Discuss ways of treating Bowel and Urinary Disorders
Bowel and Urinary Disorders Research Paper

Urinary Tract Infections Urinary tract infections are one of the most common infections in childhood. Urinary tract infections are formed when pathogens are exposed into the urinary bladder. Depending on the severity of the infection, Urinary tract infections can cause permanent kidney damage, and abnormality of the urinary tract. There are factors to consider in avoiding UTI’s. Some people are unfortunately prone to infections are unable to consider any avoidance. Doctors are now able to use certain tests, which function to detect bacteria in the urinary bladder. Due to an enormous amount of research, doctors also can prescribe medicine to rid the infection.Bowel and Urinary Disorders Research Paper Urinary tract infections infect all kinds of people, but some are more prone to this infection than others. Women are much more likely to get an infection then men. Peoples bodies that do not develop aerobic and anaerobic microorganisms in their per urethral area, will probably suffer from UTI’s most of their life. If microorganisms are lacking in the per urethral area, bacteria is able to enter the bladder which forms UTI’s. Small children are also more prone to urinary tract infections.Urinary Infections have several causes. One thing that causes urinary infections is antibiotics. Antibiotics disturbs the anaerobic and aerobic microorganisms which allows bacteria to grow in the bladder. Another factor that causes UTI’s is the urination process. Bowel and Urinary Disorders Research Paper

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This is a reflective essay based on an episode of care that I was directly involved in managing during a community placement. This episode of care will be analyzed using up to date references, health care policies and relevant models. Issues and theories relating to leadership qualities and management styles will also be explored, taking into consideration any legal, ethical and political factors that may have impacted on patient care. Care delivery, delegation and prioritization will be examined along with team working, risk assessment and patient safety. I will also take into consideration my role as a supervised student nurse and analyze the roles and responsibilities of those supervising me and what influence this has on my practice. These issues will be debated and questioned within the framework of leadership and management theory

In order that I could use this situation for my reflection the patient will be referred to as “Mrs A”. In this assignment confidentiality will be maintained by the use of pseudonyms, this is to maintain privacy and confidentiality in line with the NMC Code of Professional Conduct (NMC, 2008), “as a registered nurse, midwife or health visitor, you must protect confidential information”, and to “Treat information about patients and clients as confidential and use it only for the purpose for which it was given.”Bowel and Urinary Disorders Research Paper

Starting an extended practice placement as a third year nursing student enables the student to develop their knowledge and skills in management and leadership ready for their role as a qualified adult nurse. During my extended practice placement there were many opportunities to develop these skills and manage my own caseload of patients and arrange many complex aspects of their care.

During this placement an 88 year old patient, to be known as Mrs A, was due to be discharged from a rehab center following recurrent falls, issues with safety at home, and self neglect, the referral had been made by a concerned General Practitioner. Mrs A had spent the last 6 weeks receiving holistic multidisciplinary care, including; intensive physiotherapy, occupational therapy and nursing care. Mrs A had made much improvement and was able to safely administer her own medication.

One of the Physiotherapists called Ken, had commented during handover, that Mrs A had seemed confused during their session together, and asked if the nurses would go in and review her. Upon visiting Mrs A it was clearly evident that she was not herself, and seemed confused. Following discussion with my mentor I felt that Mrs A was not safe to administer her own medication. I recommended to the patient to let the rehabilitation staff administer her medication. Mrs A consented to this, thus reducing a great risk of Mrs A causing her-self harm. I delegated to the support workers to obtain a urine sample which was tested and confirmed that Mrs A had a urinary tract infection, antibiotics were prescribed by her GP. The team leader at the rehabilitation center was informed of Mrs A’s infection and plan to handover the administration of her medication to them, she was happy with this decision and pleased that I had informed her.Bowel and Urinary Disorders Research Paper

This episode of care was managed effectively as the underlying cause of the patients confusion was discovered and treated, a risk assessment was completed and a referral was promptly made to medicine management and a dos sett box was supplied to Mrs A, to help her manage her own medications safely. All members of the multi-disciplinary team were fully committed to the team approach to care delivery and this facilitated efficient and organized care delivery. The care delivered was patient-centered and teamwork was integral to providing this care.Bowel and Urinary Disorders Research Paper

First will be a discussion on the importance of self awareness and how this awareness enabled a more assertive and confidant approach to be made to managing patient care.

Self awareness must be considered as the foundation for management and is a vital skill and quality needed in leadership. If you wish to provide care that is of a high standard and improve your own performance as a skilled health care professional you need to manage the cognitive, effective and behavioral self in order to engage effectively in therapeutic relationships. Self awareness is the process of understanding one’s own beliefs, thoughts, motivations, biases and limitations and recognizing how they affect the care and services provided (Whetten and Cameron, 2010).

Without being self aware, recognizing personal and cultural beliefs, and understanding interpersonal strengths and limitations, it is impossible to establish and maintain good relationship with co-workers and patients. Mallows Hierarchy of Needs Theory (1954) depicts self-actualization at the highest level of the hierarchy of needs. This relates to the need to maximize potential and achieve a sense of personal fulfillment, competence, and accomplishment (Maslow, 1954). It is important as a student nurse to be completely aware of strengths and weaknesses, and to be conscious of any limitations, self-awareness helps to exploit strengths and cope with weaknesses (Walshe and Smith, 2006).Bowel and Urinary Disorders Research Paper

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When organizing and planning patient care it is vital to have effective management and leadership skills, this is part of every nurse’s role, and involves planning, delivering and evaluating patient care. These management responsibilities are part of every nurse’s role (Sullivan and Garland, 2010) and to exhibit these professional behaviors demonstrates their value to the organization (Huber, 1996). To understand nursing management it is crucial to understand what nursing management is and the theory behind it.

Managers are defined as “a member of a specific professional group who manages resources and activities and usually has clearly defined subordinates” (Gopee & Galloway, 2009). Another definition of management is a process by which organizational goals are met through the application of skills and the use of resources (Huber, 1996).

Borkowski (2010) argues that Douglas Gregor made a significant impact on organizational behaviour and was an American social psychologist that proposed the ‘X-Y’ theory of management and motivation. Mc Gregor (1966) describes the ‘X-Y’ concept as the theory that underpins the practices and attitudes of managers with regard to their employees. Huber (2006) states that theory ‘X’ managers assume that employees are lazy, that they dislike responsibility, would rather be directed, oppose change and desire safety. Theory ‘X’ implies that employees are rational and easily motivated (either by money or threat of punishment); therefore managers need to impose structure and control and be active managers (Huber, 2000).Bowel and Urinary Disorders Research Paper

Huber (2000) asserts that the opposing theory, (‘Y’) assumes that people are not lazy and unreliable by nature rather that they are self-directed and creative if well motivated in order to release their true potential. Businessmen balls.com (2002) asserts that most managers are inclined towards the ‘X’ theory and usually obtain poor results whereas managers who implement the ‘Y’ theory produce better performance and results thus allowing people to grow and develop (Business balls.com, 2002).

Urinary tract infection is one of the most common infections as cited by the National Hospital Ambulatory Medical Care Survey that can affect both pediatrics and adults [4,6]. Locally, this type of infection was ranked as fourth leading cause of Morbidity in Iloilo City [15]. Such infections can be acquired either as health care associated or in the community. The cause of such infection also includes the following but not limited to poor hygiene, sex, instrumentation, anatomic structure, etc. [6]and Out of the several causative agents, Escherichia coli and other coliforms played as major causative agents[7,10].Bowel and Urinary Disorders Research Paper

Urinary tract Infections are commonly treated with sulfamethoxazole – trimethoprim and fluoroquinolones[7,10,12]. However, due to the frequency of antibiotic use, recurrent or chronic UTI and inappropriate use of antibiotics leads to the resistance of the common uropathogens specifically Enterobacteriaceae[13]. Other factors that lead to the acquisition resistance such as adaptation, transduction, conjugation, transformation, transposons, and efflux are also one of the reasons that render the commonly used antibiotic less effective. According to the WHO[14], antimicrobial resistance is of global concerns because of the following reasons: it hampers the control of infectious diseases, threatens a return to the pre-antibiotic era, increases costs of health care, jeopardizes health-care gains to society and threatens health security, damages trade and economy.

Most infections begin in the urethra, the tube that drains the bladder. It is theorized that because in women the opening of the urethra is in close proximity to the anus and vagina in women, organisms can more readily move from these openings to the urethra. This is said to account for the higher infection rate in women. In women the risk of UTI increases with sexual activity and age.

Post-menopausal women may experience bladder or uterine prolapse or a shifting of these structures from their normal position. The shift can lead to incomplete emptying of the bladder and create conditions conducive to bacterial colonization. Postmenopausal women also experience changes in hormone production, particularly estrogen, which can alter vaginal flora, the good organisms that populate the vagina and fight bacteria.Bowel and Urinary Disorders Research Paper

Other risk factors for UTIs are obstructions in the urinary tract such as kidney stones. Poor bladder emptying and bladder control in the elderly put them at risk. In men an enlarged prostate may impede the flow of urine and increase risk. People who have catheters placed for diseases or surgical procedures are at risk despite extraordinary sanitation procedures employed during catheter placement and maintenance. Disorders such as diabetes that alter or weaken the immune system raise the risk of UTI by lowering natural resistance.

Several studies have suggested that women who use a diaphragm have a higher incidence of UTIs than those who use other means of birth control. In some women, intercourse may trigger the onset of a UTI although the reason for this has yet to be determined.

Bladder Conditions and Symptoms
The first and most important point to remember is that everyone with a bladder problem can be helped and many can be completely cured.Bowel and Urinary Disorders Research Paper

If you have been diagnosed with incontinence problems, you can use the bladder menu to find out more information about your specific condition or problem. If you have not been diagnosed by a health professional, the following questions about your symptoms should help you find the information you are looking for.

Overactive Bladder
Many of these symptoms can be caused by a condition called Overactive Bladder.

Do you have a sudden urge to go to the loo or are unable to hold on and reach the toilet in time? You may have Urgency or Urge Incontinence
Do you find you need to go to the loo very often and more than 8 times a day? This may be Frequency
Do you often need to get up during the night? You may have Nocturia
Do you wet the bed at night? You may have Nocturnal Enuresis
If you have one or more of the above symptoms, you may have Mixed Urinary Incontinence
Do you leak when you laugh, cough, sneeze or exercise? You may have Stress Urinary Incontinence, called SUI for short and often referred to as bladder weakness or weak bladder Bowel and Urinary Disorders Research Paper
Do you sometimes dribble urine without noticing or need to strain to pass urine? You may have Overflow Incontinence.
Many bladder problems are common in both men and women, whilst some are related to the anatomical differences between men and women.

Once you have a clearer idea of what your problem may be or if you have been diagnosed you can visit our treatment section to see what your options are for managing your symptoms or condition. Information dealing with the more practical and emotional side of coping with bladder problems can be found by visiting the support section.

Voiding dysfunction program UCSF Pediatric Urology

UCSF pediatric urology has a dedicated program for addressing bladder and bowel dysfunction. In this clinic we help manage the following issues: daytime urinary incontinence (enuresis), nighttime urinary incontinence (bedwetting), urinary urgency and frequency, urinary holding, recurrent urinary tract infections, constipation, and stool accidents. This program consists of a multidisciplinary team including a pediatric urologist, a nurse practitioner, and a clinical nurse. We use state-of-the-art technology and resources to diagnose and treat these conditions in children. Anne Arnhym, NP is medical director and overseas our continence clinic at the UCSF Mission Bay site in conjunction with Dr. Hillary Copp. Lucille Huang, NP overseas our Oakland Children’s site in conjunction with Dr. Michael DiSandro. Both sites have state of the art facilities including urodynamics. Bowel and Urinary Disorders Research Paper

Constipation

Constipation occurs when stool remains too long in the colon or stool moves too slowly through the colon. As stool remains in the colon, fluid is reabsorbed by the body. The longer the stool remains, the more fluid is reabsorbed. This can make the stool hard and small. As this stool remains in the colon, more stool will accumulate. These stools can combine and make very large stools. Eventually the entire colon can fill with stool. The accumulation of stool can then cause the colon to stretch, which then causes the stool to move even slower through the colon and makes the problem worse.

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In some cases, constipation is obvious, as in situations where the child is passing hard, dry, pellet-like stools with straining or only has a bowel movement every few days. Other signs of constipation include; large bowel movements, stomach ache, clogging the toilet with stool, soiling/smearing (sometimes referred to as “skid marks”) in the underwear. The soiling and smearing of stool is caused by liquid stool finding its way around the retained hard stool and eventually leaking to the underwear.

Constipation in children is almost always caused by withholding of stool. One common reason children will withhold stool is due to fear of stooling, maybe because of a past painful stool. Another reason is that many children do not like to stool outside the home, maybe because of “dirty bathrooms at school”. Young children, unlike adults and adolescents, rarely become constipated because of poor diet.Bowel and Urinary Disorders Research Paper

Constipation and Urology

There is a close relationship between the muscles and nerves that control bladder functions and those that control bowel movements. In addition, the bladder and the colon are close together in the body. Large amounts of stool in the colon can put pressure on the bladder which can cause the bladder to not fill as much as it should, or cause the bladder to contract when the bladder is not supposed to contract. This large amount of stool can also cause the bladder to not empty well. All of these problems can lead to daytime wetting, nighttime wetting, urinary tract infections, and in some cases vesicoureteral reflux (see separate handouts).

Treatment

It is important to treat your child’s constipation to help treat your child’s bladder symptoms. Constipation treatment has two parts. The first part is to “clean out” the colon of all the retained stool. This usually takes a few days and can be done over a long weekend. In some cases the clean out may need to be repeated. The second part is to keep the colon cleaned out while the bowel and bladder heal. The maintenance phase can take 6-12 months. Both phases require medication. Because poor diet didn’t cause the constipation, usually changes in the diet do not cure the problem. This is different in adults where poor diet is often the cause of constipation.Bowel and Urinary Disorders Research Paper

What Is Urinary Retention?
Urinary retention is an inability to completely empty your bladder. There are two main types of urinary retention:

Chronic bladder retention is an ongoing condition that develops over time. You may be able to urinate but have trouble starting a stream or emptying your bladder. You may feel the need to urinate frequently, or feel an urgent need to urinate even when you can’t or after you’ve finished.

Acute bladder retention is a sudden inability to urinate. It can cause severe discomfort and is considered a medical emergency.

What Causes Urinary Retention?
Possible causes include:

Blockage in the urinary tract.

Bladder stones. A stone formed anywhere in the urinary tract may become lodged in the bladder. Large stones may completely block the opening to the urethra, the tube that carries urine from the body.

Nerve problems or spinal cord injury. Nerve damage can interfere with the transmission of signals between the brain and the bladder that are required for voiding.

Medications. Medications that calm overactive nerves may inhibit the bladder’s nerve cells and interfere with urine flow. These can include antihistamines used to treat allergies, antispasmodics used to treat stomach cramps and muscle spasms, and antidepressants.Bowel and Urinary Disorders Research Paper

Surgery. Anesthesia dulls nerve receptors, causing some patients to experience temporary urinary retention.

Infections. Infections of the urethra or bladder, such as urinary tract infections (UTI), can cause swelling or inflammation that compress the urethra and block urine flow.

Constipation. A hard stool in the rectum can push against the bladder and urethra, causing the urethra to be pinched shut.

Cystocele. A condition in which the wall between a woman’s bladder and her vagina weakens and allows the bladder to droop into the vagina, enabling urine to remain trapped in the bladder.

What Are the Symptoms of Urinary Retention?
Symptoms may include:

Discomfort
Difficulty starting a urine stream
Weak flow of urine
Frequent need to urinate
Feel the need to urinate after voiding
Small amount of leakage
Symptoms of Acute Bladder Retention
Symptoms of acute bladder retention may include:

Severe discomfort
Pain in the lower abdomen
Urgent need but inability to urinate
Bloated lower belly
How Is Urinary Retention Diagnosed?
Diagnosis starts with a detailed medical history and thorough physical exam. The doctor may be able to feel your distended bladder by lightly tapping on the lower belly. Additional testing may include:

Urine sample
Cystoscopy. Use of a scope to view inside the bladder and urethra Bowel and Urinary Disorders Research Paper
X-ray and CT scan. To look for narrowing or obstruction in the urinary tract, or determine if the bladder is out of its normal position
Urodynamic tests. To measure the bladder’s ability to empty steadily and completely and identify obstructions
Electromyography. Used to measure muscle activity when the doctor suspects the urinary problem is related to nerve damage
How Is Urinary Retention Treated?
Treatment will depend on the cause of the urinary retention and the individual patient. Treatment options include:

Medications
Self-cauterization. Using a small tube (catheter) inserted at regular intervals into the urinary tract to completely drain the bladder
Behavioral therapies and lifestyle changes. Including fluid and diet modification and Kegel exercises to strengthen pelvic floor muscles
Sacral nerve stimulation. Uses mild electrical pulses to stimulate the nerves and improve bladder function
Cystoscopy/Cystourethroscopy. Use of a scope to examine the bladder lining, take biopsies, and find and remove a stone that may be blocking the bladder opening
For acute bladder retention, initial treatment will involve catheterization, a small tube inserted into the bladder through the urethra to drain the urine and relieve immediate pain and distention. Long-term treatment will depend on the cause.Bowel and Urinary Disorders Research Paper

What Are the Complications of Urinary Retention?
Complications may include:

Urinary tract infection (UTI). When urine stays in the bladder, bacteria can grow and infect the urinary tract.
Bladder damage. If the bladder becomes stretched too far or for long periods of time, the muscle may be permanently damaged and lose its ability to contract.
Chronic kidney disease. If urine backs up into the kidneys it can lead to permanent kidney damage, reduced kidney function and chronic kidney disease.
Urinary retention is the inability to voluntarily void urine. This condition can be acute or chronic. Causes of urinary retention are numerous and can be classified as obstructive, infectious and inflammatory, pharmacologic, neurological, or other. The most common cause of urinary retention is benign pro static hyperplane. Other common causes include prostration, cystitis, urethritis, and vulvovaginitis; receiving medications in the anticholinergic and alpha-adrenergic agonist classes; and cortical, spinal, or peripheral nerve lesions. Obstructive causes in women often involve the pelvic organs. A thorough history, physical examination, and selected diagnostic testing should determine the cause of urinary retention in most cases. Initial management includes bladder catheterization with prompt and complete decompression. Men with acute urinary retention from benign prostatic hyperplasia have an increased chance of returning to normal voiding if alpha blockers are started at the time of catheter insertion. Suprapubic catheterization may be superior to urethral catheterization for short-term management and silver alloy-impregnated urethral catheters have been shown to reduce urinary tract infection. Patients with chronic urinary retention from neurogenic bladder should be able to manage their condition with clean, intermittent self-catheterization; low-friction catheters have shown benefit in these patients. Definitive management of urinary retention will depend on the etiology and may include surgical and medical treatments.Bowel and Urinary Disorders Research Paper

Urinary retention is the inability to voluntarily urinate. Acute urinary retention is the sudden and often painful inability to void despite having a full bladder.1 Chronic urinary retention is painless retention associated with an increased volume of residual urine.2 Patients with urinary retention can present with complete lack of voiding, incomplete bladder emptying, or overflow incontinence. Complications include infection and renal failure.

The bladder is a balloon-shaped hollow muscle. It is designed to stretch as it fills up and contract as it empties. The bladder muscle can become so weak that it is unable to contract strongly enough to empty. Damage to the nervous system can also affect the bladder’s ability to contract e.g. Parkinson’s disease, Multiple Sclerosis and Alzheimer’s disease.Bowel and Urinary Disorders Research Paper

Urinary retention is a side effect of the bladder not emptying properly. This is also known as having residual urine.
There are 2 main causes:

Obstruction to the flow of urine through the urethra
Weak bladder muscle
Other causes could be insufficient urine in the bladder to enable urination caused by going to the toilet too frequently as a side effect of an overactive bladder or in an attempt to control incontinence. Or a learned voiding dysfunction – for example, a fear of using the toilet or to use toilets outside the home.

What is urinary retention?
Urinary retention is the inability to empty the bladder completely. Urinary retention can be acute or chronic. Acute urinary retention happens suddenly and lasts only a short time. People with acute urinary retention cannot urinate at all, even though they have a full bladder. Acute urinary retention, a potentially life-threatening medical condition, requires immediate emergency treatment. Acute urinary retention can cause great discomfort or pain.Bowel and Urinary Disorders Research Paper

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Chronic urinary retention can be a long-lasting medical condition. People with chronic urinary retention can urinate. However, they do not completely empty all of the urine from their bladders. Often people are not even aware they have this condition until they develop another problem, such as urinary incontinence—loss of bladder control, resulting in the accidental loss of urine—or a urinary tract infection (UTI), an illness caused by harmful bacteria growing in the urinary tract.

What is the urinary tract and how does it work?
The urinary tract is the body’s drainage system for removing urine, which is composed of wastes and extra fluid. In order for normal urination to occur, all body parts in the urinary tract need to work together in the correct order.

Kidneys. The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine. The kidneys work around the clock; a person does not control what they do.

Ureters. Ureters are the thin tubes of muscle—one on each side of the bladder—that carry urine from each of the kidneys to the bladder.Bowel and Urinary Disorders Research Paper

Bladder. The bladder, located in the pelvis between the pelvic bones, is a hollow, muscular, balloon-shaped organ that expands as it fills with urine. Although a person does not control kidney function, a person does control when the bladder empties. Bladder emptying is known as urination. The bladder stores urine until the person finds an appropriate time and place to urinate. A normal bladder acts like a reservoir and can hold 1.5 to 2 cups of urine. How often a person needs to urinate depends on how quickly the kidneys produce the urine that fills the bladder. The muscles of the bladder wall remain relaxed while the bladder fills with urine. As the bladder fills to capacity, signals sent to the brain tell a person to urinate soon. During urination, the bladder empties through the urethra, located at the bottom of the bladder.

Three sets of muscles work together like a dam, keeping urine in the bladder.

The first set is the muscles of the urethra itself. The area where the urethra joins the bladder is the bladder neck. The bladder neck, composed of the second set of muscles known as the internal sphincter, helps urine stay in the bladder. The third set of muscles is the pelvic floor muscles, also referred to as the external sphincter, which surround and support the urethra.

To urinate, the brain signals the muscular bladder wall to tighten, squeezing urine out of the bladder. At the same time, the brain signals the sphincters to relax. As the sphincters relax, urine exits the bladder through the urethra.

This essay aims to provide a comprehensive account of the gastrointestinal disorder, Irritable Bowel Syndrome. The aetiology, pathology, and prognosis of the disorder will be described, along with details pertaining to its epidemiology. The diagnosis and management of the disorder will be described, followed by a discussion of the health implications experienced by patients and the economic costs of the disorder. Conclusions will be made based on the information and evidence discussed throughout the essay.Bowel and Urinary Disorders Research Paper

Irritable Bowel Syndrome (IBS), also known as spastic colon, nervous diarrhea, and functional bowel, is one of the most common gastrointestinal disorders worldwide (NICE, 2008). It is a chronic, functional disorder of the gastrointestinal tract which is characterized by symptoms of abdominal pain or discomfort of the lower abdomen, bloating, and disordered defecation (Silk, 2003). This latter symptom can manifest in four different forms (Allison, 2002): constipation predominant; diarrhea predominant; alternating between constipation and diarrhea; or, non-extreme. Furthermore, although symptoms are predominantly gastrointestinal, other symptoms can include back ache, nausea, heartburn, lethargy, urinary problems, faintness, palpitations, and loss of appetite (Fortson and Lee, 2004). Symptoms are usually worse after eating and most people experience ‘flare-ups’ lasting between 2-4 days. Indeed, a key characteristic of IBS is a cycle of relapse and remission (Silk, 2003).

Worldwide, IBS affects an estimated 10-20% of the population at any one time, although the figure may be higher because not everyone seeks help for the condition (Hungin et al. 2003; Hungin et al., 2005). IBS can affect both genders of all ages, although it is twice as common in females (Voci and Cramer, 2009). It can occur at any age, but typically develops in individuals who are 20-30 years old (Wangen, 2006). Incidence tends to reduce with age (Wilson et al., 2004). Furthermore, more women report constipation predominant IBS, while more men report diarrhoea predominant IBS (Heitkemper and Jarrett, 2001). Women also tend to report a worsening of symptoms during menstruation, suggesting a hormonal link with IBS (Moore et al., 1998).

Despite there being no clear aetiology for IBS, there is a general consensus that it is a multifactorial disorder of a biopsychosocial nature (Allison, 2002). Possible factors involved in its development include an abnormality with how the muscles move food through the digestive tract, pain-sensitive digestive organs, a malfunctioning immune system, a problem between the central nervous system and the digestive system, or an abnormal response to infection. Environmental, dietary, and genetic factors that are as yet known are also suspected to play a role in the aetiology of IBS.Bowel and Urinary Disorders Research Paper

Diagnosis
A diagnosis of IBS can be made using the Rome III criteria of ‘red flag’ symptoms (Paterson et al., 1999). According to these criteria, an individual is diagnosed with IBS if they have experienced, for at least 6-months, any of the following symptoms: abdominal pain or discomfort; bloating; or, change in bowel habit. In addition, the individual has to present with abdominal pain or discomfort that is relieved by defecation or associated with changes in bowel frequency or stool formation, and have at least two of the following: altered stool evacuation (i.e. straining, urgency, incomplete evacuation); abdominal bloating (i.e. distension, tension, or hardness); symptoms made worse by eating; mucus from the rectum. Reported lethargy, nausea, backache and bladder symptoms are also indicators that might inform a diagnosis of IBS. Furthermore, there are a number of tests that are carried out to exclude other diagnoses. These include a full blood count, erythrocyte sedimentation rate or plasma viscosity (screening test), c-reactive protein (found in blood), and, antibody testing for coeliac disease (RCN, 2008).

The ‘red flag’ symptoms that require the individual to be referred to secondary care for further investigation include unintentional and unexplained weight loss, rectal bleeding, and, a family history of bowel or ovarian cancer (NICE, 2008). In people aged 60-years or over, a change in bowel habit lasting more than 6-weeks with looser and/or more frequent stools also acts a ‘red flag.’ Other indicators for referral include anaemia, abdominal or rectal masses, and inflammatory markers for inflammatory bowel disease (NICE, 2008).

Treatment
There is no cure for IBS, but it can be managed and controlled through lifestyle changes and medicine. NICE provide clinical guidelines on the management of IBS in primary care, which were developed through input from the National Collaborating Centre for Nursing and Supportive Care (NCC-NSC). These guidelines include the provision of general lifestyle advice, particularly in terms of dietary and physical activity advice (NICE, 2008). The treatment and management of IBS is largely focused on providing individuals with the information required to self-manage their condition through diet, physical activity, and medication for specific symptoms.Bowel and Urinary Disorders Research Paper

Dietary advice includes having regular meals, taking time to eat, drinking at least eight cups of water daily, and restricting consumption of tea, coffee, alcohol, fizzy drinks, high-fibre foods, resistant starch (i.e. whole grains, legumes, seeds), and fresh fruit. Individuals with diarrhoea are advised to avoid sorbitol, which is an artificial sweetener found in sugar-free sweets and drinks. Individuals with wind and bloating, on the other hand, are advised to increase intake of oats and linseeds. If diet is assessed as being a key factor in the IBS symptoms, the individual is referred to a dietician for single food avoidance and exclusion diets.

In terms of physical activity, individuals who score low in physical activity on the General Practice Physical Activity Questionnaire (GPPAQ) are provided with brief advice and counselling aimed at increasing their activity. The importance of physical activity in the management of IBS cannot be underestimated. Indeed, a study conducted in Sweden demonstrated that even a minimal increase in physical activity can improve symptoms of IBS (n=102) (Johannesson et al., 2011).

First-line pharmacological treatment is dependent on the primary symptoms reported by the individual. For example, there is support for the provision of antispasmodic agents such as hyoscine or peppermint oil to control symptoms of abdominal pain and spasms (Ford, 2008). Laxatives are an option for constipation, whilst loperamide is the recommended first choice of anti mobility agent for diarrhoea (NICE, 2008). Second-line pharmacological treatment includes the consideration of tricyclic antidepressants for mood and analgesic (pain relieving) effect if first-line treatments do not work (Bell, 2004). Selective serotonin re uptake inhibitors are considered if tricyclic antidepressants do not work. However, due to the potential side-effects of these second-line medications, follow-up after 4-weeks and then every 6-12 months is advised (NICE, 2008).Bowel and Urinary Disorders Research Paper

Psychological Implications
If individuals with IBS do not respond to second-line pharmacological treatments after 12-months, referral for psychological support such as cognitive behavioral therapy (CBT), hypnotherapy, or psychotherapy requires consideration (NICE, 2008). Indeed, although it is not a life-threatening condition, IBS can result in a great deal of psychological distress. One study found that half of the patients attending IBS clinics presented with a diagnosable psychiatric disorder (Silk, 2003). Anxiety and depression have been reported in people with IBS and stress and major life events have been found to often precede the onset of bowel symptoms (Silk, 2003). Strong associations have been found between IBS and Generalised Anxiety Disorder (GAD), with this comorbidity adding to social impairments (Lee et al., 2009). There is also a higher prevalence of childhood physical and sexual abuse among individuals diagnosed with IBS, further indicating the potential efficacy of providing psychological support (Allison, 2002).Bowel and Urinary Disorders Research Paper

The psychological impact of IBS is likely to result from that fact that it can be extremely debilitating and can severely impact quality of life (Heitkemper and Jarrett, 2001). Activities of daily living can be detrimentally impacted and individuals with IBS often experience lethargy and fatigue, which can limit physical activity and social life (Jones et al., 2000). Bertram et al. (2001), who conducted focus groups with people diagnosed with IBS, found that the condition resulted in high levels of frustration and social isolation. There was also an inconsistency in how individuals with IBS perceived their illness and how they felt others perceived their illness. In particular, there was frustration with a lack of understanding from family, friends, and colleagues in terms of the severity and unpredictability of the illness. Many participants also felt that health care professionals did not take the illness seriously. There is some evidence, however, to suggest that health professionals’ attitudes towards IBS are changing. In a study conducted by Nunn (2003), the majority of nurses disagreed with a statement suggesting that patients with IBS were demanding and lazy.

Nevertheless, the stigma surrounding IBS can result in individuals with IBS not accessing the support they need. When combined with the general lack of effective treatments for IBS, people often try to treat themselves. It has been estimated that 50% of people with IBS use complementary and alternative medicine (Hussain and Quigley, 2006). The NICE (2008) guidelines on the use of complementary and alternative medicine, however, recommend against encouraging their use, especially acupuncture and reflexology.Bowel and Urinary Disorders Research Paper

Economic Implications
Evidence suggests that disease relapse and remission accounts for 36-50% of all gastrointestinal consultations, although many patients do not seek help and often attempt to self-treat (Gunn et al., 2003; Parker, 2004). IBS has a significant impact on healthcare resources in both primary and secondary care (Ringstrom et al., 2007). It also contributes to both direct and indirect costs. Evidence suggests that disease relapse and remission accounts for 36-50% of all gastrointestinal consultations, although many patients do not seek help and often attempt to self-treat (Gunn et al., 2003; Parker, 2004).

IBS can lead to increased absenteeism at work and higher rates of health care utilisation, making it a public health problem (Talley, 2008). In a systematic review of the economic cost of IBS in the UK and US, total direct cost estimates per patient per year ranged from $348-8750 (£211.79-5325.25) (calculated for year 2002) (Maxion-Bergemann, Thielecke, and Bergemann, 2006). The average number of days off work per year because of IBS was between 8.5 and 21.6; indirect costs ranged from $355-3344 (£216.25-2037.04). Of note, however, is that the total costs and cost components of IBS were influenced by factors such as the demographic of the patient group and study variables, such as design and databases used. Further research is needed on the cost-effectiveness of diagnostic procedures and treatments for IBS in order to help define strategies to help IBS patients improve their quality of life and, in turn, reduce related healthcare and economic costs.Bowel and Urinary Disorders Research Paper

Conclusion
This essay has outlined the aetiology and epidemiology of Irritable Bowel Syndrome, which is one of the most common gastrointestinal disorders worldwide. IBS is a chronic disorder that cannot be cured, but requires self-management through lifestyle, pharmacological treatments, and psychological support. The direct and indirect costs of the condition are vast due to the relapsing and remitting nature of the symptoms. Due to there being no clear cause for IBS, stigma still exists regarding its seriousness, which can prevent people seeking medical support. In order to reduce the direct and indirect costs of this common, quality of life depleting illness, healthcare professionals need to take it seriously and assist patients in the long-term management of the physically and psychologically limiting symptoms.

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For the past several years, one of the top reasons people have come to the website of The Simon Foundation for Continence is for information on diabetes and urinary/bowel dysfunction. As we know, common risk factors are associated with and link these conditions. A growing number of people with type 2 diabetes mellitus and prediabetes are trying to understand the links between diabetes and the different kinds of bladder and bowel dysfunction they encounter; they need information and education. Wound care nurses are in a perfect position to provide this information and to teach prevention in outpatient clinics and home care settings.Bowel and Urinary Disorders Research Paper

The United States diabetes forecast is not good, nor does it appear it will improve any time soon. The newest statistics from the Centers for Disease Control and Prevention (CDC), published in October 2018, show the prevalence of people, 20 years of age and older, with diagnosed type 2 diabetes continues to rise, from 6.2% in 1999–2000 to 10.0% in 2015–2016. The total prevalence of diabetes (diagnosed and undiagnosed) increased from 9.0% in 1999–2000 to 12.9% in 2015–2016.1 In 2017, the CDC reported 84 million Americans (1 in 3) are living with prediabetes.2

Because we currently have a large portion of the US population presenting with diabetes and prediabetes, patients need to understand the normal progression of these diseases. This understanding needs to include the risk for incontinence and other bladder and bowel complications and how these symptoms can be prevented by taking steps to manage diabetes. What patients do to improve their health — allaying and/or reversing the damage of diabetes and its precursors — may well depend on the amount and quality of information and education provided by health care professionals.

Nerve damage. Our patients need to understand diabetes can lead to nerve damage that effects peripheral, autonomic, and cranial nerves and, as such, both bladder and bowel. Nerve damage can lead to multiple and ongoing changes in bladder function known as diabetic cystopathy; this includes decreased/diminished bladder sensation of filling, increased bladder capacity, and impaired detrusor contractility (a flaccid or atonic bladder). An underactive bladder often is the chief cause of diabetic cystopathy. Ongoing nerve damage can lead to changes that may include a weak stream, dribbling, incomplete emptying, urinary retention with elevated post void residuals, and frequency.3 The residual urine in the bladder can lead to chronic urinary tract infections (UTIs), which may lead to frequency and urgency. Persistent and repeated UTIs may lead to infection of the kidneys. A person with diabetes also may experience an overactive bladder with or without urge incontinence (affecting both men and women and increasing with age3).

Likewise, the bowel is impacted (no pun intended) by a diabetic condition known as diabetic enteropathy. Constipation alternating with diarrhea is a common symptom, along with large bowel dysfunction. Diarrhea may be associated with bowel incontinence and often occurs at night. Constipation can make it difficult for persons to empty their bladder. Nearly 60% of patients with diabetes are affected by constipation without diarrhea. Severe constipation leading to megacolon or colonic intestinal pseudo-obstruction are rare occurrences. The risk for bowel incontinence increases with acute hyperglycemia, which inhibits external anal sphincter function and decreases rectal compliance.4 Teaching patients with diabetes about good bowel habits and a healthy bowel diet will help prevent these complications.Bowel and Urinary Disorders Research Paper

Gestational diabetes. Women with diabetes or who have developed gestational diabetes may deliver large-sized infants. These women are susceptible to injuries of the perineum and bladder, particularly the urinary sphincter. This, in turn, can result in urinary retention or urinary incontinence, as well as fecal incontinence.

The role of medicines. There are also pharmacologic implications in addition to the neural effects of diabetes on bladder/bowel function. Congestive heart failure from diabetes-related coronary artery disease can cause legs and feet to retain water.Bowel and Urinary Disorders Research Paper This may lead to patients getting up many times at night to urinate (nocturia) and may lead to nocturnal incontinence. Patients on angiotensin-converting-enzyme (ACE) inhibitors, which are frequently used to treat high blood pressure in persons with diabetes, may experience a cough. Coughing can trigger stress urinary incontinence or make it worse. Calcium channel blockers (CCBs), also used to treat high blood pressure, can make it difficult for the bladder to contract and empty completely, potentially leading to overflow incontinence or retention. Additionally, some CCBs can cause swelling in the feet and constipation, further worsening function. Instructing patients to elevate their legs during the afternoon along with other simple remedies may help relieve some of these symptoms. Also, working with the prescribing practitioner on medication schedules may provide relief.

Stroke. A stroke from diabetes may effect bladder sensation and the ability to retain urine. Additionally, any secondary cognitive impairment can make it difficult for an individual to toilet independently (and if severe, even toileting with assistance may be difficult). Teaching patients and their caregivers how to create a safe environment for toileting and about toileting aids for the home will help improve this process for everyone involved. Patients and caregivers often do not know where to find information on the different kinds of toileting aids available and where to purchase them. Clinicians can direct them to websites such as Continence Central (continencecentral.org) and provide multiple vendors of toileting aids. Bowel and Urinary Disorders Research Paper

Ambulatory ability. Patients with diabetes may have mobility challenges due to diabetic neuropathy, peripheral vascular disease, and/or amputation. These challenges can prevent them from reaching a toilet and/or removing clothing “in time,” leading to episodes of functional incontinence. Counseling the patient and caregivers on alternate clothing (such as the use of Velcro instead of buttons and pull-on pants in lieu of those with zippers) and clearing pathways to the bathroom may reduce these episodes and may prevent slips and falls. You also might suggest the use of products that will keep patients dry if leakage occurs.

Metabolic disorders. Metabolic syndrome is the cluster of biological factors characterized by abdominal obesity, dyslipidemia, hypertension, and type 2 diabetes. The number of people with this syndrome continues to rise in the US. In 2017, the CDC reported that among US adults aged 18 years or older, the prevalence rose by more than 35% from 1988–1994 to 2007–2012, increasing from 25.3% to 34.2%. Additionally, during the time period from 2007 to 2012 low education level (odds ratio [OR] 1.56; 95% confidence interval [CI]: 1.32–1.84) and advanced age (OR 1.73; 95% CI: 1.67–1.80) were independently associated with increased likelihood of metabolic syndrome.5 Because type 2 diabetes is part of this syndrome, these individuals also may become part of our wound care patient population and further increase the numbers of people with bladder and bowel dysfunction.Bowel and Urinary Disorders Research Paper

Urinary and bowel dysfunction are risks our patients should understand and know. We can help our patients lower their risks of these complications through education. Counseling on diet, exercise, smoking cessation, blood sugar control, and follow-through on treating any associated hypertension, high cholesterol, and obesity will go a long way in helping reach the goal of Health People 2020(healthy people.gov/2020/topics-objectives/topic/diabetes). The huge return on our investment in educational efforts on the risks for bladder and bowel dysfunction in patients with diabetes, along with solutions for prevention and/or treatment, is worthy of our time and effort.

Function
The bladder is connected to the kidneys by two long tubes called ureters. When urine is produced by the kidneys, it travels down the ureters to the bladder, where it is stored. The bladder has four layers.

From the inside out, the epithelium is the first layer on the inside of the bladder. It acts as a lining for the bladder. The lamina propria is the next layer. It consists of connective tissue, muscle and blood vessels. Wrapped around the lamina propria is the layer called the muscularis propria or detrusor muscle. According to John Hopkins Pathology, this layer consists of thick, smooth muscle bundles. The final, outer layer is the perivesical soft tissue, which is made up of fat, fibrous tissue and blood vessels.

The other parts of the bladder are located at the bottom of the sack. An opening at the bottom of the bladder is connected to the urethra. A circular, muscular sphincter pinches tight to keep the opening and the urethra from leaking urine.

When a person urinates, the detrusor muscles contract to squeeze the urine out of the bladder while the sphincter relaxes to open the opening of the bladder and urethra. The opening at the bottom of the bladder empties urine into the urethra, where it then empties from the body.Bowel and Urinary Disorders Research Paper

Diseases & conditions
Many diseases and conditions can originate in the bladder. “The most common bladder problems I see in my practice in women are frequent urges to urinate and leakage of urine,” said S. Adam Ramin, urologic surgeon and founder of Urology Cancer Specialists in Los Angeles, California. Leakage and frequent urges often are caused by the decreased capacity of the bladder and overactivity of the bladder. An overactive bladder can be caused by a wide range of conditions, including constipation and excess caffeine in the system, according to the Mayo Clinic. Leakage of urine, or incontinence,can also be caused by bladder spasms or stress. A bladder sling is sometimes used to treat stress urinary incontinence.

“The most common bladder problems in men are frequent urination at nights and incomplete bladder emptying. This is usually due to an enlarged prostate causing obstruction of bladder emptying,” Ramin told Live Science.Bowel and Urinary Disorders Research Paper

Bladder infections may be another cause of frequent urination. Bladder infections, also called cystitis, are among the most common bacterial infections, according to Harvard Health. Around one-third of all females get a bladder infection at least once. Some of the symptoms include burning or pain during urination, needing to urinate a lot though only a small amount of urine is passed each time, sudden needs to urinate, lower abdomen pain and cloudy or bloody urine.

Another problem that can originate in the bladder is bladder cancer. About 577,400 people in the United States live with bladder cancer, according to the National Cancer Institute. It typically affects older people, though younger people have been known to develop bladder cancer, according to the Mayo Clinic. Some symptoms of bladder cancer include blood in the urine, frequent or painful urination and back or pelvic pain.

An anterior prolapse, also called a prolapsed bladder or cystocele, is a bladder problem specific to females. It happens when the tissue between a woman’s bladder and vaginal wall weakens due to a strain. The weakening allows the tissue to stretch and the bladder bulges into the vagina, according to the Mayo Clinic. Bowel and Urinary Disorders Research Paper

Bladder stones are caused by concentrated urine that crystallizes in the bladder. Typically, people who have problems emptying their bladder have problems with bladder stones, according to the Mayo Clinic.

Promoting good bladder health
Sometimes, there is no choice but to hold urine, but it may not be good for the bladder. “Holding your urine for a short period of time, usually up to one hour, is typically okay,” Ramin said. “However, protracted and repeated holding of urine may cause over-expansion of bladder capacity, transmission of excess pressure into the kidneys, and the inability to completely empty the bladder. These problems in turn may lead to UTI [urinary tract infection], cystitis and deterioration of kidney function.”Bowel and Urinary Disorders Research Paper

Drinking plenty of water throughout the day can also help prevent bladder stones by preventing the concentration of minerals that cause the stones. The Mayo Clinic suggests asking a medical profession about how much water the body needs according to age, size and activity level.

This patient education piece is designed to help improve patients understanding regarding rectal prolapse, specifically its presentation, evaluation and treatment. This information may also be useful to the friends, families, and caregivers of patients dealing with rectal prolapse.

Treatment of this condition may often require surgery, and this patient education material is intended for patients with rectal prolapse who are considering or have been recommended surgery. It will address why surgery may have been recommended, what the various treatment options are, what it involves and how it may help patients.

WHAT IS RECTAL PROLAPSE?
Rectal prolapse is a condition in which the rectum (the last part of the large intestine before it exits the anus) loses its normal attachments inside the body, allowing it to telescope out through the anus, thereby turning it “inside out”. While this may be uncomfortable, it rarely results in an emergent medical problem. However, it can be quite embarrassing and often has a significant negative impact on patients quality of life.Bowel and Urinary Disorders Research Paper

Overall, rectal prolapse affects relatively few people (2.5 cases/100,000 people). This condition affects mostly adults, and women over 50 years of age are six times as likely as men to develop rectal prolapse. Most women with rectal prolapse are in their 60’s, while the few men who develop prolapse are much younger, averaging 40 years of age or less. In these younger patients, there is higher rate of autism, developmental delay, and psychiatric problems requiring multiple medications.

Although an operation is not always needed, the definitive treatment of rectal prolapse requires surgery.Bowel and Urinary Disorders Research Paper