Cath Lab Digest

A n excellent resource for students in medical and nursing schools, as well as practicing healthcare providers (HCPs) in acute and long-term care, Managing and Treating Urinary Incontinence addresses a variety of topics related to urinary incontinence (UI). Among these topics are the types and causes of incontinence, how bowel function affects UI, available protective products, behavioral treatments, and surgical and pharmacological interventions used to treat UI.

The author introduces the subject with a comprehensive overview of incontinence, emphasizing that most HCPs do not realize UI and overactive bladder (OAB) affect 17 million people and cost $28 billion per year to treat. Because little is taught about UI in social work programs or medical and nursing schools, few HCPs understand that incontinence is the major reason for nursing home admissions or, because UI is not a socially acceptable subject for discussion, few people seek treatment.

Aspects of bladder function, including the anatomy and physiology of nervous innervation of the bladder and pelvic floor muscle anatomy, as well as the impact of these systems on UI, are presented. Although the focus is on the elderly patient, the book acknowledges that young and middle-aged adults frequently have problems with UI. However, changes in nervous and muscular systems predispose the elderly to UI.

The classifications of UI are explained in great detail. Transient or acute UI occurs during an illness (infection, dehydration, delirium, or impaction) and, once treated, usually disappears. Persistent, or chronic, UI occurs because of long-term abnormalities in the lower urinary tract. Among the latter types are stress, urge, mixed, overflow, and functional incontinence. Major factors that identify individuals at risk are discussed.

Bowel function and its relationship to UI is rarely discussed and often poorly understood by lay individuals and HCPs. Bowel problems are presented in detail with illustrations describing various stool type.

Treating UI begins with a good assessment. The author provides an extensive overview of the clinical, functional, neurological, urological, and environmental determinations needed to diagnose and treat UI. Instructions on maintaining a bladder record to monitor periods of incontinence and to track the frequency, timing, and number of incontinent periods are provided.

Toileting and retraining programs are emphasized and begin with advice on determining the person's cognitive ability to participate. Programs involve scheduled voiding (toileting on a fixed schedule), prompted voiding (increasing the individual's awareness of the need to void), bladder retraining (voiding by the clock rather than by the urge and gradually increasing the intervals between voiding to decrease obsessive toileting), and pelvic muscle rehabilitation.

Biofeedback techniques help assess pelvic muscle strength. The patient practices pelvic muscle exercises (Kegel's exercises) taught by the HCP and uses biofeedback to increase tone (an outcome indicator). Increased bladder tone helps retain urine and prevent "accidents."

Skin care is important with incontinence; a wet environment can predispose an individual to skin breakdown. The author provides an extensive description of the variety of devices and methods available to increase continence, collect urine, and promote dryness.

Although surgical intervention is an option, most people prefer to take a pill to cure a problem. The chapter on pharmacological therapy offers a comprehensive description of the various pharmacological agents used to treat urge incontinence (anticholinergics, antidepressants, and tertiary amines) and stress incontinence (alpha-adrenergic agents and hormones). Lists of drugs, actions, dosages, and side effects are included.