Urinary Incontinence and Catheterization: Care and Management
Urinary Incontinence: Types and Characteristics
Continence is the ability to voluntarily control bladder function. Incontinence is characterized by involuntary, unconscious loss of urine through the urethra. The physician must objectively assess the evidence of wetness.
Types of Urinary Incontinence
- Stress Incontinence: Increased pressure on the bladder leads to conditional urine loss.
- Urge Incontinence: Bladder dysfunction causes a sudden, strong urge to urinate, leading to leakage.
- Overflow Incontinence: Occurs with urethral obstruction, causing the bladder to overfill and leak.
- Reflex Incontinence: Associated with neurological injury, resulting in urination without the sensation of needing to void.
Products for Managing Incontinence
- Urinary Collector: Silicone or rubber devices used to collect urine in incontinent men. Good hygiene is required twice daily.
- Absorbents or Diapers: Disposable products designed to keep the skin dry. Different types are available for day or night use. Change every 2-3 hours for bedridden patients.
Hygienic Measures
- Assess, record, and establish a pattern of urination.
- Encourage bladder emptying every 1-2 hours when awake and every 4 hours when asleep.
- Measure urine leakage on clothing.
- Teach Kegel exercises (contraction and relaxation of perineal muscles).
- Control intake of bladder irritants.
- Use absorbent products as needed.
Diuresis Bag
A diuresis bag is used with a catheter to collect urine. These bags are transparent and graduated. They can have a closed or open circuit, which is connected to a collection bag.
Urinary Catheterization
Catheterization is the introduction of a catheter through the urethra into the bladder.
Auxiliary Tasks
- Prepare the necessary materials.
- Prepare the patient.
- Assist with the delivery of sterile materials.
- Collect materials at the end of the procedure.
Objectives of Catheterization
- Facilitate the evacuation of urine.
- Collect sterile urine samples.
- Perform bladder irrigation.
- Introduce contrast agents or medications.
- Prevent tension on pelvic or abdominal wounds.
- Prevent urine from irritating surgical wounds.
Types of Catheters
- Foley: Flexible, available in various diameters with 1, 2, or 3 lumens. Features multiple side holes. One lumen drains urine, another inflates a balloon with physiological saline, and the third is for bladder irrigation.
- Robinson: Single-lumen with a rounded tip and a single hole at the distal end. Used for temporary catheterization.
- Pezzi: Semi-rigid, single-lumen with 2 or more holes. Inserted surgically and can remain in place for several days.
- Malecot: Semi-rigid, single-lumen.
Catheterization Duration
- Temporary: Less than 30 days.
- Permanent: Long-term, continuously connected to a collection bag.
- Intermittent: The catheter is inserted and removed at regular intervals.
Complications of Catheterization
- Creation of a false passage due to trauma.
- Obstruction leading to urinary retention.
- Urinary tract infection due to upward migration of bacteria.
- Hematuria (blood in the urine).
- Incorrect catheter placement.
- Incorrect catheter fixation.
Care of a Permanent Catheter
- Monitor for low diuresis.
- Maintain adequate hygiene.
- Prevent erosions in the urethral tract with good hygiene.
Cleaning and Maintenance of a Permanent Catheter
Wear gloves. Clean the perineal area. Secure the catheter. Clean the urinary meatus with soap and water, moving downward. In women, separate the labia majora to prevent urinary infections and inflammation.