4 types of incontinence need different treatments
Understand patient’s lifestyle to make assessment
One of the results of a good assessment for incontinence and a patient’s bladder diary is that you can more accurately identify which type or types of incontinence your patient is experiencing, says Carolyn Crumley, RN, MSN, CWOCN, wound, ostomy, and continence clinical nurse specialist and president at WOC Care in Lee’s Summit, MO.
If the patient suffers from stress incontinence, there is a loss of urine when they cough, laugh, or sneeze, Crumley says.
"Often early postmenopausal or younger elderly women suffer from this type of incontinence as a result of muscles that are stretched during childbirth or a lack of estrogen following menopause," she says.
Both of these conditions contribute to weakness of the pelvic floor muscles, but Kegel’s exercises in which the women contract and relax the muscles can help strengthen them, she says.
Urge incontinence is the loss of urine as a result of always feeling the need to go to the bathroom, Crumley says. "These patients go to the bathroom frequently, sometimes every 30 minutes," she says. Treatment includes retraining the bladder by increasing the interval between bathroom visits.
"We get patients to relax and distract themselves when they first feel the urge by counting backwards from 100 or by contracting the pelvic floor muscles," she says.
By having patients increase the interval between bathroom visits and having them go when they are more relaxed, the bladder is emptied more completely and there is less urine leaked, she adds.
Overflow incontinence is primarily seen in men and results from the patient not fully emptying the bladder. "This problem can be caused by an enlarged prostate that blocks the bladder and keeps it from emptying," Crumley says.
This condition usually results in the patient having urinary tract infections, she adds. A urologist can rule out malignancy of the prostate and may perform a transurethral resection to eliminate the blockage, she says. There also is medication to help control weak bladder muscles, she adds.
Another method to help patients with overflow incontinence is to teach patients how to intermittently catheterize themselves to empty the bladder then remove the catheter, Crumley says. This prevents the bladder from constantly being distended and prevents further weakening of the bladder muscle, she explains.
If you’ve ruled out stress, urge, and overflow incontinence, then your patient suffers from functional incontinence, which is a category that describes a wide range of patients, Crumley says.
"You might have a stroke victim who may make it to the bathroom but because of mobility problems may take too long getting the clothing off before the urine leaks," she says. "Or you might have a patient with dementia who just doesn’t understand that it is time to go to the bathroom," she adds. n