Reflective accounts

Urinary continence

The CPD article on promoting urinary continence in older women emphasised that incontinence is not an inevitable part of the ageing process and can be treated and managed effectively.

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Urinary incontinence involves involuntary leakage of urine. This problem affects women of all ages, but prevalence is higher with increasing age. Nearly one third of the female population aged over 65 years experiences urinary incontinence, and prevalence is higher among older females who live in care homes. The most common types of urinary incontinence are stress, urgency and mixed incontinence, nocturnal enuresis and overactive bladder.

There are a surprising number and diversity of factors that increase a woman’s risk of developing urinary incontinence. These include genetics, age-related changes, urinary tract infections, constipation, medications, obesity, smoking, high-impact exercise, diet, menopause and pregnancy, as a result of pelvic floor damage during childbirth. It is important that nurses are aware of these risk factors, which were described in the article.

Other factors that can contribute to urinary incontinence include problems with the function of the lower urinary tract, bladder or sphincter, as well as acquired, progressive or degenerative neurological diseases or conditions such as stroke, multiple sclerosis, Parkinson’s disease, head or spinal cord injuries, dementia, multiple system atrophy and cauda equina syndrome.

To identify older women experiencing urinary incontinence, it is important that healthcare professionals ask trigger questions during routine healthcare contacts – such as ‘do you ever have to rush to the toilet urgently to empty your bladder?’ or ‘how often do you go to the toilet to empty your bladder during the day or at night?’ – because many older women may not want to talk about or admit to experiencing incontinence. If the response indicates a potential problem, further assessment can then be undertaken.

This CPD article raised my awareness of the importance of devising health promotion information leaflets for patients, emphasising the factors that contribute to urinary incontinence. For example, to avoid the embarrassment of urinary incontinence, many women reduce their fluid intake to reduce the volume of urine produced, but this can increase the concentration of urine, causing further discomfort.

Bladder irritants

In addition, coffee, carbonated beverages, artificial sweeteners and acidic drinks act as bladder irritants and stimulants, creating episodes of urinary incontinence.

After reading this article, I have a greater knowledge and understanding of the risk factors for urinary incontinence in older females. I intend to emphasise to older female patients that problems with urinary continence are treatable and are not merely a normal part of growing older.

These patients should be made aware of the many collaborative health approaches that can be used to treat urinary continence, promote continence and provide specialist information and education.

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