Understanding Renal Physiology Changes and Urinary Incontinence
Changes in the Physiology of Renal Elimination
There is a decrease in weight and volume of the kidney, which in 80 years, an individual can weigh 30% less than in a young adult. Renal blood flow decreases due to sclerosis of the arteries, which causes a decrease in the rate of glomerular filtration. The number and size of the nephron also reduce. The tubules responsible for absorption and excretion decrease in length and volume.
Problems Causing Changes in Storage
- Difficulty in starting micturition
- Incomplete emptying of the bladder and urinary retention
- Decreased capacity to store urine
These changes occur in the individual, leading to:
- An increase in the frequency of voids
- Pollakiuria
- Nocturia
- Less ability to postpone evacuation
- Accidental loss with minimal pressure
Urinary Incontinence
Urinary incontinence is the loss of voluntary control. Incontinence refers to the involuntary loss of urine through the urethra, which is objectively demonstrable and can cause social problems and hygiene issues for the individual.
Types of Incontinence
A person in old age can experience the same types of incontinence as at any age, but the most common is functional incontinence, where the urinary tract is intact, but continence is altered by external problems. The most frequent causes of acute incontinence in the elderly are:
- D: Delirium, dehydration
- I: Infection of the urinary tract
- In: Atrophic vaginitis or urethritis
- Q: Medicinal (pharmaceutical)
- Q: Psychological (especially depression)
- E: Endocrine (hypercalcemia, hyperglycemia)
- A: Mobility restrictions
- S: Fecal impaction
English diapers (diapers) may be necessary for management.
Functional Incontinence of Urine
This situation occurs when a normally continent person cannot reach the toilet in time, resulting in involuntary emission of urine. Demonstrations show that the time required to reach the toilet exceeds the time between the sense of urgency and uncontrolled micturition, leading to urine loss before reaching the toilet.
Outcome Criteria
To eliminate or reduce incontinence episodes, it is essential to describe the causative factors of incontinence and identify adjuvants. The elderly person must identify techniques that increase bladder control, reduce environmental barriers, and use aids to assist in voiding and mobility.
The elderly person should practice pelvic floor exercises, control fluid intake, maintain a regular bowel pattern, understand voiding habits, and ensure skin integrity and comfort.
Training for Bladder Control
Training for bladder control is necessary to regain control. Please note the following:
- Assistance systems provide control and comfort.
- The call system is indicated for immobilized elderly individuals.
- Accessibility to toilets favors continence.
- Some medications affect normal urinary function.
Strengthening the Pelvic Floor
Western women are often less aware of the need to strengthen the pelvic floor, which is responsible for counteracting gravity and supporting the abdominal viscera. It plays an important role during labor, delivery, and the puerperium.
Product Absorption
Precautions must be taken to ensure that patients can return products and reject dependent behavioral treatments. Napkins should be used as an option for control.
Nursing Care
- Provide the person with plenty of fluids to dilute urine.
- Encourage the person to mobilize more and walk.
- Prevent the ascent of bacteria through the ureters to the kidneys through proper hygiene.
- Advise the person to shower instead of bathing.
- Avoid contamination from vaginal and anal incontinence.
- Follow a diet that includes waste acids to acidify urine.
- Avoid using a balancing technique for residual urine from front to back to facilitate voiding.