Pathophysiology of Urinary System

1. Altered Urinary Production

a. Polyuria

Polyuria (or diuresis) refers to the production of abnormally large amounts of

urine by the kidneys, often several liters more than the client’s usual daily output.
Polyuria can follow excessive fluid intake, a condition known as polydipsia, or may
be associated with diseases such as diabetes mellitus, diabetes insipidus, and
chronic nephritis. Polyuria can cause excessive fluid loss, leading to intense thirst,
dehydration, and weight loss.

b. Oliguria

Oliguria is low urine output, usually less than 500 mL a day or 30 mL an hour
for an adult. Although oliguria may occur because of abnormal fluid losses or a
lack of fluid intake, it often indicates impaired blood flow to the kidneys or
impending renal failure.

c. Anuria

Anuria is a condition when the kidneys stop producing urine. This condition
usually results from a kidney disorder. Here are some of the causes of anuria:

 Diabetes: Blood sugar is too high in diabetics can cause diabetes ketoacidosis
and cause damage to the blood vessels in the kidneys.
 Kidney Stone: This condition makes urine finally unable to get out.
 Kidney Failure: When kidney failure occurs, the kidneys begin to stop
functioning and are no longer able to filter and produce urine.
 High Blood Pressure: Uncontrolled high blood pressure can cause damage to
the blood vessels in the kidneys.
 Tumour: Tumors that grow around the kidneys can make a blockage that
prevents the discharge of urine.
  Heart Failure: If someone has heart failure, the heart cannot pump enough
blood throughout the body. The body also thinks the blood vessels are lacking
in fluids. As a result, the kidneys will compensate by stopping producing urine
to provide additional fluid to the body.

2. Altered Urinary Elimination

a. Frequency

Urinary frequency is voiding at frequent intervals, that is, more than four to six
times per day. An increased intake of fluid causes some increase in the frequency
of voiding. Conditions such as UTI, stress, and pregnancy can cause frequent
voiding of small quantities (50 to 100 mL) of urine.

b. Nocturia

Nocturia is voiding two or more times at night. Like frequency, it is usually

expressed in terms of the number of times the person gets out of bed to void.

c. Urgency

Urgency is the sudden and strong desire to voiding. There may or may not be a
great deal of urine in the bladder, but the person feels a need to voiding
immediately. Urgency accompanies psychological stress and irritation of the
trigone and urethra. It is also common in people who have poor external sphincter
control and unstable bladder contractions.

d. Dysuria

Dysuria means voiding that is either painful or difficult. It can accompany a

stricture (decrease in caliber) of the urethra, urinary infections, and injury to the
bladder and urethra. Often clients will say they have to push to voiding or that
burning accompanies or follows voiding. The burning may be described as severe,
like a hot poker, or more subdued, like a sunburn. Often, urinary hesitancy (a delay
and difficulty in initiating voiding) is associated with dysuria.
e. Enuresis

Enuresis is involuntary urination in children beyond the age when voluntary

bladder control is normally acquired, usually 4 or 5 years of age. Nocturnal enuresis
often is irregular in occurrence and affects boys more often than girls. Diurnal
(daytime) enuresis may be persistent and pathologic in origin. It affects women and
girls more frequently.

f. Urinary Incontinence

Urinary incontinence (UI), or involuntary leakage of urine or loss of bladder

control, is a health symptom, not a disease. It is only normal in infants.

 Functional Urinary Incontinence

Inability of a usually continent person to reach the toilet in time to avoid

unintentional loss of urine. Major characteristics include the urge to void or
bladder contractions sufficiently strong to result in loss of urine before reaching
an appropriate receptacle. Altered environment and sensory, cognitive, or
mobility deficits may contribute to functional incontinence.

 Overflow Incontinence

This is “continuous involuntary leakage or dribbling of urine that occurs

with incomplete bladder emptying”. It can be seen in men with an enlarged
prostate and clients with a neurologic disorder. An impaired neurologic
function can interfere with the normal mechanisms of urine elimination,
resulting in a neurogenic bladder

 Urge Urinary Incontinence

This type of incontinence is described as an urgent need to void and the

inability to stop micturition (passage of urine). The urine leakage can range
from a few drops to soaking of undergarments. Major characteristics include
urinary urgency, frequency (voiding more often than every 2 hours), and
bladder contracture or spasm. Minor characteristics include nocturia (more than
two times per night), voiding small amounts (less than 100 mL) or large
amounts (more than 550 mL), and inability to reach the toilet in time.

Urge incontinence may be related to decreased bladder capacity (e.g.,

history of pelvic inflammatory disease, abdominal surgeries, indwelling urinary
catheter), irritation of bladder stretch receptors causing spasm (e.g., bladder
infection)

 Stress Urinary Incontinence

The state in which an individual experiences a loss of urine less than 50 mL

occurring with increased abdominal pressure. Major characteristics include
reported or observed dribbling with increased abdominal pressure. Minor
characteristics may include urinary urgency and urinary frequency.

 Mixed Urinary Incontinence

Mixed incontinence is diagnosed when symptoms of both stress UI and

urgency UI are present. It is very common among middle-age and older women.
Treatment is usually based on which type of UI is the most bothersome to the
client.

 Reflex Urinary Incontinence

The state in which an individual experiences an involuntary loss of urine,

occurring at somewhat predictable intervals when a specific bladder volume is
reached. Major characteristics include no awareness of bladder filling, no urge
to void or feelings of bladder fullness, and uninhibited bladder contraction or
spasm at regular intervals. Related factors include a neurologic impairment

 Total Urinary Incontinence

The state in which an individual experiences a continuous and unpredictable

loss of urine. Major characteristics include constant flow of urine occurring at
 unpredictable times without distension, uninhibited bladder contractions or
spasms, unsuccessful incontinence refractory treatments, and nocturia.

Related factors include neuropathy that prevents transmission of the reflex

that indicates bladder fullness; neurologic dysfunction causing triggering of
micturition at unpredictable times; independent contraction of the detrusor
reflex owing to surgery, trauma, or disease that affects spinal cord nerves; or
anatomy (fistula).

g. Urinary Retention

The state in which the individual experiences incomplete emptying of the

bladder. Major characteristics for urinary retention include bladder distension and
small, frequent voiding or absence of urine output. Minor characteristics include
sensation of bladder fullness, dribbling, residual urine, dysuria, and overflow
incontinence. High urethral pressure caused by a weak detrusor, inhibition of the
reflex arc, a strong sphincter, and blockage are related factors for urinary retention.

Common causes of urinary retention include prostatic hypertrophy

(enlargement), surgery, and some medications. Acute urinary retention is the most
common complication in the first 2 to 4 hours postoperatively. Causes of chronic
urinary retention can include paraplegia, quadriplegia, multiple sclerosis, and
urethral or perineal trauma. Clients with urinary retention may experience overflow
incontinence, eliminating 25 to 50 mL of urine at frequent intervals. The bladder is
firm and distended on palpation and may be displaced to one side of the midline.

References

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Herdman, T.H. & Kamitsuru, S. (2018). Nursing diagnoses: Definitions and

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