Urinary incontinence types, diagnostic evaluation and management

complete detail about urinary incontinence

1. URINARY INCONTINENCE PRESENTED BY: SONIA DAGAR

2. INTRODUCTION : Incontinence is the inability to control the passage of urine. Urinary incontinence, the involuntary loss of bladder control and general bladder weakness . This can range from an occasional leakage of urine to a complete inability to hold any urine. Incontinence is most common among elderly. Women are more likely than man to have urinary incontinence. Children and infant are not considered incontinent, but merely untrained.

3. CAUSES AND RISK FACTORS: Bed rest – e.g. recovering from surgery Increased urine amounts, like with poorly controlled diabetes Alcohol Overactive bladder Mental confusion Pregnancy Prostate infection or inflammation Stool impaction from sever constipation, causing pressure on the bladder

4. CONT… Urinary tract infection or inflammation Weight gain Polyuria (excessive urine production) Caffeine or coca beverages also stimulate the bladder. Certain medicines such as diuretics, antidepressants, tranquilizers, antihistamines for allergy etc. Alzheimer’s disease Multiple sclerosis Parkinson’s disease Stroke and spinal cord injury

5. CONT… Bladder cancer Bladder spasms Depression Large prostate in men Nerve or muscle damage after pelvic radiation Pelvic prolapse in women Problems with the structure of the urinary tract Weakness of the sphincter

6. Types of incontinence Stress incontinence Urge incontinence Overflow incontinence Functional incontinence Gross total incontinence

7. 1) STRESS INCONTINENCE: It is involuntary lose of urine during actions – such as coughing, sneezing and lifting that put abdominal pressure on the bladder. It occurs when the sphincter muscle of the bladder is weakened. In women, physical changes resulting from pregnancy, childbirth and menopause can cause stress incontinence. In men, removal of the prostate gland can lead to stress incontinence.

8. 2) URGE INCONTINENCE: It occurs in patients who have a strong, uncontrollable, involuntary urge to urinate that leads to uncontrollable voiding of urine. It may be caused by urinary tract infections, bladder irritants, bowel problems, Parkinson’s disease, Alzheimer’s disease, stroke, injury or nervous system damage associate with multiple sclerosis. if there is no known case, it also called overactive bladder.

9. 3) OVERFLOW INCONTINENCE: It is the constant dribbling of urine usually associated with urinating frequently and in small amounts. Overflow incontinence is occurring after urinary retention. This type of incontinence may occur in people with a damaged bladder, blocked urethra and nerve damage from diabetes and in men with prostate gland problems.

10. 4) FUNCTIONAL INCONTINENCE: Many older adults, especially people in nursing homes, experience incontinence simply because a physical or mental impairment keeps them from making it to the toilet in time. For example, a person with severe arthritis may not be able to unbutton his or her pants quickly enough.

11. 5) GROSS TOTAL INCONTINENCE: It is described as continuous leaking of urine, day and night, or the periodic uncontrollable leaking of large volumes of urine. In this the bladder has no storage capacity. Some people have this because of anatomical defect. This can cause by injuries to the spinal cord or urinary system or by an abnormal opening called fistula between the bladder and an adjacent structure, such as the vagina.

12. Clinical manifestations: SENSORY SIGN: Odor of urine or feces in the room Soiling of undergarments or bed linens Irritation of perineal area Accidents while engaged in physical activity, sneezing, laughing. EMOTIONAL SIGN: Anger Decline in Social Activity Desire for Attention

13. Diagnostic evaluations: Urinalysis and urine culture Residual urine measurement Vaginal and anal examination Urodynamic studies Serum electrolytes, calcium levels and BUN/creatinine levels Spinal MRI Ultrasonography Cystourethrography Interavenous pyelograpgy (IVP) Fleuroscopy and video urodynamics Uroflowmetery, cystometer and urethral pressure profilometery(UPP) Electromyography (EMG)

14. MANAGEMENT:

15. 1) BEHAVIORAL TECHNIQUES : Bladder control training Scheduled toilet trips Biofeedback Pelvic floor muscle exercises Vaginal cone therapy Fluid and diet management 2) DRUG THERAPY : Anticholinergic agent Antispasmodics Topical estrogen Tricyclic antidepressants Alpha- adrenergic blockers Alpha – adrenergic agonists

16. MEDICAL DEVICES: Urethral inserts Pessaries Catheters Clamps and compression rings for man Electrical stimulation devices INTERVENTIONAL THERAPIES: Radiofrequency therapy Botulinum toxin type A Bulking material injections Sacral nerve stimulator

17. SURGERY : Artificial urinary sphincter Sling procedures Bladder neck suspention Laproscopic bladder suspension procedure Retropubic colposuspension Bladder augmentation Neuromodulation ABSORBENT PADS AND CATHETERS: Pads and protective garments catheters

18. KEGEL EXERCISE