Incontinence bowel and bladder

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  • 1. UNIVERSITI TEKNOLOGI MARA PUNCAK ALAM CAMPUS FACULTY OF HEALTH SCIENCES DIPLOMA IN PHYSIOTHERAPY (HS114) INCONTINENCE OF BLADDER AND BOWEL LECTURER: CIK AIMAN NADIA AKMAR BINTI RAHMAN NO STUDENT’S NAME MATRIX NUMBER 1. MOHD KHAIRI BIN MOHD AMIN 2011417444 2. ADLIN HANI BINTI MAZLAN HANAFI 2011445252 3. NAZATUL AINA BINTI AZIZLAN 2011446786 4. NUR ALIA NABILAH BINTI RASHID 2011475332
  • 2. DEFINITION - Bladder Incontinence - • Urinary incontinence means there is loss of bladder control which leads to unintentional passing of urine • There are several types of bladder incontinence which are:  Stress incontinence – occurs during certain activities like coughing, sneezing, laughing  Urge incontinence - leakage of urine which involves a strong and sudden need to urinate (American College of Obstetricians and Gynecologists, 2011)
  • 3.  Mixed incontinence – combination of both stress and urge incontinence symptoms  Overflow incontinence – loss of small amounts of urine when the bladder does not empty all the way during voiding (American College of Obstetricians and Gynecologists, 2011 & NHS Choices, 2013)
  • 4. DEFINITION - Bowel Incontinence - • Bowel incontinence is the inability to control the bowel movements, resulting in the involuntary passage of stools • Types:  Urge bowel incontinence – sudden need to defecate, with little time to reach a toilet  Passive incontinence or soiling – experience of no sensation before leakage of stools (American College of Obstetricians and Gynecologists, 2011 & NHS Choices, 2013)
  • 5. ETIOLOGY • Bladder incontinence:  Stress incontinence - weakening of urethral sphincter and pelvic floor muscles - pregnancy - childbirth - age - obesity - menopause - surgical procedures, e.g. hysterectomy (Medical News Today, 2013 & The Browning Pelvic Pain & Organic Dysfunction Treatment Center, 2010)
  • 6.  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 (Medical News Today, 2013)
  • 7. • Bowel incontinence  Rectum problems - constipation - diarrhoea d/t infection or irritable bowel syndrome, Crohn’s disease, ulcerative colitis  Sphincter muscles problem - the muscles are weakened or damaged d/t childbirth, complication of rectal surgery (NHS Choices, 2013)
  • 8.  Nerve damage - decreased awareness of sensation of rectal fullness - d/t diabetes, multiple sclerosis, stroke, spina bifida  Health condition – dementia or severe learning ability, rectal prolapse  Weakness of pelvic floor muscles - puborectalis (NHS Choices, 2013)
  • 9. PATHOLOGY BLADDER AND BOWEL INCONTINENCE
  • 10. BLADDER INCONTINENCE
  • 11. 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. (The American College of Obstetricians and Gynecologists, 2011)
  • 12. BOWEL INCONTINENCE
  • 13. Bowel function is controlled by few factors: anal sphincter pressure, rectal storage capacity and rectal sensation. Anything that interferes with these factors can result in incontinence. Fecal incontinence occur when there is direct trauma to the sphincter muscles (internal and external) such as chronic constipation or obstetric trauma. The sphincter muscles stretched, weaken and not strong enough to maintain the continence and stool will leak out. Patients with impaired continence will also decreased thermal and electrical sensitivity to stimuli. (Satish S. C. R., 2010)
  • 14. CLINICAL FEATURES BOWEL INCONTINENCE 1) Constipation 2) Diarrhea 3) Abdominal pain 4) Lower back pain 5) Bloating 6) Stomach cramp 7) Loss of appetite 8) Insomnia (Vorvick, 2011)
  • 15. CLINICAL FEATURES BLADDER INCONTINENCE 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 (Vorvick, 2011)
  • 16. URGE INCONTINENCE OCCURS : 1) Frequent urination, in a day and at nighttime 2) Loss of urine without meaning to urinate 3) Sudden and urinary urgency OVERFLOW INCONTINENCE OCCURS: 1) Bladder never feels empty 2) Frequent urination, in a day and at nighttime urinate 1) Inability to void when when the urge is felt 2) Urine dribbles even after voiding (Vorvick,2011) (Remedy’s health Communities, 2011)
  • 17. DOCTOR MANAGEMENT • Medication - Anticholinergics (medication to calm an overactive bladder) - Topical estrogen. - Anti depressant -Imipramine - Duloxetine • Medical device – Urethral insert (FemSoft insert) – Pessary (Urinary incontinence: Incontinence products to help keep you dry, 2011)
  • 18. • Surgery - Sling procedures - Bladder neck suspension - Artificial urinary spinchter (Urinary incontinence: Incontinence products to help keep you dry, 2011)
  • 19. PHYSIOTHERAPY MANAGEMENT • Pelvic floor muscle exercises - Kegel exercises • Electrical stimulation (Berghmans, 2010)
  • 20. Physiotherapy treatment Pre - operation • Keep lungs clear of fluid and prevent chest infection. o Chest physiotherapy (Breathing exercises) • Help maintain muscles tone and promote the return of blood in veins to heart. o Limb physiotherapy (Circulatory exercises) • Bed mobility Post - operation • Clear lungs and prevent chest infection o Support abdomen with soft pillow , take 4 to 5 deep slow breaths then 1 deep cough. • Reduce muscle weakness and pain on the incision site o posterior basal and lower costal breathing, concentrating on the affected side • Improve coughing, chest expansion, breathing pattern o ACBT o Triflow meter 5x hourly during awake time
  • 21. • Patient education o Posture awareness o Advice patient to continue exercises as taught • Improve muscle tone and promote the return of blood in veins to heart o Circulatory exercise • Progression for bed mobility • Ambulate patient around bed site • Patient education o Posture awareness o Cont exercising 3x/day o Avoid heavy weight lifting
  • 22. REFERENCES • Anonymous, (2011). About incontinence - types of incontinence - fecal or bowel incontinence. The Simon Foundation for Continence. Retrieved June 26, 2013 http://www.simonfoundation.org /About _Incontinence Types_Incontinence_Fecal_Bowel_Incontinence.html • Anonymous, (2013). What I need to know about bowel control. National Digestive Disease Information Clearinghouse. Retrieved June 24, 2013 http://www.digestive.niddk.nih.gov/ ddiseases/pubs/bowel control_ez/ • Haas E.(2009). Fecal incontinence, Colorectal Surgical Associates. Retrieved June 25, 2013 http://www.houstoncolon.com/fecal-incontinence/causes-texas/ • Forciea, M.A. Geriatrics Secrects. 2nd ed. Philadelphia, PA. 2000 • Medical News Today. (2013). What is urinary incontinence? What causes urinary incontinence? Retrieved June 24, 2013, from http://www.medicalnewstoday.com/articles/165408.php
  • 23. • NHS Choices. (2013). Bowel incontinence. Retrieved June 24, 2013, from http://www.nhs.uk/Conditions/Incontinence-bowel/Pages/Causes.aspx • Pickles, B. Physiotherapy with Older People. Canada. 2003 • Sandip P. V., (2009). Urinary incontinence. Retrieved June 22, 2013 http://emedicine.medscape.com/ article/452289-overview#aw2aab6b2b4aa • Satish S. C. R., American Journal Gasteroenterology. Diagnosis and Management of Fecal Incontinence. 2010; 1585-1604. http://s3.gi.org/physicians/guidelines/FecalIncontinence.pdf. Retrieved June 25, 2013. • The American College of Obstetricians and Gynecologists. (2011). Urinary incontinence. Retrieved June 24, 2013, from http://www.acog.org/~/media/For%20Patients/faq081.pdf?dmc=1&ts=20130623T 0447075241
  • 24. • The Browning Pelvic Pain & Organic Dysfunction Treatment Center. (2010). Incontinence- loss of bladder or bowel control. Retrieved June 24, 2013, from http://ppodsyndrome.com/441/ incontinence-loss-of-bowel-control/ • Tortora GJ., Derrickson B. Principle of anatomy and physiology. 13th ed. Riverstreet, Hoyoken,NJ.John Wiley & Sons. 2011 • Vorvick. L J. Urinary Incontinence. Sept 19,2011. Medline Plus. http:// www. Nlm.nih.gov/medlineplus/ency/article/003142.htm. Retrieved on June 23,2013. • Remedy’s Health Communities. Overflow Incontinence. 2013. http:// www. Healthcommunities.com/overflow-incontinence/overview-of-overflow- incontinence-shtml. Retrieved on June 27,2013.