Urinary incontinence Dr Mohammad Hatef Khorrami Urologist Fellowship of endourology isfahan...
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Urinary incontinenceUrinary incontinence
Dr Mohammad Hatef KhorramiDr Mohammad Hatef Khorrami
UrologistUrologist
Fellowship of endourologyFellowship of endourology
isfahan university of medical scienceisfahan university of medical science
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IncontinenceIncontinence
IncontinenceStress Urge mixed UnconsciousContinuousNocturnal enuresis
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EpidemiologyEpidemiology
In women %3-%11In women %3-%11 In men %2- %6In men %2- %6
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Mechanism of continenceMechanism of continence
Good complianceGood compliance sphinctersphincter
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Structure of the BladderStructure of the Bladder
Ureter
Prostategland
Detrusorsmooth muscle
Externalurethral sphincter
Pelvic floor
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Micturition ReflexMicturition Reflex
Brain Direction ofnerve impulse
Spinal cord
Bladder
Pelvic floor
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Bladder Filling & Emptying CycleBladder Filling & Emptying Cycle
The cycle ofbladder fillingand emptying
1. Bladder fills
2. First desire tourinate (bladder
half full)
Urination 3. Urinationvoluntarily inhibiteduntil time and place
are right
Detrusor musclecontracts
Detrusor muscle relaxes
Urethralsphinctercontracts
Urethralsphincterrelaxes
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EtiologyEtiology
Bladder abnormalityBladder abnormality Detrusor overactivityDetrusor overactivity Decreased bladder complianceDecreased bladder compliance
Sphincter abnormalitySphincter abnormality
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Causes of detrusor overactivityCauses of detrusor overactivity
IdiopathicIdiopathic NeurologicNeurologic CVA,brain atrophy, brain CVA,brain atrophy, brain
tumor , MS, SCItumor , MS, SCI
Non neurogenicNon neurogenic UTI, obsruction,pelvic UTI, obsruction,pelvic
organ prolaps,bladder organ prolaps,bladder tumor, bladder stone,agetumor, bladder stone,age
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Sphincteric abnormalitySphincteric abnormality
Men Men Prostate surgery,trauma, neurologicProstate surgery,trauma, neurologic
WomenWomen Urethral hypermobility,intrinsic sphincteric Urethral hypermobility,intrinsic sphincteric
insufficiency,neurogenicinsufficiency,neurogenic
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Causes of transient incontinenceCauses of transient incontinence
DeliriumDelirium Infection Infection Athrophic vaginitisAthrophic vaginitis Psychologic Psychologic PharmacologicPharmacologic Excess urine productionExcess urine production Restricted mobilityRestricted mobility Stool impactionStool impaction
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How to Recognize Patients How to Recognize Patients with incontinencewith incontinence
• Symptom assessment
• Medical history
• Physical examination
• Urinalysis
• Bladder diary
• Pad test
• Referral for medical evaluation and treatment
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Medical HistoryMedical 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
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Physical ExaminationPhysical Examination
• Abdomen exam
• Rectal exam
• Pelvic exam
•Neurologic exam
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UrinalysisUrinalysis
To rule out urinary tract urinary tract infectioninfection
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Bladder DiaryBladder Diary
Helps patientsHelps patients record details of:
• Bladder symptoms• Type/amount of drinks taken• Time/amount of urine passed
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Pad TestPad Test
A supplementary test used to confirm urine leakage and quantify the degree of urine loss.
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Pad TestPad Test
Method:Method:
• Drink 500 ml of fluid as quickly as possible
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Pad TestPad Test
Method (cont’d):Method (cont’d):
• Perform a series of physical tasks in a 1-hour period
• Walking
• Climbing stairs • Coughing vigorously • Running on the spot
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Pad TestPad Test
Method (cont’d):Method (cont’d):
• The pad is re-weighed.• A weight gain of more than 1 g
signifies that the patient is incontinent.
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Referral for FurtherReferral for FurtherEvaluation and TreatmentEvaluation and Treatment
Urodynamic testImagingEndoscopy
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treatmenttreatment
Low bladder complianceLow bladder compliance DrugDrug EnterocystoplastyEnterocystoplasty Denervation Denervation
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Treatment Treatment sphincteric dysfunctionsphincteric dysfunction
Behavioral modificationBehavioral modification DrugDrug Urethral bulking agentUrethral bulking agent surgerysurgery SlingSling Artificial sphincterArtificial sphincter
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Management of Management of Overactive BladderOveractive 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
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Bladder TrainingBladder Training
A behavioural approach to the treatment of the overactive bladder, which is often used in combination with drug therapy.
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Bladder TrainingBladder Training
Aims:Aims:
• Increase the time intervals between bladder emptying.
• Increase bladder capacity by teaching patients to resist and suppress the urge to pass urine.
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Incontinence Pads and Incontinence Pads and Protective EquipmentProtective Equipment
Absorbent pads
Dribble pouch
Reusable underpantsdesigned to carrydisposable absorbent pads
All-in-one briefs
Chair and bed pads
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Pelvic Floor ExercisesPelvic Floor Exercises
Also known as Kegel exercisesKegel exercises.
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Pelvic Floor ExercisesPelvic Floor Exercises
Aim:Aim:
To strengthen the pelvic floor muscle and increase overall muscle tone.
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BiofeedbackBiofeedback
Aim:Aim:
Helps patient identify the correct muscle for performing Kegel exercises
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BiofeedbackBiofeedback
Source: Biofeedback Instrument Corporation
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Review Diet and Fluid IntakeReview Diet and Fluid Intake
Some patients will try to reduce the risk of leakage by restricting their fluid intake.
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Review Diet and Fluid IntakeReview Diet and Fluid Intake
However, drinking too little results in concentrated urine, which itself can irritate irritate the bladderthe bladder.
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Review Diet and Fluid IntakeReview Diet and Fluid Intake
Therefore, it is important that patients are encouraged to drink appropriate amount of fluids.
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Review Diet and Fluid IntakeReview Diet and Fluid Intake
ReduceReduce consumption of:
• Caffeine (i.e. tea andcoffee)
• Carbonated soft drinks
• Alcoholic drinks
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Management of Management of Overactive BladderOveractive 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
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Role of NursesRole of Nurses
• Help to recogniserecognise patients who have problems maintaining continence
• Offer helphelp and adviceadvice to patients and relatives
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ControlControl
ConfidenceConfidence
FreedomFreedom