In the normal voiding process, all components of the lower urinary tract system, namely the detrusor, bladder neck and external urethral sphincter, function in a coordinated manner in the process of emptying and filling urine in the bladder. Physiologically, in every voiding process, it is expected that four normal voiding conditions are met, namely adequate bladder capacity, complete emptying of the bladder, emptying process takes place under good control and every bladder filling and emptying does not adversely affect the urinary tract. upper urinary tract and kidneys. If one or more of these aspects are abnormal, a micturition disorder called urinary incontinence can occur.
In women, in general, incontinence is stress incontinence, meaning that the discharge of urine is solely due to coughing, sneezing and all other movements and it is rare to find urge incontinence, where there is a sudden urge to void. This desire is so urgent that before reaching the restroom the sufferer has wet his pants. This type of incontinence is known as a neuropathic disorder of the bladder. Frequent recurrence of cystitis, as well as anatomic abnormalities that are considered to be the cause of stress incontinence, can cause urge incontinence. Stress incontinence and urge incontinence are often found together.
Clinical abnormalities that are closely related to urinary incontinence symptoms include:
a. Lower urinary tract disorders
Infection, obstruction, excessive bladder contractility, estrogen deficiency, sphincter weakness, prostatic hypertrophy.
b. Age
With age, there are several changes in the anatomy and function of the urinary organs, including: weakening of the pelvic floor muscles due to repeated pregnancies, wrong straining habits, or chronic coughing. This results in a person unable to hold urine. In addition, there is an abnormal contraction (movement) of the bladder wall, so that even though the bladder has just filled a little, it has caused the urge to urinate.
c. Neurological disorders
Brain (stroke, Alzheimer's, multi-infarct dementia, Parkinson's, multiple sclerosis), spinal cord (cervical or lumbar sclerosis, trauma, multiple sclerosis), and peripheral nerves (diabetic neuropathy, nerve trauma).
d. Systemic disorders
Congestive heart failure can also be a factor causing increased urine production and appropriate medical therapy should be given. Impaired ability to toilet can be caused by chronic illness, trauma, or impaired mobility. To overcome this, the patient must be sought to go to the toilet regularly or use a toilet substitution.
e. Functional condition
Urinary incontinence also occurs due to weakness of the pelvic floor muscles, due to pregnancy, postpartum, obesity (obesity), menopause, old age, lack of activity and vaginal surgery. The added weight and pressure during pregnancy can lead to weakening of the pelvic floor muscles due to pressure for nine months. The process of childbirth can also damage the pelvic floor muscles due to stretching of the muscles and supporting tissues as well as tearing of the birth canal, thereby increasing the risk of urinary incontinence. With decreasing levels of the hormone estrogen in women at the age of menopause (50 years and over), there will be a decrease in vaginal muscle tone and the urinary tract (urethra) muscle tone, causing urinary incontinence. Other risk factors are obesity or overweight, a history of gynecological surgery and others are also at risk of causing incontinence. The older a person is, the more likely they are to experience urinary incontinence, due to changes in the structure of the bladder and pelvic floor muscles.
f. Treatment side effects
Diuretics, anticholinergics, narcotics, calcium channel blockers, cholinestrase inhibitors.
Clinical Manifestations
Symptoms of urinary incontinence include:
- Frequent urination: is a symptom of urination that occurs more often than normal when compared to the usual pattern in a person or more often than normal which is generally accepted, ie once every 3-6 hours.
- Frequency: urinating very often, with the amount of more than 8 times in 24 hours.
- Nocturia: often wake up at night more than once to urinate.
- Urgency, namely a strong and sudden urge to urinate even though the patient has recently urinated and the bladder has not been fully filled as normal.
- Urge incontinence is a very strong urge to urinate and cannot be held back, so that sometimes before reaching the toilet the urine has come out first.
People with urinary incontinence experience irregular contractions of the bladder during the filling phase of the voiding cycle. Urge incontinence is a late symptom of urinary incontinence. The amount of urine that comes out in urinary incontinence is usually more than the capacity of the bladder, which causes the bladder to contract to excrete urine. Patients with urinary incontinence initially contract the detrusor muscle in line with the strong urge to urinate, but in some patients they realize that this detrusor contraction voluntarily tries to help the sphincter to hold urine out and inhibit the contraction of the detrusor muscle, so that the only complaints that stand out are urgency and frequency, namely approximately 80%. Nocturia is found in almost 70% of cases of urinary incontinence and the symptoms of nocturia are closely related to nocturnal enuresis. Complaints of urge incontinence are found in only one third of cases of urinary incontinence.
Nursing Diagnosis
a. Impaired urinary elimination related to sensory-motor disturbances.
b. Impaired body image related to loss of body function, changes in social involvement.
c. Anxiety related to changes in health status.
