Lecture on Genital Urinary System and Incontinence

Introduction

• Focus on incontinence within the genital urinary system, fluids, and electrolytes.
• Emphasis on active learning and preparation for patient care beyond classroom exams.

Learning Objectives

• Understand urinary incontinence and its implications for patient care.

Definition and Risk Factors

• Urinary Incontinence: Unplanned, involuntary loss of urine from the bladder.
• Affected Populations: More common in women and older adults.
• Risk Factors:
  • Age-related changes, cognitive disturbances, obesity, diabetes, genitourinary surgeries.
  • Activities like high-impact exercises, immobility, trauma, use of certain medications.
  • Factors like menopause, pregnancy, postpartum changes, and stroke.

Types of Urinary Incontinence

1. Stress Incontinence

   • Involuntary loss due to exertion, sneezing, coughing.
   • Affects women post-vaginal delivery, men post-prostate surgery.

2. Urge Incontinence

   • Strong urge to void that cannot be suppressed.
   • Triggered by bladder contractions, influenced by diet or bladder irritation.

3. Functional Incontinence

   • Due to physical or cognitive impairments; the urinary tract is intact.

4. Iatrogenic Incontinence

   • Induced by medications affecting the bladder neck.

5. Mixed Incontinence

   • Combination of different types, e.g., stress and urge incontinence.

6. Overflow Incontinence

   • Continuous leakage due to bladder overdistension.

Nursing Assessment

• Assess history, pattern, medication, dietary influences, emotional impact.
• Examine skin, especially the perineal area, for breakdown or dermatitis.

Symptom Management

• Manage triggers of incontinence and ensure hygiene.
• Utilize patient diaries, voiding history, bedside tests, urinalysis.

Treatment Approaches

1. Behavioral Therapies

   • Pelvic floor exercises (Kegels), timing voiding, adjusting fluid intake.

2. Pharmacological Therapies

   • Anticholinergic agents for urge incontinence, beta-3 adrenergic agonists.
   • Use of medications like amitriptyline, pseudofedrine sulfate with care.

3. Surgical Management

   • Procedures to stabilize bladder/urethra, periurethral bulking.

4. Fluid Management

   • Encourage normal intake, adjust timing, avoid irritants.

Nursing Interventions

• Educational initiatives to diminish stigma and promote self-management.
• Support for behavioral therapies to avoid discouragement.
• Educate on timing of medication and fluid intake to avoid nocturnal incontinence.

Psychosocial Considerations

• Address social isolation, encourage independent living.
• Treat the subject with respect, assure patients of dignity.
• Develop patient strategies for self-management and advocacy.

Conclusion

• Review learning objectives, self-test comprehension.
• Continue education through textbooks, videos, or tutoring if needed.