Dr Alakananda BanerjeePresident

Dharma Foundation of India

URINARY INCONTINENCEIN OLDER WOMEN

Urinary Incontinence

The involuntary loss of urine, which is objectively demonstrable, with such a degree of severity that it becomes a social or hygienic problem.(ICS , 1987)

10-50% of women report urinary incontinence 10-30% of women 15-64 15-40% of women >60 in community

Ratio of Women:Men 4:1 in <60 y.o. age group Ratio of Women:Men 2:1 in >60 y.o. age group Only 10-20% seek medical care

57% of the women stress incontinence 23% of women urge incontinence 20% mixed symptoms

Stress incontinence Urge incontinence Mixed Overflow incontinence Functional incontinence

Grade I

Incontinence occurs only with severe stress, such as coughing, sneezing, etc …

Grade II

Incontinence with moderate stress, such as rapid movement or walking up and down stairs

Grade III

Incontinence with mild stress, such as standing. The patient is continent in the supine position

Patient’s description about the problem

History of present illness Medical and surgical history Obstetric and gynecological

history Symptom inventory Physical Examination

Neurological examination Functional and mobility

status Cognitive status Psychological status Quality of life

Onset of incontinence Position of leakage (supine, sitting, standing) Protection (pads per day, wetness of pads) Problem (quality of life)

Urinary symptoms:urgency,frequency, nocturia,post micturition dribble, hesitancy straining to void Bowel history: Constipation,fecal incontinence Pad test Sexual dysfunction

Time and amount of :

- Fluid intake

- Urine voided

- Accidental leakage

- Protection used

- Circumstances of loss

- Sensation/urge

Access to bathroom Ambulation (needs assistance) Wheelchair Transfer aids Environment

Requirements for Continence

• aware of urge to void

• able to get to the bathroom

• able to suppress the urge until caregiver reaches the

bathroom

Urine analysis Urine culture Urodynamics Cystometrogram Uroflowmetry

Embarrassing loss of self confidence and poor self esteem Social withdrawal, isolation Disruption of intimate relationship Burden on caregivers Financial burden Increased incidence of falls and fractures that may lead to increased

mortality. Risk of medical complications like skin breakdown, pressure sores etc.

Embarrassment leads to silence Time constraints lead to inadequate attention Knowledge limits lead to patients accepting Technology limits lead to inadequate investigation Resource limits lead to inadequate access

Assess problem. Develop a care plan. Address contributing factors. Implement individualized toileting plan. Evaluate effectiveness. Awareness

Physiotherapy Approaches

For urinary incontinence

Electrical Stimulation

BiofeedbackPelvic floor muscle exercise

Behavioral training

Aims of Biofeedback To alter patho physiologic

responses of both smooth and striated muscle that mediates bladder control.

To reinforce pelvic muscle

recruitment to improve contractile

force To reinforce bladder inhibition.

.

Toileting assistanceDietary and lifestyle

Modifications

BehavioralTraining

Bladder

training

Toileting assistance is divided into 3 types

1. Habit training

2. Prompted voiding

3. Timed voiding

Toileting assistance

Catheterization allows the patient's urine to drain freely from the bladder for collection, or to inject liquids used for treatment or diagnosis of bladder

conditions. Intermitltent self catheterization is a safe, simple

technique which can transform the lives of people with urinary incontinence or difficulty voiding owing to a neuropathic or atonic bladder.

Foley cathetor Robinson cathetor

External condom cathetor

Individualised treatment (Neumann et al, 2008) Motivation and adherence (Alewijnse et al 2001)