Urinary Incontinence Has Sesven Types

8/12/2019 Urinary Incontinence Has Sesven Types

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URINARY INCONTINENCE

Dr. MOCH. RIDWAN,Sp.KFR

Lab. Ilmu Kedokteran Fisik dan RehabilitasiFKUB/RSUD Dr. Saiful Anwar

Malang


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Urinary Incontinence Definition

Urinary incontinence is unintentional loss of urine

that is sufficient enough in frequency and amount tocause physical and/or emotional distress in the personexperiencing it.

Urinary retention is the inability to empty the bladder.

With chronic urinary retention, you may be able tourinate, but you have trouble starting a stream oremptying your bladder completely


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1.Stress incontinence2. Urge incontinence

3. Overflow incontinence

4. Mixed incontinence

5.Anatomic or developmental abnormalities

6. Temporary incontinence

7. Bed-wetting


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Stress incontinence People with stress incontinence involuntarily leak

urine while exercising, coughing, sneezing, laughing orlifting. During these activities, sudden pressure to thebladder causes urine to leak. Stress incontinence is themost common type of incontinence among women. Itmay be due to weakened pelvic muscles, weakening inthe wall between the bladder and vagina, or a changein the position of the bladder.


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Other causes of stress incontinence

include: Weakening of muscles that hold the bladder in place, or

weakening of the bladder itself Weakening of the urethral sphincter muscles

Damage to the nerves controlling the bladder from diseasessuch as diabetes, stroke, Parkinson's disease and/ormultiple sclerosis, or from treatment of gynecologic orpelvic cancers with surgery, radiation or chemotherapy

In women, a hormone imbalance or a decrease in estrogen

following menopause, which can weaken the sphinctermuscle In men, benign prostatic hyperplasia (a noncancerous

overgrowth of the prostate gland), prostate cancer orprostate surgery


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Urge incontinenceA frequent, sudden urge to urinate along with little

control of the bladder (especially when sleeping,drinking, or listening to running water) is known asurge incontinence. This condition is also known asspastic bladder, overactive bladder or reflexincontinence. Urge incontinence is marked by a needto urinate more than seven times daily or more than

twice nightly. It is most common in older adults. It alsomay be a symptom of a urinary infection in the bladderor kidneys, or may result from injury, illness or surgery


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Problems caused by oversensitive bladder.


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Among the possible causes are: Stroke

Diseases of the nervous system, such as multiple

sclerosis, Alzheimer's or Parkinson's Tumors or cancer in the uterus, bladder or prostate

Interstitial cystitis (inflamed bladder wall)

Prostatitis (inflamed prostate)

Prostate removal, cesarean section, hysterectomy, orsurgery involving the lower intestine or rectum
http://www.mayoclinic.org/hysterectomy/http://www.mayoclinic.org/hysterectomy/


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Overflow incontinence

People with overflow incontinence cannot completelyempty their bladders. A constantly full bladder triggersfrequent urination or a constant dribbling of urine, orboth. This type of incontinence is often caused bybladder muscles weakened as a result of nerve damagefrom diabetes or other diseases. It can also occur whenthe urethra is blocked due to kidney or urinary stones,

tumors, an enlarged prostate in men, female bladdersurgery that is too tight, or a birth defect.


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Bladder doesn't empty completely, leading to frequenturination or dribbling.


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Functional incontinence

Functional incontinence is the most common type amongolder adults with arthritis, Parkinson's disease or

Alzheimer's disease. These people are often unable to

control their bladder before reaching the bathroom due tolimitations in moving,thinking or communicating.


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Mixed incontinence

Some people experience two types of incontinencesimultaneously, typically stress incontinence and urgeincontinence. Mixed incontinence is most commonlyfound in women. What causes the two forms may ormay not be related.


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Anatomic or developmental abnormalities

Incontinence is sometimes caused by an anatomic(physical) or neurologic abnormality. An abnormalopening between the bladder and another structure

(called a fistula) can cause incontinence, as can a leakin the urinary system.

Loss of normal bladder function may also result fromdamage to part of the nervous system due to trauma,

disease or injury. This dysfunction, called neurogenicbladder, can cause the bladder to be underactive(unable to contract and empty completely) oroveractive (contracting too quickly or frequently).


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Temporary incontinence

Sometimes incontinence comes and goes with specificconditions or as a side effect of a treatment for otherchronic or acute diseases. Temporary incontinencemay be caused by:

Severe constipation

Infections in the urinary tract or vagina

Certain medications such as diuretics (water pills);sleeping pills or muscle relaxants; narcotics, such asmorphine; antihistamines; antidepressants;antipsychotic drugs; or calcium channel blockers


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Bed-wetting

In addition, some children have nocturnal enuresis(wetting the bed at night). Bed-wetting is normal untilthe age of 5 years. It is often an inherited disorder with

a delay in neurological control of the bladder.Treatment is usually delayed to age 6 and may involveeither medication or an alarm device that will awakenthe child at the first sign of wetness.


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Diagnosis

To make a diagnosis, your doctor may order one or more ofthe following tests :

Blood tests

Urinalysis or urine culture to rule out urinary tractinfection or other abnormalities

Pad test. After placement of a pre-weighed sanitary pad,the patient is asked to exercise. Following exercise, the pad

is re-weighed to determine the amount of urine loss.

Cystoscopy (inspection of the inside of the bladder)

Urodynamic studies, to measure pressure and urine flow


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Risk factors for urinary incontinency Urinary incontinence is a disorder with multiple factors, wherein

some of them are transient and others are permanent. Variousrisk factors have been associated with increased incidence of UI.Some these are:

Immobility/chronic degenerative diseases Medications Morbid obesity Smoking Diabetes Stroke Pelvic muscle weakness Childhood nocturnal enuresis Pregnancy / vaginal delivery
http://www.healthplus24.com/diseases/quit-smoking.aspxhttp://www.healthplus24.com/diseases/diabetes.aspxhttp://www.healthplus24.com/diseases/stroke.aspxhttp://www.healthplus24.com/diseases/stroke.aspxhttp://www.healthplus24.com/diseases/diabetes.aspxhttp://www.healthplus24.com/diseases/quit-smoking.aspx


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Treatment of urinary incontinency The management of UI depends on various factors such as Age of the individual Type of incontinence

Underlying cause and Severity of the condition It may range from minor modification in the medications

being consumed to surgery for the correction of muscleactions. The correction of the underlying disorder relieves

the condition in majority of the cases. In general, thetreatment modalities can be categorized as behaviormanagement (include lifestyle changes, physical therapy,bladder retraining and use of vaginal and urethral devices),administration of medications and surgical management.


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Treatment is keyed to the type of incontinence.

The usual approaches are as follows:

Treatment is keyed to the type of incontinence. The usualapproaches are as follows:

Stress incontinence - Surgery, pelvic f loor physiotherapy,anti-incontinence devices, and medication

Urge incontinence - Changes in diet, behavioralmodification, pelvic-floor exercises, and/or medicationsand new forms of surgical intervention

Mixed incontinence - Anticholinergic drugs and surgery

Overflow incontinence - Catheterization regimen ordiversion Functional incontinence - Treatment of the underlying

cause


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In general, the first choice for treatment is the leastinvasive one, with the least number of potentialcomplications for the patient. Examples of noninvasive

treatments include medications or exercises. However,the least invasive treatment may not afford the bestoutcome in certain situations. In specific situations,minimally invasive surgery may be the most effective

form of managing urinary incontinence.


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Kegel exercises have been shown to improve thestrength and tone of the muscles of the pelvic floor (ie,the levator ani, and particularly the pubococcygeus).

During times of increased intra-abdominal pressure,tensing of these muscles tightens the connective tissuethat supports the urethra. Thus, pressure transmissionto the urethra may increase, and the urethra

compresses shut during times of increased stress.


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The exercises consist of voluntary contractions of themuscles of the pelvic floor. Because both fast-twitch andslow-twitch muscle fibers are found in the levator anicomplex, both rapid contractions and slow contractions

held for maximal duration should be performed to achievethe best possible results.

Patients can perform pelvic floor muscle exercises bydrawing in or lifting up the levator ani muscles, as if tocontrol urination or defecation with minimal contraction

of abdominal, buttock, or inner-thigh muscles. The patientcan confirm that she is using the correct muscles at homeby periodically performing the contractions during voiding

with the goal of interrupting the urinary stream.


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Initially, patients are instructed to perform thesqueezing exercise 5 times, holding each contractionfor a count of 5. Five contractions equal 1 set. Patients

should do 1 set every hour while they are awake, duringsuch activities as driving, reading, or watchingtelevision. An alternate program requires 1 set ofexercises every time the patient uses a bathroom. Soon

after starting the exercises, the patient may be able tohold each contraction for at least 10 seconds, followedby an equal period of relaxation.


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Another regimen is to perform the exercises for 10minutes twice a day using an audiocassette tape. Theaudiocassette coaches the patient to contract the

levator ani muscles for a count of 10 seconds and thento relax for a count of 10 seconds, performing 25repetitions in a row. Twenty-five contractions equal 1set. Perform the first set slowly, followed by a second

set performed rapidly.


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Approximately 6-12 weeks of exercises are requiredbefore improvement is noted, and 3-6 months areneeded before maximal benefit is reached. The key to

success with pelvic floor exercises is a commitment onthe patients part to performing them for a long periodof time. Patients who do not tend to revert back topretherapy levels of incontinence.


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Individuals who benefit most tend to be young healthywomen who can identify the levator ani muscles(specifically, the pubococcygeus portion) accurately.

Older adults with weak pelvic muscle tone or womenwho have difficulty recognizing the correct musclesneed adjunctive therapy such as biofeedback orelectrical stimulation. Patients with severe

neuromuscular damage to the pelvic floor may not beable to perform Kegel exercises, even with properinstruction.


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Biofeedback

Biofeedback therapy is a form of pelvic floor musclerehabilitation using an electronic device for individualshaving difficulty identifying levator ani muscles.Biofeedback therapy is recommended for treatment of

stress incontinence, urge incontinence, and mixedincontinence. Biofeedback therapy uses a computer and electronic

instruments to relay auditory or visual information to thepatient about the status of pelvic muscle activity. These

devices allow the patient to receive immediate visualfeedback on the activity of the pelvic floor muscles, therebyproviding incentive and confirmation of properperformance of the muscle contractions.


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Studies on biofeedback combined with pelvic floorexercises show a 54-87% improvement withincontinence. The best biofeedback protocol is the one

that reinforces levator ani muscle contraction withinhibition of abdominal and bladder contraction.Reports using this method show a 76-82% reduction inurinary incontinence. Biofeedback also has been used

successfully in the treatment of men with urgeincontinence and intermittent stress incontinenceafter prostate surgery.


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Electrical stimulation

Electrical stimulation of pelvic floor muscles producesa contraction of the levator ani muscles and externalurethral sphincter while inhibiting bladder

contraction. This therapy depends on a preservedreflex arc through the intact sacral micturition center.Similar to biofeedback, electrical stimulation can beperformed at the office or at home. Electrical

stimulation can be used in conjunction withbiofeedback or pelvic floor muscle exercises.


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Electrical stimulation therapy requires a similar type ofprobe and equipment as those used for biofeedback. Thisform of muscle rehabilitation is similar to the biofeedbacktherapy, except small electric currents are used.

Nonimplantable pelvic floor electrical stimulation usesvaginal sensors, anal sensors, or surface electrodes. Adversereactions are minimal.

Like biofeedback, pelvic f loor muscle electrical stimulationhas proved effective in treating female stress incontinence.

It may be effective in men and women with urge or mixedincontinence. Urge incontinence secondary to neurologicdiseases may be decreased with this therapy. Unfortunately,this treatment does not appear to benefit patients who arecognitively impaired.


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Bladder training generally consists of self-education,scheduled voiding with conscious delay of voiding, andpositive reinforcement. Bladder training requires thepatient to resist or inhibit the sensation of urgency and

postpone voiding. Patients urinate according to ascheduled timetable rather than the symptoms of urge. Bladder training also uses dietary tactics such as

adjustment in fluid intake and avoidance of dietarystimulants. In addition, distraction and relaxation

techniques allow delayed voiding to help distend theurinary bladder. By using these strategies, patients caninduce the bladder to accommodate progressively larger

voiding volumes.


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Initially, the interval goal is determined by the patient'scurrent voiding habits and is not enforced at night. Theinterval goal between each void usually is set at 2-3 hours,

but may be set further apart if desired. As the bladder becomes accustomed to this delay in

voiding, the interval between mandatory voids is increasedprogressively, in 15- to 30-minute increments, with

simultaneous distraction or relaxation techniques anddietary modification. Typically, the interval is increased by15 minutes per week until the patient reaches a voidinginterval of approximately 3-4 hours.


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COMPLICATIONS Complications of urinary incontinency

Specific complications such as social inhibition,frequent urinary tract infections, and formation ofkidney stones may be associated with UI. Some othercomplications may be associated with the type ofunderlying disorder.


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The lifestyle changes include weight loss in obesepatients, postural changes and decreasing the intakeof caffeine.

Physical exercises such as Kegelsexercises are advisedto strengthen the pelvic muscles.

Medications specific for UI include drugs such aspseudoephedrine and imipramine.

Surgical correction of the muscles to aid in urineretention may be advised in selected cases.1,24


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Urinary Incontinence Has Sesven Types

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