Uploaded byPoly Begum
Female urinary incontinence.
Urinary incontinence can significantly impact one's quality of life by reducing self-esteem and independence. It becomes more common with age and depends on one's level of incontinence. Overflow incontinence specifically refers to the involuntary loss of urine due to overdistension of the bladder from an underactive or blocked bladder/urethra. Treatment involves surgically correcting any obstructions or using continuous catheter drainage for non-obstructive cases.
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Similar to Female urinary incontinence.
Female urinary incontinence.
- 1. DR POLY BEGUM AssistantProfessor Diabetic Association Medical College, Faridpur
- 2. Urinary incontinenceUrinary incontinence Qualityof LifeQuality of Life • UI imposes a significant psychosocial impactUI imposes a significant psychosocial impact on individuals, their families, and caregivers.on individuals, their families, and caregivers. • UI results in a loss of self-esteem and aUI results in a loss of self-esteem and a decrease in ability to maintain an independentdecrease in ability to maintain an independent lifestyle.lifestyle. • Dependence on caregivers for activities ofDependence on caregivers for activities of daily life increases as incontinence worsensdaily life increases as incontinence worsens. April 7, 2016 2 Dr Poly Begum
- 3. Definition of UrinaryDefinitionof Urinary IncontinenceIncontinence ““ The involuntary lossThe involuntary loss of urineof urine which is objectivelywhich is objectively demonstrabledemonstrable and a social orand a social or hygienic problem.”hygienic problem.” April 7, 2016 3 Dr Poly Begum
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- 5. PrevalencePrevalence The reported incidenceof UI varies widely, ranging from 8% – 41% in women over 65 years. It becomes more common as women age, particularly after menopause. April 7, 2016 5 Dr Poly Begum
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- 7. Mechanism of urinarycontinence Normally intraurethral pressure at rest and with stress is much higher (20-50cm of water) then the intravesical pressure (10 cm of water). This is maintained by - • Apposition of the longitudinal mucosal folds. • Submucosal vascular plexus (hermetic seal). • Abundant deposion of collagen and elastic tissues througout the circumference of the urethra. • Tonic contraction of the smooth muscles in the proximal urethra and bladder neck. • Rhabdosphincter in the midurethra and levetor Ani muscles. 7April 7, 2016 Dr Poly Begum
- 8. 1. Autonomic nervoussystem control Nerve coming from the spinal cord and go directly to the bladder When bladder gets fuller, signals are sent to the brain 1. Central nervous system Voluntary control to choose when to void. April 7, 2016 Dr Poly Begum 8
- 9. University of NorthCarolina School of Medicine Center for Aging and Health Physiology April 7, 2016 9 Dr Poly Begum
- 10. Normal Voiding Cycle Filling& storage phase Emptying phase Bladder filling Normal desire to voidFirst sensation to voidBladder filling Bladderpressure Abrams P, Wein AJ. The Overactive Bladder — A Widespread and Treatable Condition. Stockholm, Sweden: Erik-Sparre Medical AB; 1998.April 7, 2016 10 Dr Poly Begum
- 11. Patho-physiology of UrinaryPatho-physiologyof Urinary IncontinenceIncontinence Basic pathology of incontinence is the rise of intravesical pressure over that of maximum urethral pressure. It may be due to mechanical injury to the supports of the bladder neck following childbirth, truma(surgery) or due to ageing overactivity of the detrusor muscles, may also be associated. April 7, 2016 11 Dr Poly Begum
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- 13. Uncontrolled Contraction ofthe Bladder Muscle Normal bladder Patients with urge incontinence Patients with urge or frequency Urethral resistance Uncontrolled bladder muscle contractions April 7, 2016 13 Dr Poly Begum
- 14. Aging ChangesAging Changes •Decreased bladder capacity • Reduced voiding volume • Reduced flow rates • Increased urine production at night April 7, 2016 14 Dr Poly Begum
- 15. Age Pregnancy Vaginal delivery, caesarian section Menopause Hysterectomy Obesity Chronic cough Constipation Urinary tract infections Functional impairment Cognitive impairment Risk Factors for UI April 7, 2016 15 Dr Poly Begum
- 16. Reversible causes ofUI - Delirium or Drugs - Restricted mobility - Infection, impaction - Polyuria II PP RR DD April 7, 2016 16 Dr Poly Begum
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- 21. Stress UIStress UI Thecomplaint of involuntary leakage with effort or exertion or on sneezing or coughing Sudden increase in abdominal pressure Urethral pressure April 7, 2016 21 Dr Poly Begum
- 22. Urge UIUrge UI Thecomplaint of involuntary leakage accompanied by or immediately preceded by urgency Involuntary detrusor contractions Urethral pressure April 7, 2016 22 Dr Poly Begum
- 23. Overactive bladderOveractive bladder •Includes urinary urgency with or without urge incontinence, urinary frequency, and nocturia • Associated with involuntary contractions of the detrusor muscle April 7, 2016 23 Dr Poly Begum
- 24. Overactive Bladder Symptom: “Experiencing astrong urge to go to the bathroom.” Urinary Urgency April 7, 2016 24 Dr Poly Begum
- 25. Overactive Bladder Symptom: “Goingto the bathroom frequently.” “Have to go to the bathroom, where the bladder wakes me up at night.” Urinary Frequency April 7, 2016 25 Dr Poly Begum
- 26. Overactive Bladder Symptom: “Loosinginvoluntary urine accompanied with the strong desire to void.” Urge Urinary Incontinence April 7, 2016 26 Dr Poly Begum
- 27. Mixed UIMixed UI Thecomplaint of involuntary leakage associated with urgency and also with exertion, effort, sneezing, or coughing Sudden increase in abdominal pressure Involuntary detrusor contractions Urethral pressure April 7, 2016 27 Dr Poly Begum
- 28. OverflowOverflow Neurogenic/Atonic Obstruction •Urethral blockage •The Bladderis not able to empty properly April 7, 2016 28 Dr Poly Begum
- 29. Functional IncontinenceFunctional Incontinence •Immobility • Aphasia • Environment • Psychological April 7, 2016 29 Dr Poly Begum
- 30. Continual IncontinenceContinual Incontinence Thisis also described as true incontinence. In this condition urine flows continuously by day and night. It is caused by some form of urinary tract fistula. April 7, 2016 30 Dr Poly Begum
- 31. Evaluation of PatientsEvaluationof Patients April 7, 2016 31 Dr Poly Begum
- 32. -History--History- • Fluid intakepattern • Number of continent and incontinence episodes • Night time urgency • Voiding Pattern – Quality of stream – Incomplete voiding April 7, 2016 32 Dr Poly Begum
- 33. -History--History- • OB/GYN history •Medications • Neurologic history – Back pain, back surgery – Stroke – Numbness, weakness, balance problems April 7, 2016 33 Dr Poly Begum
- 34. -Quantification of symptoms--Quantificationof symptoms- Voiding diary day and night for >24 hours: – Document of fluid intake – Quantification of urine output with voiding hat – Uncontrolled loss of urine at day and night – Degree of urge to go to the bathroom – Use and number of pads April 7, 2016 34 Dr Poly Begum
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- 55. Pelvic Floor ExercisesPelvicFloor Exercises April 7, 2016 55 Dr Poly Begum
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- 61. TVT – tensionfree vaginal tape April 7, 2016 61 Dr Poly Begum
- 62. TOT - TransobturatorTapeTOT - Transobturator Tape April 7, 2016 62 Dr Poly Begum
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- 72. OxybutyninOxybutynin • Both anticholinergicand smooth muscle relaxant properties • 15-58% greater reduction in urge UI than placebo • Dose: 2.5 -5 mg qd-qid, 20 mg/d maximum April 7, 2016 72 Dr Poly Begum
- 73. Tolterodine tartrateTolterodine tartrate •Pure muscarinic receptor antagonist • Dry mouth most common side effect • 3 RCT compared tolterodine (2 mg bid) to oxybutynin (5 mg tid): Equally effective and superior to placebo • Decreased urge U(I in study of 293 pts:47% tolterodine, 71% oxybutynin, 19% placebo, dry mouth 86% oxybutynin, 50% tolerodine April 7, 2016 73 Dr Poly Begum
- 74. SolefenacinSolefenacin • Dose 5to 10 mg daily • Long acting muscarinic receptor antagonist, selective for M3 • Undergoes hepatic metabolism involving cytochrom P450 • Several multinational trials with over 800 pts, vs placebo, showed efficacy low side effects (2% dry mouth) April 7, 2016 74 Dr Poly Begum
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- 84. Urinary incontinenceUrinary incontinence OverflowIncontinenceOverflow Incontinence • Involuntary loss of urine associated withInvoluntary loss of urine associated with overdistension of the bladderoverdistension of the bladder • It may have a variety of presentations,It may have a variety of presentations, including frequent or constant dribbling, orincluding frequent or constant dribbling, or urge or stress incontinence symptoms.urge or stress incontinence symptoms. • Overflow UI may be caused by an underactiveOverflow UI may be caused by an underactive or acontractile detrusor, or to bladder outletor acontractile detrusor, or to bladder outlet or urethral obstruction leading toor urethral obstruction leading to overdistension and overflow.overdistension and overflow. April 7, 2016 84 Dr Poly Begum
- 85. Treatment of OverflowincontinenceTreatment of Overflow incontinence • If any obstruction, Surgical treatment has to be done . • In case of non-obstructive group, continuous catheter drainage is required. April 7, 2016 Dr Poly Begum 85
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- 87. SummarySummary • Behavioral treatmentis effective for treating stress and urge UI and OAB • Drugs are effective for treating urge UI and OAB. • New selective agents for urge and OAB based on new understanding of bladder and urethral function • Caution needed in dosing, especially in older patients April 7, 2016 87 Dr Poly Begum
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Editor's Notes
- #8 Control of urination is dual under the influence of both the autonomic and central nervous systems: The autonomic nervous system control urination by direct nerve innervations to the bladder coming from the spinal cord. Signals are sent back to the brain, when the bladder is getting fuller. The central nervous system controls bladder emptying voluntary, which allows for an appropriate social setting for voiding, is voluntary. The autonomic nervous system control and the central nervous system can be both altered by aging or a neurological disease.
- #11 Normal voiding Cycle This diagram shows you a normal voiding cycle. I will walk you through. The normal voiding cycle is comprised of a filling/storage phase and an emptying phase. During the filling phase, the bladder muscle stretches to maintain low pressure. At the same time, the urethral sphincter is under high pressure. Sensation of bladder fullness begins when the bladder is half full at around 250cc. At around 500cc, an individual experiences a strong desire to void and the emptying phase begins. After a person chooses the right place to urinate, the urethral sphincter voluntarily relaxes, the pelvic floor relaxes and the bladder muscles contracts. Urination is happening! After this is done, the cycle resumes with bladder filling, urethral sphincter and pelvic floor tightening and bladder muscle relaxation.
- #14 Unstable Contraction of the Detrusor Muscle - In healthy individuals, the urethral pressure is greater than the bladder pressure - In patients with frequency and urgency, unstable detrusor contractions create the feeling of urgency, but incontinence does not occur because the urethral pressure remains greater than the bladder pressure In patients with urge incontinence, detrusor contractions are very strong, resulting in an increase in bladder pressure that exceeds urethral pressure; involuntary urine leakage occurs, often emptying the bladder Overactive Bladder Part of the pathology of overactive bladder is the inappropriate contraction of the detrusor muscle during the filling/storage phase of the micturition cycle. These unpredictable and involuntary detrusor contractions cause increased urinary urgency, or a strong desire to urinate. Because the bladder cannot fill appropriately or completely, bladder capacity is reduced, resulting in urinary frequency, or the need to empty the bladder frequently. The most severe form of overactive bladder occurs when detrusor pressure during these contractions overcomes sphincteric resistance, resulting in urinary incontinence.
- #16 Risk Factors for UI Known risk factors include age, pregnancy, vaginal delivery, caesarian section, menopause, hysterectomy, obesity, chronic cough, constipation, urinary tract infections, functional impairment, and cognitive impairment. References: Shamliyan T, Wyman J, Bliss DZ, et al. Prevention of urinary and fecal incontinence in adults. Evid Rep Technol Assess (Full Rep) 2007 Dec;(161):1-379. PMID: 18457475. Shamliyan T, Wyman J, Sainfort F, et al. Nonsurgical Treatments for Urinary Incontinence in Adult Women: Diagnosis and Comparative Effectiveness. Comparative Effectiveness Review No. 36 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-2007-10064-I). Rockville, MD: Agency for Healthcare Research and Quality; April 2012. AHRQ Publication No. 11(12)-EHC074-EF. Available at www.effectivehealthcare.ahrq.gov/ui.cfm.
- #25 You might say: “I am expere….” The symptoms of overactive bladder include urinary urgency—the sudden, strong need to urinate immediately
- #26 The symptoms of overactive bladder include urinary frequency—urination eight or more times a day or two or more times a night
- #27 The symptoms of overactive bladder include urge incontinence—leakage of urine that follows a sudden, strong urge to urinate
- #33 At the beginning, a complete history needs to be obtained. The urologist will ask about -fluid intake -number of continent and incontinent episodes -night time urgency -voiding pattern, such as quality of stream, or a feeling of incomplete voiding
- #34 Further, -alterations in bowel habits will be discussed -changes in sexual function, An OB/GYN history will be obtained and a neurological history, including questions about back pain, back surgery, stroke, numbness, weakness and balance problems.
- #35 For more an objective quantification through a voiding diary needs to be conducted for at least 24 consecutive hours. In the the voiding diary you will beed to document -the fluid intake, -quantification of urine output with voiding hat -documents uncontrolled loss of urine at day and night -document the degree of urge to go to the bathroom -and the use and number of pads.