URINARY TRACT INFECTION (CYSTITIS)

 refers to an infection within the lower urinary tract, usually affecting the bladder,
although the urethra and ureters may be involved. Cystitis is an inflammation of the
bladder wall, usually caused by ascending bacteria.
*the term cystitis is often used to refer to a UTI that is symptomatic.
*female: 1-2 inches (25% to have)
Male: 8 inches + antibacterial properties of prostatic fluid

URINARY INCONTINENCE
 A condition in which involuntary loss of urine is a social or hygienic problem and is
objectively demonstrable.
 Often caused by interference with sphincter control.
CAUSES
 sphincter weakness or damage – obstetric trauma, postoperative weakness,
congenital weakness (e.g postoperative catheter removal for men in reproductive
system)
 urethral deformity – recurrent UTI, gynecologic, surgery, trauma, estrogen deficiency,
vulvitis
 alteration of the urethrovesical junction – occurs in women.
 detrusor instability – caused by lesions: tumor, infection, complication of pelvic
surgery
 abdominal and perineal muscle tone – obesity, lack of exercise, loss of tone after
childbirth, prostatectomy.
 Physical – physical immobility, often of the elderly. Strokes, fractures, weakness,
failing vision, unable to see cr/bedpan.
 Psychosocial – dementia/simple confusion (don’t know what to do when urge is felt,
dependence, rebellion, attention seeker)
 Medication – narcotics, sedatives, hypnotics, alcohol, rapid-acting diuretics,
antihistamines
 Others – fecal impaction(severe constipation), bladder scarring, urethral adhesions,
dm, obesity

TYPES OF URINARY INCONTINENCE

 STRESS - increased intra-abdominal pressure caused by activities such as
coughing, laughing, sneezing, walking, or running leads to an involuntary loss of
urine; the intravascular pressure increases to overcome the resistance of the internal
sphincter in the urethra.
 ENURESIS – night time incontinence or “bed-wetting” is usually associated with
childhood, although the problem can extend into adulthood.
 URGE – inability to hold back the flow of urine when feeling the urge to void;
spasmodic bladder contractions accentuate the problem.
 OVERFLOW (paradoxic) – retention with overflow of small amounts or urine; occurs
when the intravesicular pressure exceeds maximal urethral pressure without detrusor
activity.
 REFLEX – abnormal activity of the spinal cord reflex leading to involuntary loss of
urine.
  PSYCHOLOGICAL – client aware of need to urinate, but unable to respond
appropriately to urge because of dementia or confusion.
 ENVIRONMENTAL – client aware of need to urinate, but physically unable to either
reach the toilet on own or receive adequate assistance to do so.

TREATMENT
 Weight loss
 Absorbent products
 Exercise
 Electrical stimulation
 Biofeedback
 Timed voiding / bladder training
 Medications
 Pessaries
 Peri/Trans Urethral Injections
 Surgery
 Bladder repositioning
 Marshall-Marchetti-Krantz
 Slings
 Bladder augmentation
a. Artificial urinary sphincter
b. Catheterization
 Other procedures
a. Kneading the perineum - help expel unvoided urine retained by a urethral
stricture, a urethral sphincter that is slow to close, or overdeveloped
abdominal floor muscles and connective tissue (as may be developed by the
stresses of bicycle seats.)
b. incontinence pad – highly absorbent sheet placed beneath the patient

UI in children
A baby's bladder fills to a set point, then automatically contracts and empties. As the child gets
older, the nervous system develops. The child's brain begins to get messages from the filling
bladder and begins to send messages to the bladder to keep it from automatically emptying until
the child decides it is the time and place to void. (<5y/o)

Excessive output of urine during sleep

Normally, the body produces a hormone that can slow the making of urine. This hormone is
called antidiuretic hormone, or ADH. The body normally produces more ADH during sleep so
that the need to urinate is lower. If the body does not produce enough ADH at night, the making
of urine may not be slowed down, leading to bladder overfilling. If a child does not sense the
bladder filling and awaken to urinate, then wetting will occur.

Infrequent voiding refers to a child's voluntarily holding urine for prolonged intervals. For
example, a child may not want to use the toilets at school or may not want to interrupt enjoyable
activities, so he or she ignores the body's signal of a full bladder. In these cases, the bladder
can overfill and leak urine. Additionally, these children often develop urinary tract infections
(UTIs), leading to an irritable or overactive bladder.