Urinary Incontinence in older women

1. Dr Alakananda Banerjee President Dharma Foundation of India URINARY INCONTINENCE IN OLDER WOMEN

2. 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)

3.  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

4. • Stress incontinence • Urge incontinence • Mixed • Overflow incontinence • Functional incontinence

5. 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

6.  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

7.  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

8. Time and amount of : - Fluid intake - Urine voided - Accidental leakage - Protection used - Circumstances of loss - Sensation/urge

9.  Access to bathroom  Ambulation (needs assistance)  Wheelchair  Transfer aids  Environment

10. Requirements for Continence • aware of urge to void • able to get to the bathroom • able to suppress the urge until caregiver reaches the bathroom

11. • Urine analysis • Urine culture • Urodynamics • Cystometrogram • Uroflowmetry

12.  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.

13. • 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

14.  Assess problem.  Develop a care plan.  Address contributing factors.  Implement individualized toileting plan.  Evaluate effectiveness.  Awareness

15. Physiotherapy Approaches For urinary incontinence Electrical Stimulation Biofeedback Pelvic floor muscle exercise Behavioral training

16. 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.

18. Toileting assistance Dietary and lifestyle Modifications BehavioralTraining Bladder training

19. Toileting assistance is divided into 3 types 1. Habit training 2. Prompted voiding 3. Timed voiding Toileting assistance

20.  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.

21.  Foley cathetor Robinson cathetor

22.  External condom cathetor

23.  Individualised treatment (Neumann et al, 2008)  Motivation and adherence (Alewijnse et al 2001)