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  1. INCONTINENCE M.Indumathi, year Med-surg Depart.
  2. INCONTINENCE Unable to retain the natural discharge or evacuation of urine or feces.
  3. What will you learn in the upcoming minutes? What is happening to bladder ? How will get evaluated? Therapy with medication Others Forms of interventions
  6. Anatomy Review Bladder: stores urine Urethra: tube that allows urine to pass Urethral sphincter: muscle surrounding the urethra that hold the urine Brain signals are key to coordinating the function of these anatomical structures
  7. What is happening to bladder? 1. Autonomic nervous system control – Nerve coming from the spinal cord and go directly to the bladder – When bladder gets fuller, signals are sent to the brain 2. Central nervous system – Voluntary control to choose when to void  Both can be altered by aging or neurological disease 7
  8. Normal Voiding Cycle Filling & storage phase Emptying phase Bladder filling Normal desire to void First sensation to void Bladder filling Bladder pressure
  9. DEFINITION - BLADDER INCONTINENCE/URINARY INCONTINENCE - • Urinary incontinence means there is loss of bladder control which leads to unintentional passing of urine
  10. TYPES OF INCONTINENCE • There are several types of bladder incontinence which are:  Stress incontinence – abdominal pr. occurs during certain activities like coughing, sneezing, laughing etc.  Urge incontinence –Inability to hold the flow of urine,when feeling the urge to void
  11. TYPES
  12. Mixed incontinence – combination of both stress and urge incontinence symptoms Overflow incontinence – retention with overflow of small amounts of urine. Urgency is a sudden desire to void Frequency is passing of urine seven or more/day or being awoken from sleep more than jif once a night to void.
  13. What is urinary incontinence What is stress incontinence
  14. ETIOLOGY • Bladder incontinence:  Stress incontinence - weakening of urethral sphincter and pelvic floor muscles - pregnancy - childbirth - age - obesity - menopause - surgical procedures, e.g. hysterectomy
  15.  Urge incontinence - overactivity of the detrusor muscles - cystitis - central nervous system (CNS) problems - an enlarged prostate  Overflow incontinence - an obstruction or blockage to the bladder - an enlarged prostate gland - a tumor pressing against the bladder - urinary stones - constipation
  18. Incontinence of the bladder occurs when those pelvic muscles that involves in urination get traumatized, either overstretched or tear, that leads to weakness of the muscles. As time goes by, the muscles become weaker until at certain point, they cannot support the bladder anymore. When there is high pressure from the abdominal such as coughing, sneezing, lifting or pushing heavy things, the bladder forces urine past the urethral sphincter causing incontinence to occur.
  19. CLINICAL FEATURES STRESS INCONTINENCE OCCURS WHEN: 1) Cough 2) Sneeze 3) Laughing 4) Lifting heavy objects 5) Vigorous exercise 6) Have sexual intercourse 7) Standing in prolonged time
  20. URGE INCONTINENCE OCCURS : 1) Frequent urination, in a day and at nighttime 2) Sudden urination and urinary urgency OVERFLOW INCONTINENCE OCCURS: 1) Bladder never feels empty. 2) Inability to void when the urge is felt 3) Urine dribbles even after voiding
  21. “Hello, incontinence helpline – Can you hold?” How will I get evaluated?
  22. INVESTIGATIONS • Physical examination- to identify pelvic muscle prolapse. • Urine culture & sensitivity—to identify Infections. • Pad test • Measure Postvoidal Residual Volume by bladder ultrasound or urethral catheter .
  23. • Urodynamic studies Uroflowmetry-- Bladder outlet obstruction Cystometry -- Detrusor/bladder contraction activity • Cystogram – to visualize the bladder. • Cystoscopy – Tumors, stones
  24. What is cystogram
  25. MANAGEMENT Medication - Anticholinergics (medication to calm an overactive bladder) - Anti depressant -Imipramine - Duloxetine - Topical estrogen. -alpha & beta adrenergic antagonist -phenylpropanolamine
  26. Medical device – Urethral insert (FemSoft insert) – Pessary – external condom drainage(men) Surgery - Sling procedures - Bladder neck suspension - Artificial urinary spinchter (Urinary incontinence: Incontinence products to help keep you dry, 2011)
  30. NURSING DIAGNOSIS Stress incontinence related to weak pelvic floor muscle Impaired skin integrity related to constant contact of urine with perineal tissues. Ineffective coping related to inability to control urine leakage
  31. Nursing management 31 1. Helps strengthen the muscles of the pelvic floor – improves bladder stability 2. Helps suppress the feeling of urgency Contraction Bladder Relaxatio n 1.Pelvic floor exercise:
  32. 2.Bladder training: Scheduled voiding at set times during the day Active use of muscles to prevent urine loss Keep own input and output chart 33
  33. 3.BEHAVIOUR MODIFICATION : 1. Drink less than 5 glasses/day (40 oz) 2. Stop drinking after dinner 3. Elevate legs 4. Timed voiding 5. Regular pelvic floor exercises 34
  34. Find your pelvic floor muscles. Squeeze your pelvic floor muscles as hard as you can and hold them (squeeze 3-5 sec and relax for 5 sec). Do sets of repetitions of squeezing (start with 5 repetitions: squeeze, hold, relax). Increase lengths, intensity, and repetitions every couple of days. Perform Kegel exercises 3-4x during the day. 36 Kegel exercise for men and women: