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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.

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Urinary incontinence

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  1. Urinary incontinence Dr Mohammad Hatef Khorrami Urologist Fellowship of endourology isfahan university of medical science

  2. Incontinence Incontinence Stress Urge mixed Unconscious Continuous Nocturnal enuresis

  3. Epidemiology • In women %3-%11 • In men %2- %6

  4. Mechanism of continence • Good compliance • sphincter

  5. Structure of the Bladder Ureter Detrusor smooth muscle External urethral sphincter Prostate gland Pelvic floor

  6. Micturition Reflex Brain Direction of nerve impulse Spinal cord Bladder Pelvic floor

  7. Bladder Filling & Emptying Cycle 1. Bladder fills Detrusor muscle relaxes 2. First desire to urinate (bladder half full) Urethral sphincter contracts The cycle of bladder filling and emptying Detrusor muscle contracts Urethral sphincter relaxes 3. Urination voluntarily inhibited until time and place are right Urination

  8. Etiology • Bladder abnormality • Detrusor overactivity • Decreased bladder compliance • Sphincter abnormality

  9. 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

  10. Sphincteric abnormality • Men • Prostate surgery,trauma, neurologic • Women • Urethral hypermobility,intrinsic sphincteric insufficiency,neurogenic

  11. Causes of transient incontinence • Delirium • Infection • Athrophic vaginitis • Psychologic • Pharmacologic • Excess urine production • Restricted mobility • Stool impaction

  12. How to Recognize Patients with incontinence • Symptom assessment • Medical history • Physical examination • Urinalysis • Bladder diary • Pad test • Referral for medical evaluation and treatment

  13. 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

  14. Physical Examination • Abdomen exam • Rectal exam • Pelvic exam • Neurologic exam

  15. Urinalysis To rule outurinary tract infection

  16. Bladder Diary • Helps patients record details of: • Bladder symptoms • Type/amount of drinks taken • Time/amount of urine passed

  17. Pad Test A supplementary test used to confirm urine leakage and quantify the degree of urine loss.

  18. Pad Test • Method: • Drink 500 ml of fluid as quickly as possible

  19. 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

  20. Pad Test • Method (cont’d): • The pad is re-weighed. • A weight gain of more than 1 g signifies that the patient is incontinent.

  21. Referral for FurtherEvaluation and Treatment Urodynamic test Imaging Endoscopy

  22. treatment • Low bladder compliance • Drug • Enterocystoplasty • Denervation

  23. Treatment sphincteric dysfunction • Behavioral modification • Drug • Urethral bulking agent • surgery • Sling • Artificial sphincter

  24. 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

  25. Bladder Training A behavioural approach to the treatment of the overactive bladder, which is often used in combination with drug therapy.

  26. 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.

  27. Incontinence Pads and Protective Equipment All-in-one briefs Absorbent pads Reusable underpants designed to carry disposable absorbent pads Dribble pouch Chair and bed pads

  28. Pelvic Floor Exercises Also known asKegel exercises.

  29. Pelvic Floor Exercises Aim: To strengthen the pelvic floor muscle and increase overall muscle tone.

  30. Biofeedback Aim: Helps patient identify the correct muscle for performing Kegel exercises

  31. Biofeedback Source: Biofeedback Instrument Corporation

  32. Review Diet and Fluid Intake Some patients will try to reduce the risk of leakage by restricting their fluid intake.

  33. Review Diet and Fluid Intake However, drinking too little results in concentrated urine, which itself canirritate the bladder.

  34. Review Diet and Fluid Intake Therefore, it is important that patients are encouraged to drink appropriate amount of fluids.

  35. Review Diet and Fluid Intake • Reduce consumption of: • Caffeine (i.e. tea and coffee) • Carbonated soft drinks • Alcoholic drinks

  36. 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

  37. Role of Nurses • Help to recognise patients who have problems maintaining continence • Offer help and advice to patients and relatives

  38. Control Confidence Freedom

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