Growing Old with an Overactive Bladder

Diane K. Newman | August 06, 2020

I recently saw a 77 year-old Latina woman with complaints of strong urinary urgency resulting in incontinence, frequency every 2 hours with nocturia x4.  She described urgency as “pressure in my bladder.” She reported that her symptoms were “terrible.” Her symptoms were longstanding but appeared to be worsening. She had undergone lumbar spinal fusion 18 months ago, her third back surgery. This was about the time symptoms worsened.

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diane k newman

Diane K. Newman, DNP, ANP-BC, FAAN is an Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health. She is the author of several books. The most recent is as lead editor of the 1st edition of the SUNA Core Curriculum for Urologic Nursing and of Clinical Application of Urologic Catheters, Devices and Products.

Videos
State-of-the-industry video lectures

Catheter Resource Guides

Catheter guides provided by the ANA and AHRQ
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Streamlined Evidence-Based RN Tool: Catheter Associated Urinary Tract Infection (CAUTI) Prevention

Nurse-Driven CAUTI Prevention: Saving Lives, Preventing Harm and Lowering Cost. Key Practice Strategies to Reduce CAUTI: 1) Fewer Catheters Used, 2) Timely Removal and 3) Insertion, Maintenance, and Post-Removal Care. Informed by Guidelines for Prevention of Catheter-Associated Urinary Tract Infections (CDC, 2017).

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AHRQ Safety Program for Reducing CAUTI in Hospitals

This guide and the appended tools are designed to support implementation of evidence-based practices and elimination of catheter-associated urinary tract infections (CAUTI) in your hospital unit.

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How to Use an External Male Catheter

An external catheter is used by a man to collect urine that leaks from the bladder (called “urinary incontinence”). These catheters are also called “urisheath or sheath” or “condom” or “Texas” catheters. This catheter is used on the outside of the body. It fits over the penis and connects to a drainage bag.

Patient Education Resources

Patient Education Tools for Pelvic Floor Muscle Excercises and Bladder Training
Download Controlling Your Bladder Urges With Bladder Training

CONTROLLING YOUR BLADDER URGES with BLADDER TRAINING is information about overactive bladder symptoms of urgency, frequency and urgency incontinence. This tool detail bladder training strategies including methods for controlling urinary urgency.

Download Habits That Can Affect Your Bladder

HABITS THAT CAN AFFECT YOUR BLADDER is information about foods and liquids that can irritate the bladder causing urgency, frequency and incontinence. The first page is a list of foods that are known to be bladder irritants, with a list of foods and liquids that contain caffeine. The second page lists other things that can cause bladder symptoms including herbs that have been shown to negatively impact the bladder and information on recommended daily intake of fluids and drinks.

Download Pelvic Floor Muscle Exercises

How to Do Pelvic Floor Muscle Exercises are instructions for performing pelvic muscle exercise. These are commonly referred to as “Kegels”. It details how to perform both quick and slow muscle contractions and provides tips for identifying the muscle, when to do them. These instructions are for men and women.

Download Doing the "Knack" to Stop Bladder Leaks

Doing the “Knack” to Stop Bladder Leaks reviews the strategy for stopping insentience, bladder leaks. Some refer to these as “stress strategy”. These instructions will assist a person in the use f the pelvic muscle at the time when urine leakage is most apt to occur.

Everyday Urology - Oncology Insights
Publications focusing on urologic cancer treatments through original manuscripts
By Edward Schaeffer
Published Date: March 2020

Urinary tract infections are the most common type of bacterial infection,1 accounting for at least 11 million physician office visits, 2 to 3 million emergency department visits, 400,000 hospitalizations, and approximately $2.3 billion in healthcare costs annually in the United States.2,3,4,5
By Diane Newman, DNP, ANP-BC, FAAN
Published Date: December 2016

The Core Curriculum is a first-of-its-kind textbook that can be used by nurses to study for specialty certification as a urology registered nurse, and is a source of material to support urology nursing instruction in academic programs. It has applicability to nurses in acute care, long term care, home care and rehab settings as all encounter patients with urologic problems.
Library Resources
Evidence based monographs by experts to define and guide clinical practice
Intermittent Catheters
Written by Diane K. Newman, DNP, ANP-BC, FAAN
March 4, 2020
Intermittent catheterization (IC) can be indicated as treatment for voiding problems due to disturbances or injuries to the nervous system, non-neurogenic bladder dysfunction, or intravesical obstruction with incomplete bladder emptying.

Intermittent catheterization should be performed in the presence of a residual urine volume and symptoms or complications arising from this residual volume of urine.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
March 4, 2020
Intermittent catheterization (IC) is the preferred procedure for people with incomplete bladder emptying not satisfactorily managed by other methods. Complications and adverse events can arise in both men and women but are seen especially in male patients performing intermittent self-catheterization long-term. Urethral/scrotal events can include bleeding, urethritis, stricture, the creation of a false passage, and epididymitis. Bladder-related events can cause UTIs, bleeding, and stones. The most frequent complication of IC is urinary tract infection (UTI).
Written by Diane K. Newman, DNP, ANP-BC, FAAN
March 3, 2020
The number of catheter types and designs has increased with the advancement of new technology. This has added complexity to the catheterization process for both the nurse and the patient. Catheter types are now gender specific, acknowledging the anatomical differences in urethral length between men and women. Standard male catheter length is 16” (~40cm), whereas female catheters range in length from 6-12”.  Pediatric lengths are 6-10”.  Many women find that shorter catheters do not shift and are easier to grasp and insert.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
November 29, 2019
Intermittent catheterization (IC) is the insertion and removal of a catheter several times a day to empty the bladder. This type of catheterization is used to drain urine from a bladder that is not emptying adequately or from a surgically created channel that connects the bladder with the abdominal surface (such as Mitrofanoff continent urinary diversion). Intermittent catheterization is widely advocated as an effective bladder management strategy for patients with incomplete bladder emptying due to idiopathic or neurogenic detrusor (bladder) dysfunction (NDO).
Written by Diane K. Newman, DNP, ANP-BC, FAAN
February 5, 2020
Medicare Changes Reimbursement Policy to End Re-use of Intermittent Catheters.  This change allows for up to 6 catheter changes a day in hopes to stop re-use of FDA labeled "single-use" catheters. The old policy made individuals sterilize and clean their catheters any way they knew how which lets a very high-risk opportunity to have the individual get infected with catheter-associated bacteria to arise.  No longer will catheter users suffer from severely painful UTIs.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
February 1, 2013
Patients may be concerned about the discomfort associated with intermittent catheterization, the need to maintain privacy, the fear of performing the catheterization, and the inability to find a clean and appropriate toilet when traveling outside their home. Clinicians need to consider these patient concerns in their teaching and recommend possible strategies.
Indwelling Catheters
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 5, 2020

Adherence to general infection control principles: Hand hygiene - the most important factor in preventing nosocomial infections, Aseptic catheter insertion, Proper Foley catheter maintenance, education, and care by nursing staff, Foley catheter use surveillance and feedback.

Written by Diane K. Newman, DNP, ANP-BC, FAAN
January 15, 2013
The 2009 Centers for Disease Control and Prevention (CDC) guidelines for the prevention of catheter-associated urinary tract infections (UTIs) recommends catheter use only for appropriate indications.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
January 15, 2013
Catheter related problems due to an indwelling urinary catheter (IUC) have existed as long as urinary catheters have been utilized.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
January 15, 2013
In this resource article, Diane Newman, DNP, ANP-BC, FAAN provides best practices for the management of indwelling urinary catheters starting with documenting in the patient’s medical record all procedures involving the catheter or drainage system.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
January 15, 2013
In this resource article, Diane K. Newman, DNP, ANP-BC, FAAN provides techniques and procedures for use of indwelling catheters including appropriate urinary catheter use, examples of appropriate indications for indwelling urethral catheter use and more.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
January 15, 2013
Catheters are semi-rigid but flexible tubes. They drain the bladder but block the urethra.

The challenge is to produce a catheter that matches as closely as possible to the normal physiological and mechanical characteristics of the voiding system.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
January 15, 2013
Each year, urinary catheters are inserted in more than 5 million patients in acute care hospitals and long-term care (LTC) facilities. Historically, indwelling urinary catheters (IUC) have been used in the chronically, medically compromised older adults.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
January 15, 2013
A catheter is inserted for continuous drainage of the bladder for two common bladder dysfunction : urinary incontinence (UI) and urinary retention. Indwelling urinary catheters are either inserted transurethrally or suprapubically.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
January 25, 2013
Indwelling urinary catheters (IUCs) are semi-rigid, flexible tubes. They drain the bladder but block the urethra. IUCshave double lumens, or separate channels, running down it lengthwise.
External Urinary Collection Devices
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 17, 2020
The shape and material of external urine collection devices (EUCD) have changed over the past 20 years. Historically, most EUCDs were made from latex that allowed for flexibility but also increased the risk of an allergic reaction. Latex-based sheath devices are still available but more recent ones are constructed from non-allergenic silicone.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 17, 2020
An EUCD may be external and less invasive, but they are not free of risks. Complications and adverse effects include skin lesion/ulceration and breakdown from pressure necrosis and moisture, urethral fistula or very rarely, gangrene of the penis. The majority of complications involve perineal/genital skin issues, primarily occurring in 15-30% of male patients and involve external penile shaft problems.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 10, 2020
The use of an external urine collection device (EUCD) is an effective way to manage and collect urine leakage in men and women who have urinary incontinence. However, these devices are not indicated for the management of urinary obstruction or urinary retention.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 17, 2020
An external urine collection device (EUCD) is defined as a catheter or product that attaches to the perineum. These collection systems drain urine via tubing attached to a bag or via tubing that suctions urine to a container. EUCDs are primarily used in men or women with urinary incontinence.
Written by Diane K. Newman, DNP, ANP-BC, FAAN
April 10, 2020
External urinary catheters (EUC) are used as collection devices or systems (referred in the UroToday reference center as external urine collection devices [EUCD]) for collecting and containing urine via tubing that relies on gravity to drain urine away from the penis or perineum into a drainage bag or suction that pulls urine into a container.
Pelvic Health
Conference Coverage
Recent data from conferences worldwide
Presented by Jeffrey P. Weiss, MD
Miami, FL (UroToday.com) Dr. Jeffrey Weiss provided an update of the management of nocturia. Patients are oftentimes asked to fill out a 24-hour voiding diary but compliance in completing them is sometimes very difficult to obtain.
Presented by Harris Emilio Foster, MD
Miami, FL (UroToday.com) Dr. Foster leads the audience through the AUA BPH Guidelines briefly emphasizing the new changes /updates that will be seen in the new updated BPH guidelines.
Presented by Alison P Downey, MD
Philadelphia, PA (UroToday.com) Dr. Chapple from Royal Hallamshire Hospital, Sheffield, and his colleagues presented their experience and outcome of surgical intervention in the management of bladder pain syndrome in a tertiary center.
Presented by Mikel Gray, Ph.D., RN
Philadelphia, PA (UroToday.com) Mikel Gray, Ph.D., RN provided an overview of urodynamic procedures, which were defined as a set of tests created to estimate storage and evacuation of urine from the lower urinary tract (LUT).
Presented by Shannon Novosad, MD, MPH
Philadelphia, PA (UroToday.com) Shannon Novosad, MD, medical officer at the Centers for Disease Control and Prevention (CDC) has opened Educational Course on Clinical Directions in Continence care by providing an overview