Ms Chow Ru Yi, Ruth
(National University of Singapore - School of Nursing)
A slightly overweight woman 64-years of age who had a past history of hypertension and diabetes of 8 years, was readmitted into the hospital due to a fall at home. An assessment of the patient revealed that she had been frequently dripping urine before going to the toilet. She fell as she was rushing to the toilet to prevent any spillage on the floor. The doctor diagnosed the patient as having mixed (stress and urge) incontinence.
While nursing her sprained wrists, I realised that she did not really understand what urinary incontinence was about. She was very worried that this may affect her independence and that her children may send her to an old folks home because of her condition. She clearly did not understand the term “urge” and “stress” incontinence and I was given the chance to explain the condition and how to manage it so that she can continue living her life as independently as possible. I first told her that the two groups of people that run a higher risk of urinary incontinence were the elderly and women. Factors such as childbirth, diabetes, obesity, constipation and damage to the bladder can be the cause of it.
Therefore, in order to manage her condition, we had to identify ways to prevent the causes of her incontinence.
1) Obesity and diabetes have been linked to incontinence. Hence, a healthy diet and exercise regimen can be put in place to aid her in reducing weight and maintaining good blood glucose levels.
2) Avoiding the intake of fluids may result in the irritation of the bladder lining which will further aggravate her condition.
3) Schedule toileting every two to three hours will help her fix a frequent time so that she will not wait till her bladder is full before emptying it.
4) Kegel exercises should be taught to support her bladder and sphincter function.
5) Absorbent pads and products which are readily available off the shelves at pharmacies can be an option so that going out need not be embarrassing if leakage occurs.
6) Surgical procedures are available to treat incontinence such as the artificial urinary sphincter, injection therapy, sling procedures, neuromodulation and bladder augmentation.
I was given the opportunity to speak to her daughter who was living with her. I informed her that supporting her mother overcome obstacles would help maintain her psychological health. Moreover, being an agile elderly, introducing her to a support group such as the Society for Continence (Singapore) could help her come to terms with her condition better as she can attend talks and interact with other people who might have similar experiences. Therefore, I feel that the holistic care of a patient with urinary incontinence is important, as many factors can contribute to a better quality of life for the patient with this condition.
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