2. SUNANDAR FATWA, S.ST., MM., CWCC., CST
CEO SUNANDAR WOUND CARE
CENTER
Kepala Ruang Perawatan
Bedah RSUD PURI HUSADA
TEMBILAHAN
• D. III Keperawatan di Poltekkes Depkes,
Jambi, 2002
• D. IV Keperawatan Medikal Bedah,
Poltekkes Kemenkes Bandung, 2011
• Magister Manajemen di STIE Indonesia
Malang 2014
• Praktisi Luka (Alumni WOCARE CENTER-
CWCCP & CSTP 2021)
3. OUTLINE
• Pengantar
• Prevalensi
• Definisi
• Penyebab
• International Continence Society Definition of The
Symptomps UI
• Diagnosis
• Algoritma
• Specialised Management
• Bladder Control Training
• Kesimpulan
• Referensi
4. Pengantar
The ageing process will usually be covered physically-biologically, and
psychosocially. Physical changes are decreased, decreased nervous system,
auditory system, visual system, cardiovascular system, respiration, endocrine
system, skin system, urinary system, musculoskeletal system .
Changes that occur in the urinary system is a decrease in vaginal muscle tone and
urinary tract muscle (urethra) becomes weak caused by a decrease in estrogen
hormone, causing urinary incontinence, capacity up to 200 ml or increase the
frequency of urination.
(Tien Hartini, Endang Banon Sri Bharaty* , and Titi Sulastri. The Influence of Kegel
Exercise on Urine Incontinension Reduction in Elderly . 2018)
5. Urinary incontinence is a health problem that is often found in the elderly,
especially women. Urinary incontinence is an uncontrolled elimination of urine
from the bladder or occurs outside of desire. Elderly or family rarely complain about
the problems of urinary incontinence they experience, and others because that
embarrassing or taboo problems to tell and also because the condition is
something that is normal for the elderly and does not need to be treated. It was
reported that more than half of elderly nursing residents suffer from urinary
incontinence .
(Tien Hartini, Endang Banon Sri Bharaty* , and Titi Sulastri. The Influence of Kegel
Exercise on Urine Incontinension Reduction in Elderly . 2018)
6. Prevalensi
The prevalence of urinary incontinence (UI) increases with age.
Moderate to severe UI affects 7% of women 20 to 39 yr of age, 17% 40 to 59 yr of
age, 23% 60 to 79 yr of age, and 32% 80 yr of age.
The prevalence in men is approximately one third that of women, until it equalizes in
the ninth decade.
Nursing home residents have especially high rates of UI, ranging from 60 to 78% in
women and 45 to 72% in men. The primary impact of UI is on quality of life, including
self-concept, self-esteem, and the burden of coping.
(George A. Kuchel* and Catherine E. DuBeau. Urinary Incontinence in the Elderly.
2017)
7. DEFINISI
Urinary incontinence is common and can range from the
occasional leak when you laugh, cough, sneeze or
exercise, to the complete inability to control your bladder.
(Continence Foundation of Australia, 2020)
8. Penyebab Urinary Incontinence
Incontinence can happen for many reasons. For
example, urinary tract infections, vaginal infection or
irritation, constipation. Some medicines can cause bladder
control problems that last a short time. When incontinence
lasts longer, it may be due to:
• Weak bladder muscles
• Overactive bladder muscles
• Weak pelvic floor muscles
• Damage to nerves that control the bladder from diseases such
as multiple sclerosis, diabetes, or Parkinson’s disease
• Blockage from an enlarged prostate in men
• Diseases such as arthritis that may make it difficult to get to
the bathroom in time
• Pelvic organ prolapse, which is when pelvic organs (such as
the bladder, rectum, or uterus) shift out of their normal place
into the vagina. When pelvic organs are out of place, the
bladder and urethra are not able to work normally, which may
cause urine to leak.
(National Institute on Aging. 2020)
9. Most incontinence in men is related to the prostate gland.
Male incontinence may be caused by:
• Prostatitis—a painful inflammation of the prostate gland
• Injury, or damage to nerves or muscles from surgery
• An enlarged prostate gland, which can lead to Benign
Prostate Hyperplasia (BPH), a condition where the
prostate grows as men age.
(National Institute on Aging. 2020)
10. International Continence Society Definition of The
Symptoms of Urinary Incontinence
Stress
Urinary
Incontinence
(SUI)
The complaint of involuntary leakeage on
effort of exertion , or on sneezing or
coughing
Urge Urinary
Incontinence
(UUI)
The complaint of involuntary leakage
accompanied by, or immediately preceded by,
urgency. (Urgency is a sudden compelling
desire to pass urine,which is difficult to defer)
Mix Urinary
Incontinence
(MUI)
The complaint of involuntary leakage associated
with urgency and also with exertion, effort,
sneezing or coughing
Stanley K Santiagu. Urinary incontinence
Pathophysiology and management outline. 2018
11. Diagnosis
Susan L. Vogel, MD. Urinary Incontinence in the Elderly. 2011
Most importantly, make the diagnosis:
1. Ask your patient if he/she has a problem with involuntary
urine loss.
2. Observe his/her clothing for pads or odor.
3. Think of incontinence in the depressed/withdrawn
patient or one who has begun to fall more often.
If incontinence is present, try to distinguish the three main
histories:
1. Detrusor hyperactivity/urge: the need to void and urinary
leakage are nearly simultaneous.
2. Overflow: unsensed leakage of small to moderate
amounts frequently.
3. Stress: leakage with laughing, coughing, bending, etc.
12. Algoritma UI in Elderly
Susan L. Vogel, MD. Urinary Incontinence in the Elderly. 2011
Actas Urológicas Españolas (English Edition) Volume 35, Issue 7, July–August 2011, Pages 373-388
13. SPECIALISED MANAGEMENT (1)
Specialist referral should be considered
when, in the initial assessment, a frail older
person with UI has :
(1) other significant factors (eg, pain,
haematuria);
(2) UI symptoms that cannot be classified as
urgency, stress, or mixed incontinence or
other complicated comorbidity that the
primary clinician is unable to address (eg,
dementia, functional impairment); and
(3) a response to initial management that is
insufficient
14. SPECIALISED MANAGEMENT (2)
The type of specialist will depend on local
resources and the reason for referral.
Surgical specialists could include
urologists or gynaecologists. Patients
with functional impairment could be
referred to a geriatrician or a physical
therapist. Continence nurse specialists
may be helpful for homebound patients.
The decision to refer a patient should take
into account the goals of care, the patient’s
or caregiver’s desire for invasive therapy,
and the estimated life expectancy.
(European Urology Volume 59, Issue
3, March 2011)
15. BLADDER CONTROL TRAINING
1. Pelvic muscle exercises (also known as
Kegel exercises) making these muscles
stronger
2. Biofeedback uses sensors to make you
aware of signals from your body. This may
help you regain control over the muscles
in your bladder and urethra. Biofeedback
can be helpful when learning pelvic
muscle exercises.
3. Timed voiding may help you control your
bladder.
4. Lifestyle changes may help with
incontinence.
(National Institute on Aging. 2020)
16. KESIMPULAN
One of ageing process is urinary systems
decreased and urinary incontinence is
common problems in elderly.
Many family said this experience is
normally because UI are embarassing/
taboo to communicated. It’s false, it’s a big
problems.
Focus on history and physical
examination like Kegels exercise is
helping to make bladder strong than
before.
When there is a mean, there is a way…
Together we fight incontinence…
17. Referensi
• George A. Kuchel* and Catherine E. DuBeau. Urinary Incontinence in the
Elderly. 2017
• Tien Hartini, Endang Banon Sri Bharaty* , and Titi Sulastri. The Influence of
Kegel Exercise on Urine Incontinension Reduction in Elderly . 2018
• https://bcmj.org/articles/incontinence-older-adults-role-geriatric-multidisciplinary-
team
• https://www.aplaceformom.com/caregiver-resources/articles/urinary-
incontinence
• https://www.nia.nih.gov/health/urinary-incontinence-older-adults
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116748/
• https://www.asn-
online.org/education/distancelearning/curricula/geriatrics/Chapter30.pdf
• file:///C:/Users/USER/Downloads/44-167-2-PB.pdf
• file:///C:/Users/USER/Downloads/264-815-3-PB.pdf
• https://media.neliti.com/media/publications/107046-ID-none.pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3216159/
• https://www.unboundmedicine.com/medline/research/Urinary_incontinence__in_
elderly
• https://www.ajouronline.com/index.php/AJAS/article/view/5523
• Actas Urológicas Españolas (English Edition) Volume 35, Issue 7, July 2011.
https://www.sciencedirect.com/science/article/abs/pii/S2173578611000394
• European Urology Volume 59, Issue 3, March 2011, Pages 387-400.
https://www.sciencedirect.com/science/article/abs/pii/S0302283810010894?via
%3Dihub
•
