XAVIER UNIVERSITY – ATENEO DE CAGAYAN

COLLEGE OF NURSING

In partial fulfillment of requirements of

NCM 112 - Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious,
Inflammatory and Immunologic response, Cellular Aberrations, Acute and Chronic

Altered Urinary Elimination

Submitted by:
Abragan, Camille Viktoria Ballares, Ma Therese P

Abucay, William Angelo C Canda, Brigette Keeshia V

Acabo, Gabrielle Jeanz A Canoy, Anna Isabella Lili B

Acac, Lance Alistair G Clarito, Kryschelle M

Afdal, Shamsa Hynra P Dagumbal, Jan Levin
Aparece, Dara Doreen S del Mar, Almira Louise M
Artajo, Lyka Nicole B

BSN 3 – NB

Submitted to:
Mrs. Jesusa C. Gabule, RN, MN
Clinical Instructor

September 28, 2020

 VOIDING DYSFUNCTION
A. Definition of Disease
- is a urology condition that is characterized by poor condition between the
bladder muscle, prostate (in males) and the urethra. ​In voiding dysfunction,
the normal course of emptying of the bladder is compromised. Voiding
dysfunction can affect men, women, and children.
B. Causative Agents
- Causes and risk factors of voiding dysfunction can vary by gender and age.
For example, in men, an enlarged prostate commonly leads to voiding
dysfunction because the enlarged prostate could obstruct or interfere with
normal urine flow. In women, voiding dysfunction can be caused by an
underactive bladder. In children, voiding dysfunction can be caused by
problems with potty training and/or not enough bathroom breaks.
- Other general causes and risk factors include:
● Abnormal urinating habits
● Fear of urinating due to prior urinary tract infection
● Weak pelvic floor
● The presence of scar tissue in the bladder
● Bladder stones
● Bladder tumors or cancer
● Bladder infection
C. Signs and Symptoms
- urinary tract infection
- frequent urination
- urgent urination
- pain or straining with urination
- hesitancy
- dribbling
- intermittent urine flow
- pain in the back, flank or abdomen
- blood in the urine
D. Medical Management
- Overactive Bladder (OAB)​: The first step in treating OAB is to start the child on a
schedule where they use the bathroom every 2-3 hours while they are awake.
Children are encouraged to urinate before the sense of urgency develops to help
“retrain” the bladder. After a few months on the voiding schedule, physicians may
prescribe medications that can help reduce the frequency and feeling of urgency.
 - Dysfunctional Voiding​: Most treatments for dysfunctional voiding focus on
retraining the brain and helping the bladder relax. Children are taught that normal
urination doesn’t involve squeezing the abdominal muscles, but instead, relaxing
muscles in the pelvis and bladder. A timed voiding schedule is an important part
of bladder retraining. Biofeedback and Kegel exercises (pelvic floor relaxation
and contraction) can also effectively help manage dysfunctional voiding.The
physician may also be prescribed medicine that helps the bladder relax.
- Underactive Bladder:​ Treatment for underactive bladder is primarily behavioral.
Children are put on a timed bathroom schedule to go whether or not they feel the
urge to urinate. Medications that relax the bladder can also be helpful. Children
with very large capacity bladders who aren’t able to urinate may require short
term catheterization. The use of Transcutaneous Electrical Nerve Stimulation
(TENS) has been shown to help these children as well.
E. Nursing Interventions
- Encourage adequate fluid intake (2–4 L per day), avoiding caffeine and
use of aspartame, and limiting intake during late evening and at
bedtime. Recommend use of cranberry juice/vitamin C.
- Begin bladder retraining per protocol when appropriate (fluids between
certain hours, digital stimulation of trigger area, contraction of
abdominal muscles, Credé’s maneuver).
- Promote continued mobility
- Observe for cloudy or bloody urine, foul odor. Dipstick urine as
indicated.
- Cleanse perineal area and keep dry. Insert catheter and provide
catheter care as indicated.
- Recommend good hand washing and proper perineal care.
- Refer to urinary continence specialist as indicated.
- Administer medications as ordered by the Physician
- Educate patient about the importance of limiting intake of alcohol and
caffeine.
F. References

Thomas, K. (2019, March 19). Voiding Dysfunction. Retrieved September 22, 2020,
from ​https://loyolamedicine.org/urology/voiding-dysfunction
Voiding Dysfunction. (n.d.). Retrieved September 22, 2020, from
https://www.nationwidechildrens.org/conditions/voiding-dysfunction

Voiding Dysfunction Symptoms & Causes: Boston Children's Hospital. (n.d.). Retrieved
September 22, 2020, from
http://www.childrenshospital.org/conditions-and-treatments/conditions/v/voiding-dysfun
ction/symptoms-and-causes

Wayne, G., By, -, Wayne, G., & Gil Wayne graduated in 2008 with a bachelor of
science in nursing and during the same year. (2017, September 23). Impaired Urinary
Elimination – Nursing Diagnosis & Care Plan. Retrieved September 22, 2020, from
https://nurseslabs.com/impaired-urinary-elimination/
 URINARY INCONTINENCE
A. Definition of Disease
- According to Brunner and Suddarth’s Textbook of Medical Surgical Nursing,
urinary incontinence is the involuntary loss of urine from the bladder.
B. Causative Agents
- Urinary incontinence is a symptom, not a disease (Urinary Incontinence -
Symptoms and Causes, 2019). This can be due to everyday habits, an
underlying medical condition or physical problems. The cause of urinary
incontinence depends if it is temporary or permanent.
a. Temporary urinary incontinence
○ Some drinks, foods and medications may have a diuretic effect
on the body, in which it stimulates the bladder and at the same
time increases your urine volume. These include alcohol,
caffeine, carbonated drinks and sparkling water, artificial
sweeteners, chocolate, chili peppers, spicy foods, citrus fruits,
heart and blood pressure medications, sedatives, muscle
relaxants, and large doses of vitamin C.
○ Moreover, this may be caused by an underlying medical
condition that can be easily treated, such as urinary tract
infection and constipation. UTI irritates the bladder thus
resulting in strong urges to urinate and sometimes lead to
incontinence.
b. Permanent urinary incontinence
○ Pregnancy - due to hormonal changes and increased weight of
the fetus during pregnancy it can lead to stress incontinence.
○ Childbirth - the muscles needed for bladder control can be
weakened due to vaginal delivery and also damage the
bladder nerves and supportive tissue. This can lead to a
prolapsed pelvic floor which can result in protrusion of bladder,
uterus, rectum or small intestine into the vagina.
○ Changes with age - as the person age the bladder muscle also
decreases in which lowers the capacity of the bladder to store
urine.
○ Menopause - women produce less estrogen after menopause
resulting in deterioration of tissues that helps keep the lining in
the bladder and urethra healthy.
 ○ Hysterectomy - the removal of the uterus may damage the
supporting pelvic floor muscles since the bladder and uterus
are supported by many of the same muscles and ligaments.
○ Enlarged prostate - most common in older men.
○ Prostate cancer - incontinence usually happens as a side
effect of treatment for prostate cancer.
○ Obstruction - urinary stones that form in the bladder
sometimes cause urine leakage.
○ Neurological disorder - conditions that interfere with nerve
signals that involve bladder control can lead to urinary
incontinence such as multiple sclerosis, Parkinson’s disease,
stroke, brain tumor or spinal injury.
C. Signs and Symptoms
- There are different types of urinary incontinence, one is ​stress incontinence
which is the involuntary loss of urine due to intact urethra caused by
sneezing, coughing, or changing positions.
- Urge incontinence is associated with a strong urge to void and cannot be
stopped. You will feel the need to go to the bathroom many times during the
day and even wake up from sleep to void.
- Functional incontinence ​is when the lower urinary tract function is intact but
certain cognitive impairment or physical impairment makes it difficult for the
patient to suppress voiding.
- Iatrogenic incontinence is the involuntary loss of urine due to medication such
as the use of alpha-adrenergic agents to decrease blood pressure.
- Overflow incontinence is when the bladder cannot empty, it stays full thus
leading to overflow and leakage. You will experience multiple, small urinations
each day, or ongoing dribbling.
- Lastly, ​mixed urinary incontinence involves several types of urinary
incontinence, it is the involuntary leakage due to urgency and with exertion,
effort, sneezing or coughing.
D. Medical Management
a. Behavioral Therapy
- This involves pelvic floor muscle exercises or Kegel exercises for
stress, urge and mixed incontinence. This also includes voiding diary,
biofeedback, verbal instruction, and physical therapy.
- Lifestyle changes include fluid control and limiting certain foods and
drinks such as spicy foods, coffee, tea and colas.
 b. Pharmacologic Therapy
- Anticholinergic agents are the first-line medications for urge
incontinence, this inhibits bladder contraction.
- Tricyclic antidepressant medications such as amitriptyline (Endep) and
amoxapine (Asendin) can help decrease bladder contractions and at
the same time increase the bladder neck resistance.
- Pseudoephedrine sulfate (Sudafed) may be used to treat stress
incontinence as it blocks alpha-adrenergic receptors. Caution use in
men with prostate hyperplasia.
- Hormone therapy such as estrogen can be taken by postmenopausal
women who are experiencing urge incintinence. Estrogen restores the
mucosal, vascular, and muscular integrity of the urethra.
c. Surgical Management
- This is only indicated for patients who were not successful with
behavioral and pharmacological therapy.
- For stress incontinence the surgical procedures that can be performed
are slings, bladder neck suspension or colposuspension, bulking
agents (injections, and artificial urinary sphincter.
- For urge incontinence, bladder botox treatment, nerve stimulation, and
bladder reconstruction or urinary diversion surgery can be performed.
E. Nursing Interventions
- Provide support and encouragement for patients undergoing behavioral
therapy because a lot of patients get discouraged easily when improvements
don't show quickly.
- Conduct health teachings that promote urinary continence.
a. Increase patient awareness on the amount and timing of fluid intake.
b. Advise patients to avoid taking diuretics after 4 pm.
c. Avoid drinking coffee, alcohol and other bladder irritants.
d. Drink adequate fluids, eat a well-balanced diet high in fiber, exercise
regularly, take stool softeners if indicated, to avoid constipation.
e. Void regularly, five to eight times a day (every 2-3 hours). First thing in
the morning, before each meal, before retiring to bed, and once during
the night if necessary.
f. Perform pelvic floor exercises as prescribed, every day.
g. Encourage patients to stop smoking, because smoking increases the
frequency of coughing.
- Explain the purpose of every pharmacological therapy given.
F. References
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2009). Brunner and
Suddarth’s Textbook of Medical Surgical Nursing, 12th Edition (12th ed.). Lippincott
Williams & Wilkins.

Urinary incontinence - Symptoms and causes. (2019, April 13). Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-caus
es/syc-20352808