(bowel and bladder incontinence)B&D.pptx

Bowel and bladder incontinence of bowel and bladder

1. INCONTINENCE OF BLADDER AND BOWEL SUBHAN GANI 23pr021

2. DEFINITION - Bladder I ncontinence - Urinary incontinence means there is loss of bladder control which leads to unintentional passing of urine There are several types of bladder incontinence which are: Stress incontinence – occurs during certain activities like coughing, sneezing, laughing Urge incontinence - leakage of urine which involves a strong and sudden need to urinate

3. Mixed incontinence – combination of both stress and urge incontinence symptoms Overflow incontinence – loss of small amounts of urine when the bladder does not empty all the way during voiding

4. DEFINITION - Bowel Incontinence - Bowel incontinence is the inability to control the bowel movements , resulting in the involuntary passage of stools Types: Urge bowel incontinence – sudden need to defecate, with little time to reach a toilet Passive incontinence or soiling – experience of no sensation before leakage of stools

5. ETIOLOGY Bladder incontinence: Stress incontinence - weakening of urethral sphincter and pelvic floor muscles - pregnancy - childbirth - age - obesity - menopause - surgical procedures, e.g. hysterectomy

6. 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

7. Bowel incontinence Rectum problems - constipation - diarrhoea d/t infection or irritable bowel syndrome, Crohn’s disease, ulcerative colitis Sphincter muscles problem - the muscles are weakened or damaged d/t childbirth, complication of rectal surgery

8. Nerve damage - decreased awareness of sensation of rectal fullness - d/t diabetes, multiple sclerosis, stroke, spina bifida Health condition – dementia or severe learning ability, rectal prolapse Weakness of pelvic floor muscles - puborectalis

9. PATHOLOGY BLADDER AND BOWEL INCONTINENCE

10. In continence of the bladder occurs when those pelvic muscles that involves in urination get traumatized , either overstretched or tear , that leads to weakness of the muscles . As time goes by, the muscles become weaker until at certain point, they cannot support the bladder anymore . When there is high pressure from the abdominal such as coughing, sneezing, lifting or pushing heavy things, the bladder forces urine past the urethral sphincter causing incontinence to occur.

11. BOWEL INCONTINENCE

12. Bowel function is controlled by few factors: anal sphincter pressure, rectal storage capacity and rectal sensation . Anything that interferes with these factors can result in incontinence. Fecal incontinence occur when there is direct trauma to the sphincter muscles (internal and external) such as chronic constipation or obstetric trauma . The sphincter muscles stretched, weaken and not strong enough to maintain the continence and stool will leak out. Patients with impaired continence will also decreased thermal and electrical sensitivity to stimuli.

13. CLINICAL FEATURES BOWEL INCONTINENCE Constipation Diarrhea Abdominal pain 4) Lower back pain Bloating 6) Stomach cramp 7) Loss of appetite 8) Insomnia

14. CLINICAL FEATURES BLADDER INCONTINENCE STRESS INCONTINENCE OCCURS WHEN: Cough Sneeze Laughing Lifting heavy objects Vigorous exercise Have sexual intercourse Standing in prolonged time

15. URGE INCONTINENCE OCCURS : Frequent urination, in a day and at nighttime Loss of urine without meaning to urinate Sudden and urinary urgency OVERFLOW INCONTINENCE OCCURS: Bladder never feels empty Frequent urination, in a day and at nighttime URINATE Inability to void when when the urge is felt Urine dribbles even after voiding

16. Urodynamic studies (UDS) are a group of tests that assess how well the bladder, urethra, and sphincters are storing and releasing urine. These tests help diagnose urinary disorders, particularly those related to incontinence, urinary retention, and overactive bladder. Here's a breakdown of what Urodynamic Studies typically involve : 1. Cystometry (CMG): Purpose: Measures the pressure inside the bladder as it fills with fluid. It assesses bladder capacity, compliance, and sensation. Procedure: A catheter is inserted into the bladder, and another is placed in the rectum or vagina to measure pressure. The bladder is filled with water or saline while the pressures are recorded. BOWEL & BLADDER LABORATORY FUNCTION TEST URODYNAMIC TEST

17. 2. UROFLOWMETRY: Purpose : Measures the flow rate of urine during urination. Procedure: The patient urinates into a specialized toilet or funnel that records the rate of flow. The results can indicate obstruction or poor bladder contraction . 3. PRESSURE FLOW STUDY: Purpose : Assesses the relationship between bladder pressure and urine flow rate. Procedure: This test is usually done after cystometry . It helps determine whether the bladder or the urethra is causing urinary symptoms.

18. 4. ELECTROMYOGRAPHY (EMG): Purpose : Measures the electrical activity of the muscles around the bladder and urethra. Procedure: Small sensors are placed near the urethra or rectum to record muscle activity during bladder filling and voiding . 5. POST-VOID RESIDUAL (PVR) MEASUREMENT: Purpose : Measures the amount of urine left in the bladder after urination. Procedure: A catheter or ultrasound is used to determine how much urine remains in the bladder after voiding.

19. 6. VIDEOURODYNAMICS: Purpose : Combines cystometry and X-ray or ultrasound imaging to visualize the bladder and urethra during filling and voiding. Procedure: The bladder is filled with contrast material, and real-time imaging is used to assess bladder function . 7. LEAK POINT PRESSURE (LPP): Purpose : Determines the pressure at which the bladder leaks urine involuntarily. Procedure: This can be measured during cystometry by asking the patient to cough or bear down, and the pressure at the point of leakage is recorded.

20. GASTROINTESTINAL FUNCTION TESTS (BOWEL FUNCTION TESTS): Gastrointestinal (GI) function tests, particularly those focused on bowel function, are crucial for diagnosing various conditions affecting the digestive tract. 1. Anorectal Manometry Purpose: Measures the pressure and function of the muscles in the rectum and anus. Procedure: A small, flexible tube with a balloon at the end is inserted into the rectum. The balloon is inflated, and the pressure in the anal sphincter muscles is measured during relaxation, contraction, and when simulating bowel movements. Used to Diagnose: Chronic constipation, fecal incontinence, Hirschsprung’s disease, and other anorectal disorders.

21. 2. Balloon Expulsion Test Purpose: Assesses the ability to expel a balloon, simulating the passage of stool. Procedure: A balloon is inserted into the rectum and inflated with water. The patient is then asked to expel the balloon as if they were having a bowel movement. The time it takes to expel the balloon is recorded. Used to Diagnose: Pelvic floor dysfunction, obstructed defecation, and dyssynergic defecation . 3. Colonic Transit Study Purpose: Measures how well food moves through the colon. Procedure: The patient swallows capsules containing tiny markers that are visible on X-rays. Over several days, X-rays are taken to track the movement of the markers through the colon. Used to Diagnose: Chronic constipation, colonic inertia, and motility disorders

22. 4. Defecography Purpose: Visualizes the structure and function of the rectum and anal canal during defecation. Procedure: A thick barium paste, mimicking stool, is introduced into the rectum. X-rays or MRI images are then taken as the patient expels the paste. The test assesses the mechanics of defecation. Used to Diagnose: Rectal prolapse , rectocele , anismus , and other structural abnormalities.

23. 5. Stool Tests Purpose: Analyze the content of stool to detect abnormalities such as blood, infections, or digestive enzyme deficiencies. Types: Fecal Occult Blood Test (FOBT): Detects hidden blood in the stool, which can be a sign of colorectal cancer or other GI conditions. Stool Culture: Identifies infections caused by bacteria, viruses, or parasites. Fecal Elastase Test: Measures the level of elastase , an enzyme produced by the pancreas, to assess pancreatic function. Fecal Fat Test: Evaluates the amount of fat in the stool to diagnose malabsorption syndromes.

24. 6. Hydrogen Breath Test Purpose: Detects carbohydrate malabsorption and small intestinal bacterial overgrowth (SIBO). Procedure: After ingesting a specific carbohydrate (e.g., lactose or fructose), the patient breathes into a device that measures hydrogen levels. Elevated hydrogen levels suggest malabsorption or bacterial overgrowth. Used to Diagnose: Lactose intolerance, fructose malabsorption , and SIBO . 7. Wireless Motility Capsule ( SmartPill ) Purpose: Measures pH, pressure, and temperature throughout the GI tract to assess motility. Procedure: The patient swallows a capsule that transmits data as it travels through the digestive system. The information is recorded by a wearable device. Used to Diagnose: Gastroparesis , chronic constipation, and other motility disorders.

25. 8. Rectal Sensation, Tone, and Compliance Testing Purpose: Measures the rectum’s ability to sense and respond to pressure changes. Procedure: A balloon is inflated in the rectum to different volumes, and the patient’s sensations and rectal responses are recorded. Used to Diagnose: Rectal hypersensitivity or hyposensitivity, often related to conditions like irritable bowel syndrome (IBS) or fecal incontinence.

26. ( Urinary incontinence: Incontinence products to help keep you dry, 2011 ) DOCTOR MANAGEMENT Medication - Anticholinergics (medication to calm an overactive bladder) - Topical estrogen. - Anti depressant -Imipramine - Duloxetine Medical device Urethral insert ( FemSoft insert) Pessary

27. Surgery - S ling procedures - Bladder neck suspension - Artificial urinary spinchter

28. PHYSIOTHERAPY MANAGEMENT Pelvic floor muscle exercises Kegel exercises Vaginal or rectal weights Electrical stimulation Abdominal Massage Breathing Exercises:

29. Physiotherapy treatment Pre - operation Keep lungs clear of fluid and prevent chest infection. Chest physiotherapy (Breathing exercises) Help maintain muscles tone and promote the return of blood in veins to heart . Limb physiotherapy (Circulatory exercises ) Bed mobility Post - operation Clear lungs and prevent chest infection Support abdomen with soft pillow , take 4 to 5 deep slow breaths then 1 deep cough. Reduce muscle weakness and pain on the incision site posterior basal and lower costal breathing, concentrating on the affected side Improve coughing, chest expansion, breathing pattern ACBT Triflow meter 5x hourly during awake time

30. Patient education Posture awareness Advice patient to continue exercises as taught Improve muscle tone and promote the return of blood in veins to heart Circulatory exercise Progression for bed mobility Ambulate patient around bed site Patient education Posture awareness Cont exercising 3x/day Avoid heavy weight lifting

31. Thank you