Bowel & Bladder Function

URINARY ELIMINATION
 Urination /Micturition/Voiding : Are all refer to the process of emptying the Urinary
Bladder.
 How urination occurs?
 Process of Urination is under voluntary and involuntary control.
 Kidneys make urine by filtering wastes and extra water from the blood.
 Ureters carries this urine to the bladder.
 The bladder stores urine until pressure stimulate the stretch receptors.
 Stretch receptors transmit impulse to the Voiding center in the spinal cord (2-4 Sacral
Vertebrae)
 Causing internal sphincter to relax and stimulating the urge to voiding.
 If the time and place are suitable the cerebral cortex relaxes the external Urethral sphincter
muscle and micturition occur.
 Normal Urine output is 60ml/hr or 1500ml/day.
 Urine is sterile and normally contains 96% of water.
 Solutes find in urine includes;
 Organic solutes; uria, ammonia, uric acid, creatinine
 Inorganic solutes; sodium, potassium. Chlorides, magnesium
 Normal colour of Urine can vary from pale light yellow to a dark amber color.
 Clear urine is a sign of good hydration and potential over-hydration.
 Pale yellow urine is an indicator of good hydration.
 Dark yellow urine is a sign to drink more fluids.
 Amber-colored urine can indicate dehydration.
 Orange urine can be caused by various foods or medications or be a sign of potential
liver problems.
 Red urine can be caused by foods or medications or it can also be a sign of blood in the
urine.
 Green urine can be caused by medications or food dyes, but it can be a sign of bacteria
Dark-brown urine can be a sign of liver or kidney problems.
 White urine can occur when your body contains excess calcium or phosphate, or it may
indicate a urinary tract infection.
 Normal urine has slight smell
 Dehydration can produce an ammonia like odor.
 Fruity-smelling (ketones) urine can be a sign of type 2 diabetes.
 Foul-smelling urine can indicate bacteria from an infection.
 Normal urine is clear in consistency.
 Cloudy urine can be an indication of a variety of medical conditions:
 Dehydration
 Urinary Tract Infection Blood, pus, or excess white blood cells can cause cloudy or milky
urine
 Sexually Transmitted Infections STIs can produce an excess of white blood cells, which can
cause cloudy urine.
 Kidney Stones High levels of minerals in urine can cause cloudiness and be a sign of kidney
stones
 Diabetes Cloudy urine can indicate that uncontrolled diabetes has damaged the kidneys.
 Prostate Issues An inflamed or infected prostate can lead to an increase in the amount of
white blood cells or other discharge.
 Vaginitis A vaginal infection can increase the number of white blood cells released in urine
and cause cloudiness.
 Factors Affecting Voiding
 These are the factors affecting the amount, frequency, Urine concentration, Kidney function)
and control of Voiding.
 Developmental Factors (Age)
 Psychological Factors: Privacy, normal position, sufficient time, and running water are enhancing the
process of micturition. Stressful condition may cause anxiety and muscle tension which diminish
micturition.
 Fluid and food intake
 Medication: such as Diuretics, BB or opioid (cause urinary retention)
 Muscle Tone
 Pathological Condition: Renal failure, and heart failure decreases the urine formation, kidney and
Ureters stones may obstruct the urinary flow. Prostate enlargement.
 Surgical and diagnostic procedures: such as cystoscopy, spinal anesthesia decrease the sensation for
urination.
 Problems in Urinary Elimination
 1. Altered Urinary Production
 Polyuria/ Diuresis:
 production of abnormally, large amounts of urine by the kidneys.
 Can cause excessive fluid loss, dehydration and weight loss.
 Associated with excessive fluid intake (polydipsia), DM, Diabetes insipidus, chronic nephritis.
 Oliguria: Urine less than 500 ml/day or less than 30 ml/hr,
 may occur due to ↓fluid intake, it indicate impaired blood flow to the kidney, RF
 Anuria:
 Lack of urine production less than 50 ml/day.
 Dialysis:
 removing the fluid and molecules using artificial techniques (Hemodialysis and peritoneal
dialysis).
  2. Altered Urinary Elimination:
 Frequency
 voiding more than 4-6 times/day, due to increase intake, UTI, stress, and pregnancy
 Nocturia
 voiding 2 or more times at night
 Urinary Urgency
 sudden strong desire to void. Due to stress or irritation of urethra, poor external sphincter
control, and unstable bladder contraction.

 Dysuria: painful or difficult voiding

 Due to stricture of the urethra, UTI, and injury to bladder and urethra.
 May cause (Urinary hesitancy) delay or difficulty in initiating voiding
 Enuresis
 Involuntary urination in children beyond the age when voluntary bladder control is normally
acquired (4-5 yrs).
 Nocturnal enuresis: affect boys more than girls
 Diurnal (daytime): affect women and girls more frequently.
 Urinary incontinence: or involuntary urination
 Due to UTI, Urethritis, pregnancy, Hypercalcemia, Volume over load, restricted mobility, stool
impaction, multiple vaginal birth, spinal cord injuries and neurological disorders.

 Urinary Retention:
 Inability to empty the bladder completely so the bladder become over distended which cause poor
contractility of the bladder.
 Due to Prostate hypertrophy, Surgeries, Weak bladder muscle, Bladder/urethral calculi,
Constipation, Infections that cause swelling, Uterine fibroids, Urethral stricture.and some
medications (antihistamine, anticholinargeic).

 Neurogenic Bladder:
 Impaired neurologic function of the bladder which affect the process of elimination.
 No awareness of bladder fullness, and unable to control the urinary sphincters. The bladder
become flaccid and distended or spastic, with frequent involuntary urination, occur in spinal cord
disease and brain tumor.
Following conditions may cause problems with
urination පහත සඳහන් තත්වයන් මුත්‍රා කිරීමේ ගැටළු
ඇති කළ හැක

 Kidney failure වකුගඩු අකර්මණ්‍ය වීම

 Urinary tract infection (UTI) මුත්රා ආසාදන
 An enlarged prostate පුරසථි ග්‍රන්ිය විශාල වීම
 Incontinence of urine
 Bladder Stones
How to prevent and manage urinary
problems
 Drink enough fluids, especially water
 Use the bathroom often and when needed
 Exercise regularly
 Take enough time to fully empty the bladder when urinating
 Be in a relaxed position while urinating
 Personal hygiene
 Catheterization as ordered by the doctor
Urinary catheterization
Catheters are tubes that drain urine into a bag. A client may have a catheter
because of: urinary blockage
 a weak bladder unable to completely empty
 unmanageable incontinence
 surgery (used to drain the bladder during and after surgery)
 skin breakdown (allows skin to heal or rest for a period of time).
  Types of Catheterization
 Straight Catheters
 Inserted directly into the urethra and bladder.
 Removed after insertion and drainage of bladder.
 Used intermittently.

 Supra-pubic Catheters
 Placed surgically directly through skin through a hole in the abdomen into the bladder.
 Connected by tubing to a bag used to collect and measure urine.

 External "Condom" Catheters for Men

 Does not enter the bladder.
 Four different types to adhere to the penis.
 Connected by tubing used to collect and measure urine output.
 Cannot be used to treat acute urinary retention.
 Catheter Types
 Indwelling catheter/ Foley catheter
 remains in place for an extended period (days to up to 12 weeks).
 It is held in place with a water-filled balloon inside the patient’s bladder.
 Foley catheter is typically inserted through the urethra.
 In some cases, it is inserted as a supra-pubic catheter.

 Intermittent catheter/ short term catheter

 Used temporarily to empty the bladder once, then removed.
 Intermittent catheterization needs to be done several times a day, at a designated interval or when
there is a need to pass urine.
 Traditional intermittent catheters can be washed and reused.
 Disposable intermittent catheters are designed for one time use and discarded.

 External catheter/ condom catheters –

 often used for male patients with urinary incontinence rather than urinary retention.
 Care for urinary Elimination
1. Assisting the client on/off the bed/toilet
2. Encourage to have adequate fluid intake
3. Cleaning the genital area of male female
4. Emptying, and cleaning bed pans/bedside commodes, urinals
5. Changing diaper and managing clothing
6. Care of client with urinary catheter
7. Prevent contamination දූෂණ්‍ය වීම වළක්වන්න
8. Observe signs of infection ආසාදන ලක්ෂණ්‍ නිරීක්ෂණ්‍ය කරන්න
9. Maintain accurate intake and output chart as needed අවශය පරිදි නිවැරදි ආග්‍රහණ්‍
සහ ප්‍රතිදාන සටහනක් පවත්වා ගන්න
 Bedpan and urinals are used when the client is unable to get to the bathroom in a timely
manner.
 Urinals for males; can be used when sitting or lying down; female urinals are available
 Bedside commode- used when client is not strong enough to walk the distance to the
bathroom;
Bedpan/Urinal Offering/ removing Perineal care
 Managing a urinary catheter system

 The catheter and drainage bag should be adequately fixed to

prevent trauma
 A ‘closed’ drainage system is essential to prevent infection
 Closed drainage system

 The bag should only be disconnected for connection of a new

bag

 When opening or manipulating the system a rigorous infection

control strategies are essential.

 The tip of the new drainage tube should not be touched

before pushing into the catheter
Catheter associated complications
 CA-UTI - can be introduced because of faulty handling of equipment, breaking
the closed system, or raising the drainage bag above bladder level – (fluids)
 Leakage/bleeding/blockages
 To prevent infections;
 The drainage bag and tube should always be positioned below the level of the
bladder
 There should be no kinks or occlusions in the tubing
 The bag must be kept off of the floor
 The separate single use clean container be has to be used and the drainage valve
must not touch the container on emptying the bag
 Empty the bag when 2/3 full
 The tubing should be the correct length to prevent kinking or pressure on the
bladder
 Maintaining Input Output Chart
 Purpose is to ensure accurate recording, prevent dehydration, and to prevent circulatory
overload.
 Indications;
 Fluid and electrolyte imbalance
 Kidney impairment
 Clients with burn
 Severe vomiting / diarrhea
 Heart failure
 Record for Intake: Measurements of all those fluids entering the clients body such as water,
ice chips, juice, milk, Ensure, soup, coffee, tea, soft drinks, fruit juices, gelatin, IV Fluids,
feeding tube, blood transfusion, artificial irrigations
 Record for Output: Measurements of all fluid level that leaves the clients body such as Urine,
vomitus, exhalation, diarrhea or liquid stool, blood, and wound drainage
 BOWEL ELIMINATION
 Body excretes waste products of digestion. It is a natural process of human body function.
ශරීරය ආහාර දිරවීමේ අප්‍රවවය ැැහැර කරි. එය මිනිසථ සිරුමර් ක්රියාකාරිත්වමේ සථවභාවික ක්රියාවලියකි
 Factors Affecting Bowel Elimination
 Age
 Infection
 Diet
 Fluid Intake
 Physical Activity
 Psychological factors
 Personal Habits
 Position during Defecation
 Pain
 Surgery and Anesthesia
 Medications
 Common Bowel Elimination Problems
 Constipation
 Impaction
 Diarrhea
 Incontinence
 Flatulence
 Hemorrhoids
1.Constipation
 More of a symptom than a disorder
 Decrease in frequency of BM
 Straining & pain on defecation is associated symptoms(Valsalva maneuver)
 Can be significant heath hazard (increase ICP, IOP, reopen surgical wounds,
cause trauma, cardiac arrhythmias)
2. Impaction
 Results from unrelieved constipation
 Collection of hardened feces wedged into rectum
 Can extend up to sigmoid colon
 Associated S/S: Loss of appetite, abdominal distention, cramping, rectal pain
 3. Diarrhea
 Increase in number of stools & the passage of liquid, unformed stool
 Symptom of disorders affecting digestion, absorption, & secretion of
GI tract
 Intestinal contents pass through small & large intestines too quickly
to allow for usual absorption of water & nutrients
 Irritation can result in increased mucus secretion, feces become too
watery, unable to control defecation
 Excess loss of colonic fluid can result in acid-base imbalances or
fluid/electrolyte imbalances
 Can also result in skin breakdown
Factors that promote bowel elimination
ැඩවැල් ඉවත් කිරීම ප්රවර්ධනය කරන සාධක

 Stress free environment

 High fiber diet
 Adequate fluid intake
 Regular exercise
 Personal bowel habits
 Squatting position
•ආතතිමයන් මතාර පරිසරයක් • අධික මකඳි සහිත ආහාර • ප්රමාණ්‍වත් තරල පරිමභෝජනය •
නිත්ය අභ්යාස • පුද්ගලික ැඩවැල් පුරුදු • Squatting සථථානය
Factors impairing elimination
ඉවත් කිරීමට ැාධා කරන සාධක

 Emotional stress
 Reduced fluid intake
 Immobility or inactivity
 Pain
 High carbohydrate, high fat and low fiber diet
 • චිත්තමේගීය ආතතිය • තරල පරිමභෝජනය අඩු කිරීම • නිශථචලතාව මහෝ අක්රිය වීම •
මේදනාව • අධික කාමැෝහිඩ්මර්ට්, අධික මේද හා අඩු තන්ු ආහාර
Bowel elimination problems

 Constipation: Constipation is the passage of hard dry stools. This is a common

problem
 Fecal incontinence : Inability to control bowel movements
 Hemorrhoids:Swollen veins in the lower part of the rectum and anus
 Diarrhea: Passing loose or watery stools. Intestine is unable to absorb fluid
because of infection
Maintaining good urinary and bowel
function
Encourage a client to take the following steps.
 Get plenty of fluids
 Drink 6-8 cups of fluid per day, more when the weather is hot or when
exercising.
 Cut down on alcohol and beverages containing caffeine (tea, coffee, soda).
 Make healthy food choices
 Fiber is especially important to good bowel function.
 Stay active and fit to the extent possible
 Physical activity speeds the movement of food through the digestive system.
 Relax: Don’t strain to empty the bladder or bowel or sit on the toilet too long.
 Talk to a doctor: Encourage a client to see his/her doctor whenever there are
changes or concerns about urination or bowel habits
Colostomy care

Clients with Crohn’s disease, colorectal

cancer, diverticular disease, or a serious
injury to the colon may require a
colostomy. A bag is attached to the skin
over the opening (stoma) to collect
stool as it empties from the bowel.
***Skills:

 1. Assist Client with Use of Bedpan

 2. Catheter Care
 3. Assist Client with Perineal care
 4. Colostomy care