Urinary elimination: retention, incontinence and bladder scanning
- Fundamental
Nurses assess voiding, scan the bladder for a residual when retention is suspected, and manage incontinence without an indwelling catheter.
What it is
Urinary retention is the inability to empty all the urine from the bladder; it can be acute (for example, after anaesthesia) or chronic (for example, from an enlarged prostate). Incontinence is involuntary loss of urine and has several types. A portable bladder scanner measures, non-invasively, the urine left in the bladder after voiding (post-void residual). The CDC 2009 guideline says urinary catheters should not be used to manage incontinence.
Key points
- Acute retention: sudden inability to void, for example after anaesthesia.
- Chronic retention: gradual inability to empty the bladder, for example from an enlarged prostate.
- Retention raises the risk of urinary tract infection.
- The scan is done with the patient supine and the probe above the pubis, aimed at the bladder.
- Indwelling catheters are avoided whenever possible, to reduce catheter-associated urinary tract infection.
Components
- Assessment: habits, frequency, pain or difficulty voiding.
- Examination: bladder palpation and perineal skin if there is incontinence.
- Post-void residual by bladder scanner or, if ordered, by catheterisation.
- A voiding plan and a skin-care plan.
What it is for
- Finding retention before it causes pain or infection.
- Avoiding unnecessary catheterisation.
- Protecting the skin from moisture in incontinence.
- Regaining continence with bladder training when possible.
Types of urinary incontinence
| Type | What happens | Typical example or cause |
|---|---|---|
| Stress | Leakage when coughing, laughing, jumping or straining | Weak pelvic floor after pregnancy, vaginal birth or menopause |
| Urge | Leakage after a sudden, strong need to void | Overactive bladder |
| Mixed | Combines urgency, frequency and stress | Several causes at once |
| Overflow | Small, frequent leaks from a bladder that never empties | Enlarged prostate |
| Functional | Normal bladder control, but cannot reach the toilet in time | Arthritis, limited mobility or dementia |
In nursing practice
- Bladder training: pelvic floor exercises and timed voiding; improvement may take 3 to 6 weeks.
- Timed voiding: voiding on a set schedule, with or without the urge, gradually lengthening the interval towards about 4 hours.
- Advice: limit caffeine, manage constipation, cut fluids before bed and give ordered diuretics in the morning.
- Protect the skin from moisture with incontinence products and check the perineum.
- Speak with tact: incontinence is not an inevitable part of ageing.
Common mistakes
- Placing an indwelling catheter to 'solve' incontinence.
- Catheterising without first measuring the residual with a bladder scanner, when the protocol allows it.
- Not palpating the bladder in a patient who voids small amounts often.
- Using the bladder scanner without cleaning it between patients.
- Not checking the perineal skin of an incontinent patient.
Test yourself
Think of the answer, then tap the question to see it.
What does a portable bladder scanner measure?
The urine left in the bladder after voiding (post-void residual), without having to catheterise the patient.
Is an indwelling catheter used to manage incontinence?
No. The CDC 2009 guideline recommends avoiding urinary catheters to manage incontinence, because of the infection risk.
Which type of incontinence causes small, frequent leaks in a man with an enlarged prostate?
Overflow incontinence: the bladder never empties fully and urine leaks out a little at a time.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Nursing Fundamentals, 16.4 Urinary Incontinence (Open RN (Chippewa Valley Technical College), LibreTexts, 2021); Nursing Fundamentals, 16.5 Urinary Retention (Open RN (Chippewa Valley Technical College), LibreTexts, 2021); Nursing Fundamentals, 16.9 Elimination: Applying the Nursing Process (Open RN (Chippewa Valley Technical College), LibreTexts, 2021); Guideline for Prevention of Catheter-Associated Urinary Tract Infections (2009): Summary of Recommendations (Centers for Disease Control and Prevention, 2009).
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Representative model, for educational purposes only.