Download - Urinary Incontinence in 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
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
Requirements for Continence
• aware of urge to void
• able to get to the bathroom
• able to suppress the urge until caregiver reaches the
bathroom
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 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.