Urinary incontinence

1. Urinary incontinence

2. Incontinence Unable to retain the natural discharge or evacuation of urine or feces.

3. Normal VoidingCycle Emptying phase Bladderpressure Filling & storagephase Normaldesire to void Firstsensation tovoid Bladderfilling Bladderfilling

4. Definition • Bladder incontinence/ urinary incontinence • Urinary incontinence means there is loss of bladder control which leads to unintentional passing of urine

5. Risk factors • Obesity • Smoking • Gender: Women • Old age • Prostate disease: prostate surgery or radiation therapy.

6. Some diseases : • Diabetes • spinal cord injury, • Stroke • Neurogenic bladder

7. Types • Stress Incontinence • Urge incontinence • Functional Incontinence • Overflow Incontinence • Iatrogenic Incontinence • Mixed Incontinence

8. Stress Incontinence Due to sudden Increase intra-abdominal pressure like coughing, sneezing, pregnancy, obesity and childbirth

9. Urge Incontinence It is a condition where there is a frequent feeling of needing to urinate caused by cystitis, neurological conditions, such as multiple sclerosis (MS), stroke, and Parkinson's disease

10. Functional Incontinence Functional incontinence relates to a physical, intellectual or environmental issues that can be a contributing cause of incontinence in a person with normal bladder function. eg: Alziemers disease, Dementia

11. Overflow Incontinence Overflow incontinence is the involuntary release of urine from an overfull urinary bladder, often in the absence of any urge to urinate due to nerve damage or trauma

12. Iatrogenic Incontinence • Refers to the involuntary loss of urine due to medical factors Mixed Incontinence • It involves the several types of urinary Incontinence

13. Etiology • Stress incontinence • weakening of urethral sphincter and pelvic floor muscles • pregnancy • childbirth • age • obesity • menopause • surgical procedures, e.g. hysterectomy

14. Urge incontinence • overactivity of the detrusor muscles • cystitis • central nervous system (CNS) problems • an enlarged prostate • Overflow incontinence • an obstruction or blockage to the bladder • an enlarged prostate gland • a tumor pressing against the bladder • urinary stones, constipation

15. Pathophysiology Due to Etiological factors Pelvic muscles that involves in urination get traumatized, either overstretched or tear Weakness of the muscles. Muscles cannot support the bladder anymore. Weakness of urethral sphincter Incontinence

16. Diagnostic evaluation • Physical examination: check the strength of the pelvic floor muscles. • Urinalysis: signs of infection • kidney function test • Post void residual (PVR) measurement • bladder diary: person records how much fluids they drink, how much urine is produced, and the number of episodes of incontinence.

17. Cystoscopy • Cystometrogram • CT • MRI

18. Management • Medication • Anticholinergics (medication to calm an overactive bladder) • Anti depressant • -Imipramine • - Duloxetine • Topical estrogen. • alpha & beta adrenergic antagonist • phenylpropanolamine

19. Medical device • Urethral insert (FemSoft insert) • Pessary • external condom drainage (men) • Surgery • Sling procedures • Bladder neck suspension • Artificial urinary spinchter

20. Artificial urethral sphincter

21. Pessary

22. Pessary Sling

23. Find your pelvic floor muscles.Squeeze your pelvic floor muscles as hard as you can and hold them (squeeze 3-5 secand relax for 5 sec). • Do sets of repetitions of squeezing (start with 5 repetitions: squeeze, hold, relax). • Increase lengths, intensity, and repetitions every couple of days. • Perform Kegel exercises 3-4x during the day. 36

24. Kegelexercise / pelvic floor exercise 1. Helps strengthen the muscles of the pelvic floor – improves bladder stability Bladder Relaxation 2. Helps suppress the feeling of urgency Contraction 31

25. Bladder training: • Scheduled voiding at set times during the day. • Active use of muscles to prevent urine loss • Keep own input and output chart 33

26. Behaviour modification Drink less than 5 glasses/day (40 oz) Stop drinking after dinner Elevate legs Timed voiding Regular pelvic floor exercises 34

27. Nursing management Nursing Assessment • Assess voiding pattern (frequency and amount). Compare urine output with fluid intake. Note specific gravity. • Palpate for bladder distension and observe for overflow. • Note reports of urinary frequency, urgency, burning, incontinence, nocturia, and size or force of urinary stream. Palpate bladder after voiding.

28. Assess the availability of toileting facilities. • Assess the patient’s usual pattern of urination and occurrence of incontinence.

29. Nursing diagnosis • Impaired Urinary Elimination May be related to • Bladder outlet obstruction, decreased bladder capacity, environmental barriers, surgery As evidenced by • Bladder distention, dribbling, dysuria, enuresis, incontinence, nocturia

30. Nursing interventions • Begin bladder retraining per protocol when appropriate (fluids between certain hours, digital stimulation of trigger area, contraction of abdominal muscles.) • Encourage adequate fluid intake (2–4 L per day), avoiding caffeine and use of aspartame, and limiting intake during late evening and at bedtime. • Promote continued mobility.

31. Observe for cloudy or bloody urine, foul odor. • Cleanse perineal area and keep dry. Provide catheter care as appropriate. • Recommend good hand washing and proper perineal care. • Catheterize as indicated and teach catheter care • Obtain periodic urinalysis and urine culture and sensitivity as indicated.

32. Teachpelvic floorexercise and Kegelexercise • Bladder training and behaviour modification

33. Nursing diagnosis Functional Urinary Incontinence may be related to • Altered environmental barriers to toileting, cognitive disorders, neuromuscular limitations impairing mobility or dexterity, weakened supporting pelvic structures As evidenced by • dribbling, dysuria, enuresis, incontinence, nocturia

34. Nursing diagnosis Stress Urinary Incontinence may be related to  • Aging, obesity, pelvic surgery, trauma to pelvic area as evidenced by • involuntary leakage of small amounts of urine