Urinary Incontinence and Foley Catheter

Urinary Incontinence and Foley Catheters

 

Types of UI

Mechanism

Associated Symptoms

Stress

Incompetent urethral sphincter

(post-prostatectomy)

UI w/ 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
  • R/o retention using PVR
  • Rectal exam to r/o 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