symptoms of Incontinence

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1 Types, causes and symptoms of Urinary Incontinence

2 Aims and Objectives Aim: To have an understanding of the types and causes of urinary incontinence. Objectives: To be aware of the incidence and prevalence of UI Know the causes of UI Identify the types of UI

3 What is incontinence? The International Continence Society: a condition where there is involuntary loss of urine, and is a social or hygienic problem English Oxford Dictionary: unable to hold in something

4 Incontinence is a Symptom of an Underlying Disorder - not a Disease. To remain continent we need to: Recognise the need to pass urine Recognise a toilet Be able to get there Hold on until the toilet is reached Pass urine once there

5 Incidence and Prevalence Worldwide estimates 3-25% population Elderly 30-50% (more women than men) Suggested 214 million affected worldwide Figures may not be truly accurate - Taboo nature - Differing definitions Children 15-20% of five year olds up to 2% of young adults Cost to NHS in excess of 423 million

6 The Cost of Incontinence Immeasurable cost (dignity, discomfort, smell, embarrassment) Products (pads, pants, clothing, bedding etc.) Support (informal and formal carers, laundry) Prescriptions Hospitalisation

7 Types of Urinary Incontinence Stress incontinence Urge incontinence Mixed incontinence Voiding dysfunction Functional Patients may suffer from more than 1 type

8 Cause of Urinary Incontinence Common causes: Physiological Factors affecting bladder function Factors affecting patient s ability (Norton 1996, Wells 1996, Blaivas 1998)

9 STRESS URINARY INCONTINENCE THE COMPLAINT OF INVOLUNTARY LEAKAGE OF URINE ON EFFORT OR EXERTION. FOR EXAMPLE, LAUGHING, COUGHING, SNEEZING, EXERCISE.

10 Stress Incontinence Prevalence: Most common type of female urinary incontinence (25 65 years) Definition: Stress urinary incontinence (SUI) is the complaint of involuntary leaking on effort or exertion, or on sneezing or coughing. ICS 2002

11 Stress Incontinence Normal Physiology Stress Incontinence Abdominal Pressure Eg.Cough, Sneeze, Laugh, jump. Abdominal Pressure Eg.Cough, Sneeze, Laugh, jump. Pressure from abdomen helps to squeeze the urethra shut Pressure cannot get to urethra to help squeeze it shut Pelvic floor muscles Bladder neck Pelvic floor muscles Bladder neck Good support - no bladder neck descent No urine escapes Poor support - bladder neck descent Urine escapes

12 Stress Incontinence Causes: Genetic factors Pregnancy/childbirth Menopause Obesity Post operative Prolonged straining Prolonged bed rest Smoking Strenuous physical activity Lifting

13 URGENCY THE COMPLAINT THE COMPLAINT OF A SUDDEN OVERWHELMING DESIRE TO PASS URINE WHICH IS DIFFICULT TO IGNORE.

14 URGE URINARY INCONTINENCE THE COMPLAINT OF THE COMPLAINT OF INVOLUNTARY LEAKAGE OF URINE ACCOMPANIED BY OR IMMEDIATELY PRECEEDED BY URGENCY

15 Urge Incontinence Prevalence: Affects men, women and children over 5 years of age May occur in up to 10% of women Incidence rises with age Definition: Urge incontinence is the complaint of involuntary leakage accompanied by or immediately preceded by urgency. ICS 2002

16 Urge Incontinence Causes: Idiopathic Neurogenic Local causes Medication Symptoms: Frequency urgency, urge incontinence, nocturia, nocturnal enuresis

17 NOCTURIA THE COMPLAINT OF WAKING AT NIGHT MORE THAN TWICE IN ORDER TO VOID NIGHT MAY ACTUALLY BE INTERPRETED AS WHENEVER ONE REGULARLY SLEEPS

18 MIXED URINARY SYMPTOMS WHERE PATIENTS COMPLAIN OF MORE THAN ONE URINARY SYMPTOM

19 Mixed Incontinence Definition: iti Mixed involuntary leakage of urine associated with urgency and with exertion, effort, sneezing or coughing. Abrams et al 2002 Usually occurs in women.

20 Voiding Dysfunction

21 VOIDING DIFFICULTIES Symptoms Experienced During the Voiding Phase:- Intermittent Stream Hesitancy Straining To Void After Dribble Feeling Of Incomplete Emptying py

22 Voiding Dysfunction Definition: A term used to describe any loss of urine associated with outflow obstruction or an underactive (acontractile) bladder.

23 Outflow Tract Obstruction Causes: Prostatic enlargement Urethral stricture/stenosis Chronic constipation Inhibition of urethral relaxation

24 3 Stages of Prostate Enlargement 1.Early BPH Bladder Urethra Enlargement of the prostrate starts to press on and constrict the urethra 3.Advanced BPH Thickened bladder wall 2.Moderate BPH Urethra almost completely obstructed Urethra becomes narrowed

25 Outflow Tract Obstruction Symptoms: Hesitancy Straining Poor stream Nocturia Feeling of incomplete voiding Large residual volumes may be present Recurrent UTI Constant dribbling

26 Underactive Bladder Incidence of underactive (acontractile) bladder: Associated with damage to nerve supply to bladder Usually there is a history of underlying neurological l defect

27 Underactive Bladder Non neurological Causes: Over distension of bladder Pelvic surgery Pudendal nerve damage

28 Underactive Bladder Neurological Causes: Brain stem Stroke, Parkinson s disease, MS, Dementia, Trauma, Tumour Spinal cord Spinal injury, Spina Bifida, MS, Tumour Peripheral nerve damage Diabetes

29 Underactive Bladder Overstretched bladder Residual urine Impaired sensation Overflow incontinence Impaired motor impulse from spinal cord

30 Underactive Bladder Symptoms: Poor or no sensation to pass urine Difficulty passing urine Overflow incontinence Frequency (voiding small amounts) Constant dribbling Recurrent UTI

31 Functional Incontinence Definition: iti Incontinence occurs before toilet is reached. Causes: Impaired mobility Impaired dexterity Physiological effects of ageing

32 URINARY FREQUENCY THE COMPLAINT BY THE PATIENT WHO CONSIDERS THAT HE/SHE VOIDS TOO OFTEN NORMAL VOIDING PATTERN IS BETWEEN 4AND7VOIDSPER24 HOURS

33 Any Questions

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