Urinary Incontinence and Foley Catheters¶
Thomas Horton
Background¶
| Types of UI | Mechanism | Associated Symptoms |
|---|---|---|
| Stress | Incompetent urethral sphincter (post-prostatectomy) |
UI with physical exertion (cough, laughter, sneeze) |
| Urge | ↑ bladder contraction from detrusor instability (infection, stone, T2DM, caffeine, meds, BPH |
Frequency, nocturia, sudden urge |
| Overflow | ↓ contractility/outlet obstruction (BPH, anticholinergic medications, T2DM, pelvic trauma, spinal cord disease, MS, polio) | Hesitancy, weak stream, sense of incomplete emptying |
| Functional | Physical, emotional, or cognitive disability | Depression, pain, evidence of physical, sensory, or cognitive impairment |
Evaluation¶
- Medication Reconciliation:
- Alcohol, α-Adrenergic agonists, α-Adrenergic blockers, ACE inhibitors, Anticholinergics, Antipsychotics, Calcium channel blockers, oral estrogen, GABAergic agents, NSAID’s, narcotics
- Order Hemoglobin A1C, Electrolytes (particularly calcium), UA
- Rule out retention using PVR
- Rectal exam to rule out fecal impaction
Management¶
- Skin care for urinary incontinence:
- Barrier creams: Venelex, petroleum, zinc oxide
- Diapers only when up out of bed
- Chucks while in bed (don’t hold moisture up close to the skin like diapers do)
- Offer toileting Q1-2hours
- Indications for a foley:
- Inability to void
- Need for accurate UOP monitoring when patient unable to comply
- Urinary Incontinence AND open sacral or perineal wound
- Perioperative Use
- Comfort care at end of life