Question

Case Scenario: Mrs. P is an 80-year-old retired school teacher who receives visits from a nursing agency for congestive heart failure. Mrs. P was diagnosed with dementia 4 years ago. She lives with her daughter, who is also her caregiver. In addition to dementia. Mrs. P has macular degeneration. She is blind at her left eye and has significantly impaired vision in her right, she fell and fractured her left hip 1 year ago. She walks with the assistance of a walker. She has a moderate amount of ankle and foot edema bilaterally. She always suffered from frequent constipation. Her current medication include; hydrochlorothiazide, a calcium channel blocker and a stool softener, Mrs. P is able to get in and out bed by herself but requires assistance with all other ADLs. She has been incontinent of urine for 2 years.Mrs. P voids but leaks urine before she gets to the bathroom. Mrs. P wears incontinence undergarments. She also has enuresis and usually wet in the morning

1. Enumerate and describe each different types of urinary incontinence.

2. Make a drug study of hydrochlorothiazide and stool softener

3. What is the common cause of urinary incontinence of Mrs.P?

4. How can you stop incontinence in older adult?5. Is incontinence a normal part of aging, explain?

Answer 1

Urinary incontinence is the loss of voluntary bladder control that can cause leakage of urine. It can be temporary or last for a long time.

1) The main types of urinary incontinence are as follows;

a) Stress incontinence

b) Urge incontinence

c) Overflow incontinence

d) Functional incontinence

e) Mixed inconvenience

a) Stress incontinence :

Urine leaks when exert pressure on bladder by coughing, laughing, sneezing, running, exercising or heavy lifting.

Causes:  

The most common cause of stress incontinence among women are pregnancy and child birth, especially having multiple vaginal deliveries. During pregnancy and child birth, the sphincter and pelvic muscles stretch out and are weakened.

b) Urge incontinence :

  Intense urge to urinate followed by an involuntary loss of urine.

Causes:

  Urge incontinence caused by minor condition such as infection or a more severe condition such neurological disorder or diabetes.

c) Overflow incontinence :

Frequent or constant dribbling of urine due to a bladder that doesn't empty completely.

Causes:

  Blockages of the urethra (the tube that carries urine from the bladder to outside the body) from tumors, urinary stones, scar tissue, swelling from infection caused by dropping of the bladder within the abdomen.

d) Functional incontinence :

Also known as disability associated urinary incontinence. It occurs when the persons bladder and or bowel is working normally but they are unable to access the toilet.

This may be due to a physical or cognitive condition.

Causes:

It includes psychological issues, environmental barriers to using the rest room, cognitive issues, including forms of dementia, delirium and intellectual disabilities, neurological or muscular limitations such as arthritis.

Mixed incontinence :

Morethan one type of urinary incontinence.

2) Hydrochlorothiazide:

It is a moderately potent diuretic.

Diuretics are drugs which increase the rate of urine formation.

• site of action :

They act on the early part of distal convoluted tubule.

• Mechanism of action:

It inhibit Na+ -cl- transport system. Inhibition of this system causes the retention of sodium and potassium in the lumen causing the retention of water this helps in diuresis.But they increases the reabsorption of calcium ions in to the blood.

These drugs also inhibit carbonic anhydrase in proximal tubule causing loss of carbonate.

Uses:

• used in oedema
• Hypertension
• Treatment of sodium retension.

Averse effect :

• hypokalemia
• hypochloremia
• hyperglycaemia
• muscle weakness
• Blood dyscrasias like thrombocytopenia

Stool softener : Example- Docusate

• It lowers the surface tension of water in stool due to which more amount of water retained in the stool causes evacuation.
• It takes 1-2 days for its action
• Dose:100-200mg

3) The common cause of urinary incontinence of Mrs.P was taking diuretics for the treatment of CHF.Diuretics are increase the flow of urine.Another reason is , Mrs.P was diagnosed with dementia 4 years ago.

4) we can stop urine incontinence in older adults by using following ways;

• Maintain a healthy weight
• Practice pelvic floor exercises
• Eat more fibre, which can prevent constipation , a cause of urinary incontinence .
• Don't smoke
• Avoid bladder irritants such as caffeine , alcohol and acidic foods.

5) Urinary incontinence is not an inevitable part of aging.

• Structural changes in the aging bladder and urethra may predispose the elderly to the development of urinary incontinence.
• Urinary incontinence can happen to women at any age, but it is more common in older women. This is probably because of hormone changes during menopause .
• More than 4 in 10 women 65 and older have urinary incontinence.