Non-pharmacological Interventions For Management. Urinary Incontinence

NON-PHARMACOLOGICAL INTERVENTIONS FOR MANAGEMENT OF URINARY INCONTINENCE IN ELDERLY
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Table of Contents TOC \o "1-3" \h \z \u Abstract PAGEREF _Toc532587562 \h 3Introduction PAGEREF _Toc532587563 \h 5Themes in the Literature Review PAGEREF _Toc532587564 \h 9Pathophysiology of Urinary Incontinence PAGEREF _Toc532587565 \h 9Previous Research on Urinary Incontinence PAGEREF _Toc532587566 \h 11Non-pharmacological Management of UI PAGEREF _Toc532587567 \h 12Pelvic Floor Muscle Treatment (PFMT) PAGEREF _Toc532587568 \h 12Behavioral modifications PAGEREF _Toc532587569 \h 13Robustness of the Research Methods used in the Literature Review PAGEREF _Toc532587570 \h 15Progress of Literature Review on the non-pharmacological Management of Urinary Incontinence PAGEREF _Toc532587571 \h 16Adverse effects of Non-pharmacological Interventions PAGEREF _Toc532587572 \h 17Limitations in Literature Review PAGEREF _Toc532587573 \h 17Summary of the Findings from the Review of Literature PAGEREF _Toc532587574 \h 18Conclusion and Recommendation PAGEREF _Toc532587575 \h 18References PAGEREF _Toc532587576 \h 19
Abstract
Urinary incontinence (UI) is an involuntary passage of urine from the bladder. While the condition is likely to occur in any population, it is more pronounced in elderly people (Greer, Arya, & Smith, 2013, p. 2). According to Neki (2014, p. 3), UI affects one in every three women in the age above sixty-five years. The disorder is also common in elderly. While pharmacological interventions have been proved effective in the treatment of UI in the elderly, there has been an increase in concern on their efficacy due to associated side effects that arise from use of drugs. In the recent past, scholars have been shifting towards the use of non-pharmacological interventions in the management of UI. Non-pharmacological methods include behavioral modification, environmental changes, physical exercises, and the strengthening of pelvic muscle floor to prevent them from leaking urine. UI has both social and psychological impact to the affected person. Currently, a lot of literature on the management of UI has been published online, creating a challenge for readers looking for information on the management of UI. The purpose of this literature appraisal is to provide a systematic review of the scientific literature on UI, communicate their credibility, trustworthiness, and reliability for use in academic research as well as for those that are interested in the information regarding management of UI in adults.
In the process of appraising reviewed articles, this paper will mainly focus on the key learning points that researcher intended to communicate in the article, the target audience of the article, the methodology used, the discussion of results, and the declaration of the conflict of interest, if any. While the internet has simplified the search for information regarding the treatment and management of clinical disorders, there are also resources that present flawed information. The problem with flawed resources is that they are likely to interfere with the health of the patient or harm the progress that a person may have made in the recovery process. As a result, there is a need for critical appraisal of research literature, specifically the peer-reviewed articles that have been selected in this study on the management of UI in elderly.
Key Terms
Elderly, Urinary incontinence, management of UI, pharmacological intervention, non-pharmacological intervention, physiology of UI, urinary bladder, pelvic floor muscle training(PFMT)
Introduction
Urinary Incontinence (UI) is emerging to be a common disorder in the aging population. According to Burgio (2014), sixty-nine percent of women are likely to develop UI in their lifetime. Cook and Sobeski (2013) define UI as a common disorder in adults that is caused by the relaxation of the bladder and pelvic muscle that causes uncontrolled urination or leakage of urine. UI is a distressing disorder as the person may appear physically healthy but psychologically distressed due to this disorder. UI impairs the quality of life in the affected population, especially as the affected individual struggles to maintain normal living standards. For the aging population, most of them are already at a higher risk of developing other disorders such as dementia, diabetes, and stroke. Presence of UI is another burden. For patients with other age-related disorders, their physician may have already recommended pharmacological treatment for them. Most of them may feel uncomfortable with the drugs and consider alternative use of non-pharmacological treatments.
The purpose of any medical literature is to provide unbiased, accurate, and robust medical information that can be used for decision-making in the medical field. The information in the medical literature has to be free of conflict of interest, rendering it reliable for use in enhancing care for patients and improving their quality of life. In online databases, hundreds of journal articles are added every hour, making it impossible for the reader to determine a credible source that can be used in the decision-making and enhancing the quality of life. In areas where there are alternative treatment approaches, it becomes necessary for the reader to distinguish between flawed and credible peer-reviewed resources. In this study, twenty peer-reviewed research articles on non-pharmacological management of urinary incontinence in elderly were critically appraised.
Different factors led to this critical literature appraisal. First, there is a need for readers to understand the motive of the research article before commending it to others or using the information therein for making medical decisions. Flawed information or information containing conflict of interests can endanger the health of the patient as well as the reputation of the professional that uses that information. Another concern is that many authors are coming up with research articles for sale online. Practicing nurses and unregistered nurses can use the information for purposes of completing their studies without necessarily determining the credibility of the information. The mere assumption that an article has been published in the medical database does not imply that it is a credible source for research. The learner has to take into consideration the credibility of the research resource.
Another factor that led for this literature appraisal is the fact that patients are increasingly using internet resources to search for information on the treatment and management of diseases and disorders. When people look for information online, they hardly have time to determine the credibility of the resources. A few that use medical databases hardly consider the conflict of interest of the author. As a result, there are high chances of readers being exposed to unreliable information and making wrong decisions. I was recently asked by my father whether she could forego her medications since he had started walking to church. He had read online that physical exercises have significant impact on the health of the aging population. I wanted to tell him not to do that and when I researched online, I found a lot of resources talking about the same issue. I decided to research and appraise research articles on this topic to understand what authors have written about the management of UI in adults.
Research articles for this paper were mainly obtained from web databases after confirming their availability from Keele University Library. I typed the key word “Urinary incontinence,” three hundred and thirty-seven search results were displayed. I then started filtering the search results based on their relevance to the topic of study. I was only interested in articles published between 2010 and 2018, so most of the articles were excluded as they did not fit in this category. I remained with two hundred and ten research articles. After filtering by date, I remained with seventy journals. The next step was to filter the journals by the age of the target population. Ten research articles that had recruited children as samples for the study were excluded and I remained with sixty articles. I then decided to search each article individually on the internet and started excluding them based on the number of reviews. For articles published between 2010 and 2014, I only selected those that had more than ten reviews. For articles between 2015 and 2017, I allowed them to have a minimum of two reviews. After carrying out this exclusion criterion, I remained with thirty-two research articles. I then started excluding the remaining articles based on reference lists and cited external resources, including the number of citations. This criterion left me with twenty research articles which have been appraised in this study. The diagram below summarizes the literature search criteria and the exclusion criteria.
Figure SEQ Figure \* ARABIC 1. Literature Search and Exclusion
The main objective of this review was to determine the reliability of the published literature on the non-pharmacological treatment and management of urinary incontinence in the elderly. By narrowing the review to twenty research articles on the treatment and management of UI in the elderly, the researcher hoped that he could make a sound recommendation on the treatment of UI in the elderly using non-pharmacological interventions.
Themes in the Literature Review
Urinary incontinence (UI) has become a major concern for clinicians, patients, and the aging population at large. As people age, there are high chances of developing different age-related disorders that affect the quality of life and also cause distress for the patient. Some patients may be admitted in clinical care homes, while others may manage the conditions at home. Additionally, scholars have mainly focused on the treatment and management of UI with the hope that correct interventions can help patients manage the disorder and lead productive lifestyles. The primary concern with the need to intervene is to help patients and the general public to develop an understanding of the role of non-pharmacological interventions in the management of UI. When people do not have sufficient knowledge on the treatment and management of diseases, they can easily become victims of misinformation or can easily misinterpret information. Understanding the literature on the treatment and management of UI creates a community of informed population that cannot be manipulated by misinformation.
Pathophysiology of Urinary Incontinence
According to Anderson et al. (2014), UI affects more than two hundred million people. Burgio (2014) explains that UI is not a disease. UI is mainly caused by the relaxation of the pelvic muscles that causes the bladder to weaken, leading to uncontrolled involuntary release of urine. In women, this condition is more pronounced. According to Greer, Arya, and Smith (2013), UI increases with age in both men and women. While there is an increased concern that UI is associated with other age-related issues such as depression for the affected population, scholars have increasingly become aware of the management of this disorder through behavioral modification and non-pharmacological interventions. Before delving into the understanding of the literature on UI and non-pharmacological interventions, it is necessary that one understands the pathophysiology of UI in adults.
According to Price, Dawood, and Jackson (2010), the bladder controls urine with the help of detrusor muscle and the urinary sphincters. In any given population, UI is more pronounced in women than in men and is mainly caused by stressors. Stress, in this case, refers to the physical stressors that exert pressure on the lower abdomen which then exerts pressure on the bladder, leading to the leakage or causing the bladder to release the urine involuntarily (Stenzelus et al., 2015). The major cause of the physical stress on the bladder could be laughter, movement, climbing stairs, or obesity.
For the bladder to hold urine and retain it until the person is ready to release it, urethra closure pressure must always be higher than the bladder pressure (Menezes, Virtuoso, & Mazo, 2015). Urethra muscles have a resting allowance that enables them to withstand pressure when the pressure in the bladder exceeds that of the urethra muscles. During activities such as coughing, laughing, or moving rapidly, the pressure in the bladder increases several times that of the urethra muscles, making the urethra to open and release urine. Any intervention to help in the treatment or management of UI has to take into consideration the relationship between the urethra closure, the resting pressure in the urethra, and the general mechanism of how the urethra responds to the pressure from the bladder. As a result, any research literature on the treatment and management of UI in adults must account for how the intervention strategy is likely to have an impact on the closure and opening of the urethra sphincter and the elements that are likely to affect this process.
Apart from pathophysiological factors, there are also risk factors that can interfere with the anatomy of the bladder and its support system, leading to pronounced cases of UI in women compared to men. According to Tong (2014), pregnancy and birth-related complications are among the factors that interfere with the urethral sphincter muscles in women, leading to pronounced cases of UI. During the delivery process, pressure on the pelvic muscles is likely to cause the bladder to shift its position, making it to lose the support of sphincter muscles. When this happens, the woman loses her natural ability of controlling the flow of urine. In men, accidents or injuries are likely to interfere with the position of the bladder, making it impossible for the support system of muscles to hold it in position for muscles to protect it from the pressure. In the review of literature on the management of UI in this paper, the primary theme is to analyze the extent to which scholars have agreed or differed with one another on UI management in the aging population.
Previous Research on Urinary Incontinence
Previous studies on UI have often focused on its treatment from the pharmacological approach. According to Groepel et al. (2010), most studies have narrowed down to UI in women and ignored the prevalence of this condition in men. Among the literature studies selected for this review, thirteen of them mention the prevalence of UI in women while seven are at least biased to some extent to treatment of UI in women. None of the selected reviews appears to focus on the UI in men. The explanation for this could be due to a flawed understanding that UI is mainly caused by vaginal delivery complications, which is to some extent true. This should not be however, warrant the reason for ignoring the prevalence of this condition in men.
According to Prince et al. (2010), substantial factors contribute to the presence of U...