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The involuntary loss of urine, which is objectively demonstrable, with such a degree of severity that it becomes a social or hygienic problem is a common scene in older women. These slides focus on role of physiotherapy in treatment of urinary incontinence in older women
The involuntary loss of urine, which is objectively demonstrable, with such a degree of severity that it becomes a social or hygienic problem is a common scene in older women. These slides focus on role of physiotherapy in treatment of 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
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
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
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.