Upload
others
View
0
Download
0
Embed Size (px)
Citation preview
URINARY INCONTINENCE
IS IT A PROBLEM IN FAMILY
DOCTORS` PRACTICES?
Maria Magdalena Bujnowska - Fedak
Department of Family Medicine,
Wrocław Medical Academy, Poland
Urinary incontinence is the
involuntary loss of urine
from the bladder.
URINARY INCONTINENCE DEFINITION
The International Continence Society (ICS) defines incontinence as ‘a condition where involuntary loss of urine is a social or hygienic problem and is objectively demonstrable’ ( weak for epidemiological purposes).
Other definitions: ‘any uncontrolled urine loss in the previous 12 months without regard to severity’, more than two episodes in a month’
URINARY INCONTINENCE DEFINITION
URINARY INCONTINENCE PREVALANCE
UI prevalance in women varies between 14-40,5%;
UI prevalance in men varies between 1,6-24%; according to the definition applied, the country of survey and the method of survey.
UI IS THE SOCIAL DISEASE.
It is supposed that about 4-6 millions people in Poland suffers from urinary incontinence (UI).
Bladder control problem concerns especially women.
URINARY INCONTINENCE
13 million Americans are incontinent; 11 million are women (85%)
1 in 4 women ages 30-59 have experienced an episode of UI.
50% or more of the elderly persons living at home or in long-term care facilities are incontinent.
AMERICAN FACTS ABOUT URINARY INCONTINENCE
$16.4 billion is spent every year on
incontinence-related care: $11.2 billion
for community-based programs and at
home, and $5.2 billion in long-term
care facilities.
$1.1 billion is spent every year on
disposable products for adults.
AMERICAN FACTS ABOUT URINARY INCONTINENCE
Stress incontinence happens when
the bladder can't handle the increased
intra abdominal pressure during
exercise, coughing, laughing or
sneezing.
This kind of incontinence happens
mostly to women under 60 and in men
who have had prostate surgery.
TYPES OF URINARY INCONTINENCE
Urge incontinence is caused by a
sudden, involuntary bladder
contraction (abnormal detrusor
muscle contraction, ‘overactive
bladder’).
It is characterised by an abrupt and
strong desire to void, urgency,
nocturia. It is more common in older
adults.
TYPES OF URINARY INCONTINENCE
STRESS AND URGE INCONTINENCE
COMPARISON OF SYMPTOMS
SYMPTOMS STRESS INCONTINENCE
URGE INCONTINENCE
RELEASINGFACTOR
coughing, laughing, physical activity, lifting, changingposition
sudden stimulus, changing position
URINE FLOW immediate delayed
URINE VOLUME small ---> big small
URGENCY sometimes YES
NOCTURIA rarely YES
SPONTANEOUS RECOVERY
NO occasionaly
Mixed incontinence is a combination of both stress and urge incontinence, and is most common in older women.
Overflow incontinence, in which thebladder becomes too full (over-distention of the bladder) because itcan't be fully emptied, is rarer and isthe result of bladder obstruction orinjury. In men, it can be the result ofan enlarged prostate.
TYPES OF URINARY INCONTINENCE
Total incontinence: continuous loss
of urine with minimal activity, usually
seen in women with severe stress UI.
Functional incontinence: urine loss
due to acute or chronic impairment of
both physical or cognitive function.
TYPES OF URINARY INCONTINENCE
RISK FACTORS ARE JUDGED TO BE:
Constitutional
Urogynaecological
Neurogenic
Behavioural
RISK FACTORS FOR URINARY INCONTINENCE
Constitutional:
Age (elderly)
Sex (women)
Obesity
Race ( eg. Caucasian race)
RISK FACTORS FOR URINARY INCONTINENCE
Urogynaecological:
Minor pelvic surgery (e.g.
hysterectomy)
Uterine prolapse, cystocoele
Oestrogen deficiency (
menopause)
Childbirth, pregnancy
RISK FACTORS FOR URINARY INCONTINENCE
Neurological risk factors relate
rather to overactive bladder and
detrusor hyperreflexia than to
stress incontinence ( e.g. Parkinson`s
desease, Alzheimer`s disease, SM,
dementia, depression, brain tumors,
stroke, brain and spinal cord injuries,
congenital defects, polineuropathy).
RISK FACTORS FOR URINARY INCONTINENCE
Behavioural:
Diet: caffeine, alcohol and tobacco
consumption
Constipations
Drugs
Low physical activity ( physical
disability)
Psychosocial disorders, toilet habits
RISK FACTORS FOR URINARY INCONTINENCE
Others:
URINARY TRACT INFECTIONS!
Chronic diseases: diabetes,
hipercalcemia
RISK FACTORS FOR URINARY INCONTINENCE
Near 2/3 cases of UI remains undiagnosed!
Patients do not often reveal the problem: shame, lack of confidence to the doctor, lack of information about the illness, UI as ‘a natural consequence of aging’ etc.
Doctors haven’t sufficient knowledge and skills in diagnosing and treating UI.
URINARY INCONTINENCE
Review medical and social history Question the patient about possible
urinary incontinence including time
of onset, frequency and severity.
Inquire about symptoms such as
urgency, nocturia, hematuria,
dribbling and hesitancy.
EVALUATION FOR UI
Perform physical examination,
especially abdominal, genital, rectal,
and skin examination,Valsalva
maneuver for women.
Determine presence/absence of
indwelling catheter. If present,
determine whether use is indicated.
Complete functional, environmental,
and mental status assessment.
EVALUATION FOR UI
Perform diagnostic test results:
urinalysis and urine cultures.
• Perform bladder ultrasonography or
catheter insertion to evaluate post-
void residual urine.
• Perform basic analytic and
biochemical blood tests: glucose,
creatinine, electrolytes etc.
• Perform urodynamic tests (optional).
Complete bladder diary or voiding
record.
EVALUATION FOR UI
Treatment for UI depends on
the type of incontinence, its
causes, and the capabilities
of the patient.
URINARY INCONTINENCE TREATMENT
Pelvic Muscle Rehabilitation— toimprove pelvic muscle tone andprevent leakage.
Kegel exercises. Regular, daily
exercising of pelvic muscles can improve,and even prevent, urinary incontinence.This is particularly helpful for youngerwomen. Should be performed 30-80 timesdaily for at least 8 weeks.
Biofeedback. Used in conjunction with
Kegel exercises, biofeedback helps peoplegain awareness and control of their pelvicmuscles.
UI TREATMENT
Pelvic Muscle Rehabilitation— to improvepelvic muscle tone and preventleakage.
Vaginal weight training. Small weights
are held within the vagina by tightening the vaginal muscles. Should be performed for 15 minutes, twice daily, for 4 to 6 weeks.
Pelvic floor electrical stimulation. Mild
electrical pulses stimulate muscle contractions. Should be performed in conjunction with Kegel exercises.
Magnetic therapy (ExMI).New method in testing
UI TREATMENT
Behavioral Therapies —to help people regain control of their bladder.
Bladder training teaches people to resist the urge to void and gradually expand the intervals between voiding.
Toileting assistance uses routine or scheduled toileting, habit training schedules, and prompted voiding to empty the bladder regularly to prevent leaking.
UI TREATMENT
Pharmacologic Therapies —to improve incontinence medically.
Anticholinergic drugs – first-line pharmacotherapy (oxybutynin, tolterodine, darifenacin, solifenacine) prevents urge incontinence by relaxing sphincter muscles.
Bladder relaxants ( e.g.imipramine), for urge incontinence.
Mirabegron – strong and selective agonist of β3-adrenergic receptors (OAB).
UI TREATMENT
Pharmacologic Therapies —to improve incontinence medically.
Alpha-adrenergic antagonists ( e.g. pseudoephidrine), for stress incontinence.
Duloxetine (SNRI), for stress incontinence.
Estrogen replacement therapy, mostly vaginal, may be helpful in conjunction with other treatments for postmenopausal women with UI.
UI TREATMENT
Surgical Therapies —to treat specific anatomical problems.
Sling procedures (TVT Tension Free
vaginal Tape surgery), bulking injections (such as collagen), artificial sphincter and other surgical procedures support or move the bladder to improve continence.
UI TREATMENT
Other supporting methods (to keep people dry):
Indwelling urethral catheters
Pelvic organ support devices (
e.g. pessaries, vaginal rings,
vaginal balls)
Disposable absorbent products
UI TREATMENT
Patients and professionals should learn about the different treatment options for incontinence.
Patients and their families should
know that incontinence is not
inevitable or shameful but is treatable
or at least manageable.
All management alternatives should
be explained.
UI EDUCATION
Patients and professionals should learn about the different treatment options for incontinence.
Professional education about UI
evaluation and treatment should be
included in the basic curricula of
undergraduate and graduate training
programs of all health care providers,
as well as continuing education
programs.
UI EDUCATION
URINARY
INCONTINENCE
I KNOW…