pathological and functional factors (Shaw & Wagg, 2017). Age-related changes in the lower urinary tract can be associated with urinary incontinence. Older adults have decreased bladder capacity, sensation of filling, and urinary flow rate. They have increased urinary frequency, prevalence of post void, residual volumes and outflow tract obstruction in men. Furthermore, some medications such as diuretics, lithium, opioids, and calcium channel blockers has been associated with urinary incontinence. Furthermore, changes in the brain has been linked to different geriatric syndromes including decline in continence. Lastly, some comorbidities that are associated with urinary incontinence include hypertension, diabetes, congestive heart failure, arthritis, depression and anxiety (Shaw & Wagg, 2017). McDaniel, C., Ratnani, I., Fatima, S., Abid, H. M., & Surani, S. (2020, July 12). Urinary Incontinence in Older Adults Takes Collaborative Nursing Efforts to Improve. Cureus, 12(7), 9161. doi: 10.7759/cureus.9161more1 UnreadUnread5 Views Views urinary incontinence discussion post

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  •  Shaw, C., & Wagg, A. (2017, January). Urinary incontinence in older adults. Medicine in Older Adults, 45(1), 23-27. Retrieved from https://doi.org/10.1016/j.mpmed.2016.10.001
  • References
  • Urinary incontinence can lead to skin breakdown including, pressure ulcers, urinary tract infections that can lead to sepsis, and falls (McDaniel et al., 2020). Moreover, it can lead to emotional problems that can impair quality of life. Evaluations, implementing interventions and management is needed. Also, educating evidence-based practices to healthcare providers is important (McDaniel et al., 2020).
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  • Tallona Boddy posted Mar 1, 2021 11:38 AM
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  • The 70 year-old female patient speaking with her NP, appears to be suffering from stress incontinence.  Stress incontinence is defined as the leakage of urine when pressure is placed on the bladder and leakage of urine occurs (Mayo Clinic, 2020a). The other form of incontinence is overactive bladder, which results in a sudden and urgent need to void and at times can be uncontrolled, resulting in urine leakage (Mayo Clinic, 2020b). Overactive bladder is caused by the involuntary spasm of the muscle of the bladder, even when it is not full (Mayo Clinic 2020b). The spasm contractions of the bladder then create an urgency for the individual to empty their bladder.  Some of the risk factors for developing overactive bladder include age, incomplete emptying of the bladder, decline in cognitive function, excessive intake of alcohol or caffeine, neurological conditions, diabetes and abnormalities in the bladder (Mayo Clinic, 2020b).   Mayo Clinic. (2020a, March 19). Stress incontinence. https://www.mayoclinic.org/diseases-conditions/stress-incontinence/symptoms-causes/syc-20355727less1 UnreadUnread5 ViewsViews
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  • Mayo Clinic. (2020b,  March 20). Overactive bladder. https://www.mayoclinic.org/diseases-conditions/overactive-bladder/symptoms-causes/syc-20355715
  • References
  • The cause of stress incontinence is due to the weakening of the patient’s pelvic floor muscles and/or the  weakening of the urinary sphincter (Mayo Clinic, 2020a).  The pelvic floor muscles and urinary sphincter are the mechanisms our bodies use to seal the bladder closed when not voiding.  If these are weak, urine can leak out, especially if pressure is placed on them such as sneezing and coughing.  Factors that contribute to the weakening of these mechanisms include, childbirth, prostate surgery, obesity, frequent coughing, and generalized weakness from other illnesses or aging (Mayo Clinic, 2020a).
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  •             Female patient was embarrassed to discussed her on going urinary incontinence (UI) problem. She thought urinary incontinence is a sign of aging. Harding et al. (2020) explained that “UI is an involuntary leakage of urine. Although incontinence is more prevalent among older adults, it is not a natural consequence of aging. UI has traditionally been viewed as a social or hygienic problem” (P. 56384).  Matos et al. (2019) states that “UI is among the geriatric syndromes, which is considered the most recurrent pathology and also extremely important in the geriatric setting, as it generates consequences that affect psychological and social aspects, modifying quality of life (QOL), reducing self-esteem and limiting the individual’s autonomy” (p. 568). According to Huether et al. (2020), Stress incontinence is the involuntary loss of urine during coughing and laughing and sneezing, or other physical activity that increased abdominal pressure. Stress incontinence is common in women over 60 years of age urinary incontinence discussion post. Jolping et al. (2020) stated that patient engagement, an original shared-decision aid (SDA) was used to educate women about incontinence types, risk factors, bladder irritants, lifestyle changes, and daily Kegel exercises.    Jopling, A. G. (2020). Effective Screening for Female Urinary Incontinence at the Well-Woman Examination. Urologic Nursing, 40(3), 139–148. https://doi-org.wilkes.idm.oclc.org/10.7257/1053-816X.2020.40.3.139Mirelle Aires Botelho De Matos, Bruna Letícia Alves Barbosa, Mara Cecília Costa, Francisca Cecília Viana Rocha, Camila Aparecida Pinheiro Landim Almeida, & Fernanda Cláudia Miranda Amorim. (2019). The Urinary Incontinence Repercussions Towards the Elderly’s Life Quality. Revista de Pesquisa: Cuidado e Fundamental, 11(3), 567–575. https://doi-org.wilkes.idm.oclc.org/10.9789/2175-5361.2019.v11i3.567-575less1 UnreadUnread5 ViewsViews
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  • Harding, Mariann M.,Kwong, Jeffrey,Roberts, Dottie,Hagler, Debra,Reinisch, Courtney. Lewis’s Medical-Surgical Nursing E-Book (Kindle Locations 56384-56385). Elsevier Health Sciences. Kindle Edition.
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  • Sheryl Dixon posted Mar 3, 2021 10:44 PM
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  • Urinary incontinence (UI) means a person leaks urine by accident. While it may happen to anyone, urinary incontinence is more common in older people, especially women. Incontinence can often be cured or controlled. The body stores urine in the bladder. During urination, muscles in the bladder tighten to move urine into a tube called the urethra. At the same time, the muscles around the urethra relax and let the urine pass out of the body. When the muscles in and around the bladder don’t work the way they should, urine can leak. Incontinence typically occurs if the muscles relax without warning (NIH,2017).Among the elderly postmenopausal women, the pelvic muscles show loss of volume and tone. The ligamentous and connective tissue support for the pelvic organs gradually fail because of ageing urinary incontinence discussion post. The weakened pelvic floor increases the risk of pelvic organ prolapse causing cystocele, rectocele and uterine prolapse. Stage 3-4 prolapse of pelvic organs can cause UI. A weakened pelvic floor also allows a hypermobile urethra to slide downwards during sudden increase in intra abdominal pressure. NIH, (2017). Urinary Incontinence in Older Adults. Retrieved from https://www.nia.nih.gov/health/urinary-incontinence-older-adultsless1 UnreadUnread6 ViewsViews
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  • Si Ching, Lim (2017) Managing the Elderly with Urinary Incontinence and Dementia. Int Arch Urol Complic 3:027. doi.org/10.23937/2469-5742/1510027
  •                                                                            References
  • Among the elderly men, it is estimated that histological evidence of Benign Prostatic Hyperplasia (BPH) is present in 90% of men by age 80. Although BPH is synonymous with ageing, it does not correlate directly with prostatic enlargement. Lower Urinary Tract Symptoms (LUTS) which consist of voiding and storage symptoms are common among the elderly men and increase in severity with age. Prostatic enlargement causes bladder outlet obstruction with voiding and storage symptoms. The association between LUTS and BPH in elderly men are temporal in onset but are not causally related. The differential diagnoses of LUTS in elderly men include urological and functional causes such as neurological disorders, Diabetes Mellitus, urethral stricture, etc. (Si Chim,2017).
  • Urinary incontinence increases with rising age. Ageing is associated with changes in the lower urinary tract which predispose an elderly to UI. As we age, bladder capacity and contractility reduce, with reduced ability to defer voiding once the urge to do so arises. The post-void residual urine volume increases with age. During the storage phase, detrusor shows increased uninhibited contractility urinary incontinence discussion post.
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  • Gisselle Mustiga posted Mar 2, 2021 4:43 PM
  • Urinary incontinence refers to loss of bladder control leading to involuntary leakage of urine. The condition is quite common in women more than men. It is experienced by 1 in 3 older women globally; hence this 70 year old woman patient experiencing this. UI has a prevalence of between 10% and 34% among the elderly (Neki, 2016). Notably, the condition is under reported due to hesitation or shame. UI is associated with rashes, skin irritation and urinary tract infections. The main signs and symptoms of the condition are urine leakages and frequent loss of small to moderate amounts of urine (Huether et al. 2020). Some of the major type of urinary incontinence included mixed incontinence where the patient experiences more than one type of the condition, overflow incontinence characterized by constant and continuous flow of urine, stress incontinence in which leakages results from pressure in the bladder, urge incontinence and functional incontinence.

References

Mayo Clinic, (2021). Urinary Incontinence: Overview. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808   less0 UnreadUnread

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  • Neki, N. (2016). Urinary Incontinence in Elderly. Journal of Krishna Institute of Medical Sciences University 5(1):5-13. https://www.researchgate.net/publication/292194746_Urinary_Incontinence_in_Elderly
  • Huether, S. E., McCance, K. L. & Brashers, V. L. (2020). Understanding Pathophysiology 7^th ed. Elsevier Mosby urinary incontinence discussion post.