- Observe patient's voiding patterns, time of voiding, amount voided, and whether voiding is provoked by stimuli. Accurate, thorough assessment forms the basis of an effective treatment plan.
Discuss stress incontinence and associated social stigma with patient in a nonjudgmental manner. Tell patient that many people experience incontinence. Patient may be reluctant to discuss incontinence, which can have a negative effect on self-image. A nonjudgmental approach may help ease embarrassment and encourage open discussion of the problem.- Assist patient in obtaining appropriate evaluation and care for the underlying causes of stress incontinence to ensure prompt diagnosis and treatment.
- Develop an individualized toileting schedule, increasing intervals by 30 minutes until the patient achieves a 2- to 3-hour pattern. Bladder retraining may help alleviate symptoms.
Teach patient to do Kegel exercises to strengthen pelvic floor muscles. Instruct patient to tighten muscles of pelvic floor to stop flow of urine while urinating and then to release muscles to restart flow to strengthen the urinary sphincter muscle and restore control.- Help patient reduce intra-abdominal pressure by losing weight, avoiding heavy lifting, avoiding chairs or beds that are too high or too low. These measures reduce intra-abdominal pressure and bladder pressure.
- Promote patient's awareness of condition through education to help patient understand illness as well as treatment.
- Provide supportive measures:
- Respond to call bell quickly, assign patient to bed next to bathroom, put night-light in bathroom, and have patient wear easily removable clothing (gown rather than pajamas, and Velcro fasteners rather than buttons or zippers). Early recognition of problems promotes continence; easily removed clothing reduces patient frustration and helps achieve continence.
- Provide privacy during toileting to reduce anxiety and promote elimination.
- Have patient empty bladder before meals, at bedtime, and before leaving accessible bathroom area to promote elimination, avoid accidents, and help relieve intra-abdominal pressure.
- Encourage high fluid intake, unless contraindicated, to moisten mucous membranes and maintain hydration.
- Suggest patient eat increased amount of salty food before going on a long trip (unless contraindicated). Increased sodium decreases urine production.
- Make protective pads available for patient's undergarments, if needed, to absorb urine, protect skin, and control odors.
- If surgery is scheduled, give attentive, appropriate preoperative and postoperative instructions and care to reduce patient's anxiety and build trust in caregivers.
- Encourage patient to express feelings and concerns about urologic problems. This helps patient focus on specific problem.
- Review the current medication regimen for drugs that can contribute to stress incontinence, including diuretics, central nervous system depressants, and anticholinergics. Discuss with the physician the possibility of changing medications or the medication schedule to relieve symptoms.
Refer patient and family members to psychiatric liaison nurse, support group, or other resources, as appropriate. Community resources typically provide health care not available from other health agencies.- Alert patient and family members about need for toilet schedule. Prepare for discharge according to individual needs to ensure that patient will receive proper care.
Suggested NIC Interventions
Pelvic Muscle Exercise; Teaching: Individual; Urinary Elimination Management; Urinary Habit Training; Urinary Incontinence Care |