Elimination from the urinary tract is usually
taken for granted. Only when a problem arise
do most people become aware of their urinary
habits and any associated symptoms
Urinary Elimination – is essential to health and
voiding can be postponed for only so long
before the urge normally becomes too great to
control.
PHYSIOLOGY OF URINARY ELIMINATION
Deprnds on effective functioning of:
Upper urinary tract
Kidney,ureters
Lower urinary tract
Bladder, urethra, pelvic floor
Cardiovascular System
Nervous System
Everyday our kidneys process around 200 liters
of blood and around 1 to 2 liters of waste is
removed as urine.
Nephron – functional unit of the kidney, urine is
formed here.
Glomerulus – fluids and solutes move across
endothelium of capillaries into the capsule
Bowman’s capsule – filtrate moves from here
into the tubule of the nephron.
Proximal convoluted tubule – most of the water
and electrolytes reabsorbed
Ureters
25-30 cm long and 1.25 cm in diameter
Upper end funnel shaped, enters kidney
Lower end enters bladder at posterior
Bladder
Hollow organ serving as reservoir for urine
Urethra
Extends from bladder to meatus
Pelvic floor
Vagina, urethra, and rectum
URINATION
Known also as MICTURITION and VOIDING
Refers to process of emptying the bladder
Urge to void happens when adult bladder
contains 250mL and 450mL of urine and in
children 50-200mL
Older adults whose cognition is impaired may
not be aware of the need to urinate or able to
respond to this urge by seeking toilet facilities.
FACTORS AFFECTING VOIDING
1. Developmental Factors
 INFANTS –urinates more or less 20
times a day odorless and colorless
 PRESCHOOLERS – independent toileting
at this stage child is taught to wipe from
front to back to prevent infection.
 SCHOOL AGE – child urinates 6 to 8
times a day. Enuresis – involuntary
passing of urine. Nocturnal Enuresis
(bed wetting) – involuntary passing of
urine during sleep.
 Older adults – excretory function
decrease, older adults arise during the
night to void (nocturnal frequency)nand
retention of residual urine. Predisposing
to bladder infections.
2. Psychocosial Factors
Set conditions, like privacy, normal
conditions, sufficient time and running
water helps stimulate the micturition reflex
Voluntary suppression of urination due to
the time pressure, may increase UTI
3. FLUID and FOOD INTAKE
Healthy body maintains a balance between
the amount of fluid ingested and the
amount of fluid eliminated
Fluids such as alcohol and caffeine increases
urine production, while Na rich foods and
fluids cause retention.
4. MEDICATIONS
Those affecting the ANS interfere with
normal urination process and causes
retention
DIURETICS- increase urine formation by
preventing reabsorption of water and
electrolytes
5. MUSCLE TONE
Good muscle tone maintain the stretch and
contractility of detrusor muscle so bladder
can fill and empty completely.
6. Pathologic Conditions
a. disease of the kidney – affect the ability
of the nephrons produce urine
b. heart and circulatory disorder – affects
blood flow, interfering with urine
production
c. Urinary stones – obstruct ureter
d. Hypertrophy of the prostate gland –
obstruct the urethra
7. SURGICAL/ DIAGNOSTIC PROCEDURES
a. Cystoscopy – swelling of urethra
b. Surgery – postoperative bleeding, turning
the urine pink or red
c. Spinal anesthetics – decreases awareness
of need to void
ALTERED URINE PRODUCTION
POLYURIA ( diuresis )
Production of abnormally large amount of
urine by the kidneys. POLYDIPSIA –
excessive fluid intake
OLIGURIA
Low urine output, less than 500mL a day
ANURIA
Lack of urine production
ALTERED URINARY ELIMINATION
FREQUENCY – voiding at frequent intervals,
more than 4-6 times per day
NOCTURIA – voiding 2 or more times at
night
URGENCY – sudden, strong desire to void
DYSURIA – voiding that is either painful or
difficult
ENURESIS – involuntary urination in
children when voluntary bladder control is
normally acquired, usually 4 to 5 years of
age.
URINARY RETENTION – accumulation of
urine and over distention of the bladder
caused by impairment in the emptying
capacity of the bladder.
URINARY INCONTINENCE
Involuntary leakage of urine or loss of
bladder
STRESS URINARY INCONTINENCE – occurs
due to weak pelvic floor muscles causing
urine leakage when laughing, coughing,
sneezing, etc.
URGE URINARY INCONTINENCE – urgent
need to void and the inability to stop
micturition
MIXED URINARY INCONTINENCE – Mix of
stress UI and urgency UI

Overflow Incontinence – continuous

involuntary leakage or dribbling of urine
resulting to incomplete bladder emptying

URINE COLOR

BROWN URINE
LIGHT BROWN URINE
ORANGE URINE
RED/PINK URINE

BLUE/GREEN URINE
CLOUDY URINE