Impaired urinary elimination can occur as a result of a physical abnormality, a sensory impairment, or as a secondary cause of a disorder or disease. Symptoms can vary widely from bladder distention to painful urination to a complete lack of bladder control. Treatment depends on the cause and can include noninvasive interventions such as bladder training to surgical options.
Impaired urinary elimination can be embarrassing and frustrating and have a large impact on quality of life. Nurses can guide patients in understanding the causes of their symptoms and how to prevent and manage them.
Causes of Impaired Urinary Elimination (Related to)
- Sensory-motor impairment
- Anatomical abnormalities (obstruction)
- Urinary tract infections
- Renal diseases
- Congenital disorders
- Weakened bladder muscles (older age, pregnancy)
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
Objective: (Nurse assesses)
- Bladder distention
- Retention as detected through bladder scanning
- Use of catheterization
- Patient will verbalize techniques to prevent urinary infection and retention
- Patient will demonstrate how to properly self-catheterize/clean indwelling catheter
- Patient will achieve a normal elimination pattern free from frequency and urgency
- Patient will verbalize diet changes to incorporate to improve urinary elimination
Nursing Assessment for Impaired Urinary Elimination
1. Identify causes of impaired urinary elimination.
UTIs, cystitis, multiple sclerosis, tetraplegia, dementia, an enlarged prostate, stroke, urologic surgeries, and chronic kidney disease are a few examples that contribute to impaired urinary elimination.
2. Assess voiding pattern and symptoms.
Assess the symptoms the patient is experiencing to lead to a diagnosis. Dribbling and incomplete urination may signal a prostate issue. Frequency and burning are common with UTIs. Back/flank pain can signal kidney problems.
3. Monitor labwork and urinalysis.
A urinalysis and culture can diagnose or rule out an infection. Kidney function should be assessed for acute or chronic renal disease. A prostate-specific antigen (PSA) blood test can detect inflammation levels of the prostate.
4. Review medications.
Certain medications have anticholinergic effects which make voiding difficult. These can include antipsychotics, tricyclic antidepressants, and antiparkinson drugs.
5. Compare intake and output.
Compare intake amount and type (caffeine, water, soda) to the amount of urine output as well as the color (clear, amber, concentrated) to determine hydration levels.
6. Assess for issues with catheterization.
Some patients rely on intermittent self-catheterization or permanent suprapubic catheters due to bladder dysfunction. Ensure they are performing their catheterizations correctly and not introducing bacteria due to poor techniques. Also, assess if patients with indwelling catheters still require them. Prolonged or unnecessary catheterization increases the risk of infection.
7. Review diagnostic tests.
Urodynamic testing, cystoscopy, and imaging of the kidneys/ureters/bladder (KUB) can identify structural issues, diseases, and cancer that may be causing problems.
Nursing Interventions for Impaired Urinary Elimination
1. Educate on bladder training.
Patients with incontinence or an overactive bladder can teach their bladders to increase the amount of urine to hold. This starts by keeping a log of when urine leakage occurs and how many hours the patient waits before urinating. Based on this, they choose an interval and gradually add 15 minutes to it over the course of weeks or months. The patient should go to the bathroom at each set time, even if they don’t feel an urge, and if they feel an urge before the set time, remind themselves the bladder isn’t full yet.
2. Encourage water intake.
If not contraindicated, encourage the patient to drink plenty of water. This may seem counterintuitive if the patient has incontinence or an overactive bladder, but too little water will have worse effects. Proper hydration promotes urinary elimination by maintaining renal function and flushing bacteria and waste products.
3. Limit other fluids.
Patients should limit their intake of coffee and caffeine, carbonated beverages, and alcohol as these can be irritating to the bladder and cause increased frequency and urgency. Soda and sweet tea are huge culprits for kidney stones.
4. Educate on supplements.
Patients frequently affected by UTIs may benefit from cranberry supplements. Cranberry juice is acidic and may irritate the bladder like other fruit juices and research has shown it may not be all that helpful. Cranberry in the form of a concentrated supplement, however, has been shown to be effective at preventing (not actively treating) UTIs.
5. Have the patient demonstrate catheterization techniques.
A patient with a chronic indwelling or suprapubic catheter or who self-catheterizes is at an increased risk for infection. Observe the patient perform their cath care to ensure they are using the proper techniques such as cleaning daily using water and mild soap and keeping the drainage bag below the level of the bladder.
6. Use bladder scanning.
While inpatient, use a bladder scanner to monitor for urinary retention. This non-invasive ultrasound and can quickly assess the need for further intervention. A post-void residual (PVR) is done after a patient voids to assess how much urine is left in the bladder. This can provide information about the patient not effectively emptying their bladder.
7. Educate on proper hygiene.
Females are at an increased risk for UTIs due to a shorter urethra in close proximity to the anus. They should be instructed to wipe from front to back after using the bathroom, void immediately after sexual intercourse, wear cotton underwear and loose clothing, and change out of wet bathing suits as soon as possible.
8. Refer to urology.
Chronic urinary elimination problems need further assessment. A urologist can perform testing and provide treatments to ease pain, incontinence, and retention.
9. Educate on pelvic floor exercises.
Kegel exercises are helpful for both men and women in strengthening the pelvic floor muscles and preventing urine leakage. The patient should squeeze and hold the pelvic floor muscles for 3-5 seconds, repeat for 10 repetitions, 3 times daily.
10. Educate on medications.
If ordered by a physician, medications can help with retention and overactive bladder. Flomax helps relax bladder muscles relieving obstruction. Ditropan is an anticholinergic that prevents bladder contractions that cause the urge to urinate.
11. Use incontinence supplies.
Incontinent episodes and urgency can be embarrassing. Discreet incontinence pads and adult diapers can prevent uncomfortable situations when a bathroom isn’t available or the bladder cannot be held.
References and Sources
- Byram Healthcare. (2019, May 6). Commonly Performed Urology Tests. Byram Healthcare. https://www.byramhealthcare.com/blogs/commonly-performed-urology-tests
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Harvard Health Publishing. (2010, April 20). Training your bladder. Harvard Health Publishing. https://www.health.harvard.edu/healthbeat/training-your-bladder
- Kubala, J. (2021, October 4). Does Cranberry Juice Help Treat UTIs? Myth vs. Science. Healthline. https://www.healthline.com/nutrition/cranberry-juice-uti
- Medline Plus. (2021, January 10). Kegel exercises – self-care. Medline Plus. https://medlineplus.gov/ency/patientinstructions/000141.htm
- Nabili, S. N. (2020, March 24). Bladder Control Medications. Emedicine Health. https://www.emedicinehealth.com/understanding_bladder_control_medications/article_em.htm#facts_on_bladder_control_medications
- Wallace, R. (2017, September 28). 11 Foods to Avoid if You Have OAB. Healthline. https://www.healthline.com/health/11-foods-to-avoid-if-you-have-oab