Transcript Urinary incontinence

Urinary incontinence
Dr Mohammad Hatef Khorrami
Urologist
Fellowship of endourology
isfahan university of medical science
Incontinence
Incontinence
Stress
Urge
mixed
Unconscious
Continuous
Nocturnal enuresis
Epidemiology


In women %3-%11
In men %2- %6
Mechanism of continence


Good compliance
sphincter
Structure of the Bladder
Ureter
Detrusor
smooth muscle
External
urethral sphincter
Pelvic floor
Prostate
gland
Micturition Reflex
Direction of
nerve impulse
Brain
Spinal cord
Bladder
Pelvic floor
Bladder Filling & Emptying Cycle
1. Bladder fills
Detrusor muscle relaxes
Urethral
sphincter
contracts
The cycle of
bladder filling
and emptying
Detrusor muscle
contracts
Urination
Urethral
sphincter
relaxes
3. Urination
voluntarily inhibited
until time and place
are right
2. First desire to
urinate (bladder
half full)
Etiology

Bladder abnormality

Detrusor overactivity
Decreased bladder compliance

Sphincter abnormality

Causes of detrusor overactivity





Idiopathic
Neurologic
CVA,brain atrophy, brain
tumor , MS, SCI
Non neurogenic
UTI, obsruction,pelvic
organ prolaps,bladder
tumor, bladder stone,age
Sphincteric abnormality

Men

Prostate surgery,trauma, neurologic

Women

Urethral hypermobility,intrinsic sphincteric
insufficiency,neurogenic
Causes of transient incontinence








Delirium
Infection
Athrophic vaginitis
Psychologic
Pharmacologic
Excess urine production
Restricted mobility
Stool impaction
How to Recognize Patients
with incontinence
•
•
•
•
•
•
•
Symptom assessment
Medical history
Physical examination
Urinalysis
Bladder diary
Pad test
Referral for medical evaluation
and treatment
Medical History
Other questions that your doctor/nurse might ask:
• History of previous surgery or
radiotherapy involving the pelvic
region
• Medications currently taking
• Main symptoms (complaints)
• Duration of symptoms
Physical Examination
• Abdomen exam
• Rectal exam
• Pelvic exam
•Neurologic exam
Urinalysis
To rule out urinary tract infection
Bladder Diary
Helps patients record details of:
• Bladder symptoms
• Type/amount of drinks taken
• Time/amount of urine passed
Pad Test
A supplementary test used to
confirm urine leakage and
quantify the degree of urine loss.
Pad Test
Method:
• Drink 500 ml of fluid as quickly as
possible
Pad Test
Method (cont’d):
• Perform a series of physical tasks in
a 1-hour period
• Walking
• Climbing stairs
• Coughing vigorously
• Running on the spot
Pad Test
Method (cont’d):
• The pad is re-weighed.
• A weight gain of more than 1 g
signifies that the patient is
incontinent.
Referral for Further
Evaluation and Treatment
Urodynamic test
Imaging
Endoscopy
treatment




Low bladder compliance
Drug
Enterocystoplasty
Denervation
Treatment
sphincteric dysfunction






Behavioral modification
Drug
Urethral bulking agent
surgery
Sling
Artificial sphincter
Management of
Overactive Bladder
• Drug therapy
• Bladder training
• Incontinence pads and protective
devices
• Bladder self-catheterization
• Pelvic floor exercises
• Biofeedback
• Review diet and food intake
• Skin care and cleanliness
• Surgery
Bladder Training
A behavioural approach to the
treatment of the overactive
bladder, which is often used in
combination with drug therapy.
Bladder Training
Aims:
• Increase the time intervals
between bladder emptying.
• Increase bladder capacity by
teaching patients to resist and
suppress the urge to pass urine.
Incontinence Pads and
Protective Equipment
All-in-one briefs
Reusable underpants
designed to carry
disposable absorbent pads
Absorbent pads
Dribble pouch
Chair and bed pads
Pelvic Floor Exercises
Also known as Kegel exercises.
Pelvic Floor Exercises
Aim:
To strengthen the pelvic floor muscle
and increase overall muscle tone.
Biofeedback
Aim:
Helps patient identify the correct
muscle for performing Kegel
exercises
Biofeedback
Source: Biofeedback Instrument Corporation
Review Diet and Fluid Intake
Some patients will try
to reduce the risk of
leakage by restricting
their fluid intake.
Review Diet and Fluid Intake
However, drinking too
little results in
concentrated urine,
which itself can irritate
the bladder.
Review Diet and Fluid Intake
Therefore, it is important
that patients are
encouraged to drink
appropriate amount of
fluids.
Review Diet and Fluid Intake
Reduce consumption of:
• Caffeine (i.e. tea and
coffee)
• Carbonated soft drinks
• Alcoholic drinks
Management of
Overactive Bladder
• Drug therapy
• Bladder training
• Incontinence pads and protective
devices
• Bladder self-catheterization
• Pelvic floor exercises
• Biofeedback
• Review diet and food intake
• Skin care and cleanliness
• Surgery
Role of Nurses
• Help to recognise
patients who have
problems
maintaining
continence
• Offer help and advice
to patients and
relatives
Control
Confidence
Freedom