Urinary incontinence is the involuntary loss of urine as a result of problems controlling the bladder. Reflex Urinary Incontinence involves dysfunction of the normal neurological control mechanisms for coordination of detrusor contraction and sphincter relaxation. This is most often caused by a problem in the central nervous system. Reflex incontinence can occur as a result of stroke, Parkinson’s disease, brain tumors, spinal cord injuries or multiple sclerosis. The patient with reflex incontinence experiences periodic urination without an awareness of needing to void. Urination is constant throughout the day and night. Urine volume is consistent with each voiding. Residual urine volumes are usually less than 50 mL. Urodynamic studies will indicate detrusor contraction when bladder volume reaches a particular amount.
Patient establishes a regular voiding pattern.
Ascertain the patient’s recognition of the need to urinate. Patients with neurological impairments may have damaged sensory fibers, and may not have the sensation of the need to void.
Measure and record urine volume with each voiding. Urine volumes are usually consistent with reflex incontinence.
Review the results of urodynamic studies. A cystometrogram will measure bladder pressures and fluid volumes during filling, storage, and urination. Electromyography will record detrusor activity during voiding. Test results will indicate the point of coordination between detrusor muscle and sphincter activity.
Allow the patient to maintain a “bladder diary.” Data about fluid intake and voiding pattern provides a basis for planning bladder management techniques.
Tell the patient to limit fluid intake 2 to 3 hours prior bedtime and to void just before going to bed. Restricting fluid intake and voiding before going to bed reduces the need to interrupt sleep for voiding.
Allow voiding at scheduled intervals before predictable urination. Voiding at regular intervals, based on knowledge of the patient’s voiding pattern, lowers the possibility of uncontrolled incontinence.
For the male patient, acknowledge the application of an external catheter. An external catheter attached to a gravity drainage device enables the patient to remain dry.
If spontaneous voiding is not possible, catheterize the patient at regular intervals. Emptying the bladder at regular intervals will reduce incontinence episodes. The risk for infection is noteworthy with indwelling catheters.
Explain the importance of absorbent pads in social situations. Absorbent pads will preserve clothing when the patient is in public. The patient needs to learn about replacing the pads at regular intervals to prevent skin irritation from exposure to urine and moisture.
Demonstrate to patient or caregiver intermittent catheterization. This method drains the bladder at particular periods.
Work with the patient and family to establish a reasonable, manageable voiding program. Participation in plan of care promotes additional knowledge and appropriate management.