Urinary incontinence is a common condition in older adults that is not a normal part of aging. It can be caused by age-related changes, medical conditions, medications, and environmental factors. There are different types of urinary incontinence including stress, urge, overflow, functional, and mixed incontinence. Evaluation involves taking a history, physical exam, urinalysis, post-void residual measurement, and sometimes urodynamic testing. Management uses a stepped approach starting with conservative treatments like lifestyle changes, pelvic floor exercises, and behavioral therapy. If conservative treatments are ineffective, pharmacologic therapy and sometimes surgical options may be used.
The Rehabilitation Institute of Chicago's Karen Grube presents on the effects of Physical Therapy on Scleroderma. Find out what the current research tells us about PT and Scleroderma and what kind of problems PT can help.
THE URINARY INCONTINENCE AND IT'S MANAGEMENT DETAILS WITH APPROPRIATE EXPLANATION
Introduction of urinary incontinence,
Etiology of urinary incontinence,
Risk factors associated with urinary incontinence,
Types of urinary incontinence,
Pathophysiology of Urinary incontinence,
Clinical manifestations of urinary incontinence,
Diagnostic evaluations of urinary incontinence,
Management of urinary incontinence- Behavioural techniques, Drug therapy, surgical management, medical devices and Physiotherapy assessment and management in details with appropriate explanation with the help of the SlideShare .
Telegram channel - https://t.me/bhuneshwarmishra08/4?single
Facebook page - https://m.facebook.com/Bhuneshwarmishra08/
Instagram page - https://www.instagram.com/the_perfect_physio_tutorial/?r=nametag
YouTube channel - https://youtube.com/channel/UCCIEa_xDe3B-6BLfQaJb8PQ
The Rehabilitation Institute of Chicago's Karen Grube presents on the effects of Physical Therapy on Scleroderma. Find out what the current research tells us about PT and Scleroderma and what kind of problems PT can help.
THE URINARY INCONTINENCE AND IT'S MANAGEMENT DETAILS WITH APPROPRIATE EXPLANATION
Introduction of urinary incontinence,
Etiology of urinary incontinence,
Risk factors associated with urinary incontinence,
Types of urinary incontinence,
Pathophysiology of Urinary incontinence,
Clinical manifestations of urinary incontinence,
Diagnostic evaluations of urinary incontinence,
Management of urinary incontinence- Behavioural techniques, Drug therapy, surgical management, medical devices and Physiotherapy assessment and management in details with appropriate explanation with the help of the SlideShare .
Telegram channel - https://t.me/bhuneshwarmishra08/4?single
Facebook page - https://m.facebook.com/Bhuneshwarmishra08/
Instagram page - https://www.instagram.com/the_perfect_physio_tutorial/?r=nametag
YouTube channel - https://youtube.com/channel/UCCIEa_xDe3B-6BLfQaJb8PQ
Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that's so sudden and strong you don't get to a toilet in time.
If urinary incontinence affects your daily activities, don't hesitate to see your doctor. For most people, simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence.
describes its definition, causes, clinical manifestations, diagnosis and rx.
feedback and inquiries; gufuabdikadir96@gmail.com
Urinary incontinence affects millions of people.Urinary incontinence is leakage of urine you can’t control. Also referred to as loss of bladder control. No matter what you call it, if you have it, you may feel like you’re the only one because people don’t really talk about it. But you’re not alone.
Urinary incontinence simply means involuntary leaking of urine.
Incontinence can range from leaking just a few drops of urine to complete emptying of the bladder.
Social and hygienic problem.
A benign (not cancer) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hyperplasia and BPH.
here give the knowledge that you should possess to manage acute and chronic urine retention. the lecture is more concerned about practical patient care and ward setting management. you should minimally be aware about following facts regarding urine retention. the multiple causes of retention will be discussed later in detailed manner. Direction of the lecture seems more toward BPH and acute retention management. beware there are many aspects of a patient present with an AUR. do no harm and always try to keep patient satisfaction. Let me know about your comments an Ideas. try to improve the quality. good luck.
Precise guide for DGNM, B.Sc Nursing & M.Sc Nursing Students .. regarding Uirinary incontinence / Bladder Incontinence, and its management. Highly recommended for II B.Sc Nursing Students
social cognition domains and impairment.pptxDoha Rasheedy
Social cognition refers to a set of neurocognitive processes underlying the individuals’ ability to “make sense of others’ behavior” as a “crucial prerequisite of social interaction” The different psychological processes by which we perceive, interpret, and process social information about ourselves and others. These processes allow people to understand social behavior and respond in ways that are appropriate and beneficial Social cognitive impairments are a prominent concern, or even a core facet, of several neurodegenerative (e.g., behavioral variant of frontotemporal dementia), neuropsychiatric (e.g., schizophrenia, major depressive disorder, and bipolar disorder), and neurodevelopmental (e.g., autism spectrum disorder and attention deficit hyperactivity disorder) conditions, and often occur after acute brain damage (e.g., traumatic brain injury and stroke). Moreover, such deficits are critical predictors of functional outcomes because they affect the ability to create and maintain interpersonal relationships, thereby removing their benefits in everyday life Social cognitive disturbances might be relatively subtle and harder to detect informally. Structured social cognitive assessment is, therefore , mandated.
Basic of geriatrics and internal medicine for physiotherapistDoha Rasheedy
collection of lectures for physiotherapy undergraduate students including notes of common health issues (frailty, sarcopenia, osteoporosis, neuropsychiatric issues, constipation, metabolic syndrome and its components, orthostatic hypotension, CLD, CKD, anemia, immobilization, dizziness, falls, fatigue) and how to handle in practice.
summary of age related changes and geriatric pharmacology, safe analgesic prescription in elderly
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
1. URINARY INCONTINENCEURINARY INCONTINENCE
Dr. Doha RasheedyDr. Doha Rasheedy
lecturer of geriatric medicinelecturer of geriatric medicine
Geriatric medicine departmentGeriatric medicine department
Ain Shams UniversityAin Shams University
2. URINARY INCONTINENCE
• Urinary incontinence (UI), defined as the involuntary
leakage of urine, is a common clinical condition that
occurs frequently in older adults
• Urinary incontinence is not a normal part of aging. It
is a loss of urine control due to a combination of:
-Age related changes.
-Genitourinary pathology.
-Comorbid conditions and medications.
-Environmental Obstacles.
•
3.
4. Epidemiology
• Estimates suggest that at least 25% to 30% of all adults
will experience UI at some point in their lives.
• In people older than 65 years, the estimated prevalence of
UI ranges from approximately 35% for those who reside in
the community to more than 60% for those who live in
long term care facilities
5. Impact of UI
• UI is associated with a dramatic reduction in overall
and health-related quality of life for older adults.
• UI has been linked to many other important health
risks, including depression and functional disability,
which may result in social isolation and inability to
participate in desired activities.
• Elderly individuals with UI have a higher risk for falls
and fractures compared with those who do not leak
urine.
• Incontinence may have a negative effect on sexual
health in men and women.
• UI may also be a marker for increased mortality risk in
some patients.
6. Classification
Two broad categories of UI seen in older adults include:
• transient incontinence
• chronic incontinence.
Both can be subdivided into several additional categories.
9. Stress Incontinence
• Stress incontinence is characterized by loss of urine with
activities that increase intraabdominal pressure. Examples
include coughing, sneezing, lifting, or laughing. the pressure
inside the abdomen exceeds the closure pressure at the
urethral outlet leading to leakage of urine
• The cause is often due to inadequate closure of the external
urethral sphincter. Urethral hypermobility with loss of support
of the urethra is also seen in some women with stress
incontinence.
• In men, the most common associated risk factors include a
history of either radical prostatectomy for treatment of
prostate cancer or transurethral resection of the prostate for
treatment of benign prostatic hyperplasia.
10. URGE UI
• Urge incontinence is
typically associated
with sudden onset of a
sensation of needing
to void, with loss of
urine occurring before
the patient is able to
reach toilet facilities.
11. • Caused by uninhibited contractions of the bladder
detrusor muscle.
• The term ‘‘overactive bladder,’’ this condition due to irritation of the
reflex arc. There are two forms, including OAB-dry, which is
characterized by urinary urgency and frequency but no leakage of
urine, and OAB-wet, which includes UI (causes include UTI, Stone)
• The term bladder hyperreflexia due to activation of neuronal
regulation above level of reflex arc : Common causes, multiple
sclerosis, Parkinson disease, stroke, spinal cord injuries, and
disorders such as spinal stenosis. Dementia may also be
associated with urge incontinence
12. Overflow Incontinence
• Overflow incontinence is typically associated with either outlet
obstruction or poor detrusor contractility and incomplete
bladder emptying.
• In men, benign prostatic hyperplasia may lead to outlet
obstruction and overflow incontinence. Urethral strictures are
more common in men. in women , prior incontinence surgery
or large cystocele.
• Patients typically experience frequent loss of small volumes of
urine, in contrast to the larger volumes of urine leakage
associated with urge incontinence
13. Functional Incontinence
• urinary leakage that occurs as a result of factors not
directly associated with the bladder, which may prevent
independent toilet use. The most common examples in
older adults include limitations in either mobility or
cognition
14. Mixed UI
• more than one type of UI occurs at a time, the
combination of stress and urge UI is extremely
common. Some patients can describe the
predominant symptom and this may be amenable to
initial therapy.
• Another unique form of mixed incontinence that is
more common in older adults is termed ‘‘detrusor
hyperactivity with impaired contractility (DHIC)’’. In
this condition, patients experience urinary urgency
and frequency caused by uninhibited contractions of
the detrusor. However, when they try to void
voluntarily, the bladder does not contract adequately,
and therefore does not empty completely. This may
lead to associated overflow incontinence
15. Asking The Right Questions
“Do you leak with you cough, laugh, or sneeze?”
“Do you ever get the feelings of gotta go,
gotta go, gotta go!?!”
“Do you not always make it when you are racing for the
bathroom?”
“How many times do you get up during the night?”
“Do you feel a bulge?”
“Do you have to shift your upper body to urinate?”
16. Evaluation
• History:
1.onset, frequency, volume, timing, precipitants ( eg, caffeine,
diuretics, alcohol, cough, medications).
2.Character:
• Sudden, compelling urgency suggests urge UI.
• Loss with cough, laugh, or bend suggests stress UI.
• Continuous leakage suggests intrinsic sphincter insufficiency or
overflow.
18. Laboratory
• UA and urine C&S, glucose and calcium if polyuric : renal
function tests and B12 if urinary retention ; urine cytology if
hematuria or pain.
19. Testing include:
• bladder diary which record time and volume of
incontinent and continent voids, activities and time of
sleep, knowing oral intake is sometimes helpuful
• standing full bladder stress Test ( for patients with
symptoms of stress UI ) relax perineum and cough once
immediate loss suggests stress, several seconds delay
suggests detrusor overactivity.
20.
21.
22.
23. Postvoid residual
•bladder ultrasound after voiding is preferred to catheterization.
If > 100 ml repeat if still > 100 suggests detrusor weakness ,
neuropathy, medications, fecal impaction, outlet obstruction, or
DHIC.
24. Urodynamic Studies
• not routinely indicated ; indicated before corrective
surgery, when diagnosis is unclear, when empric
therapy is ineffective or if postvoid residual volume >
200-300 ml ( possibly lower in men ).
• This may range from simple urodynamics, with
measurement of bladder capacity or noninvasive
uroflowmetry, to more complex multichannel studies
that examine storage and emptying capabilities.
• Simultaneous measurement of detrusor pressure and
urinary flow may be particularly helpful to differentiate
between outlet obstruction and detrusor insufficiency
in patients with symptoms of overflow incontinence
27. • Male <40 years max flow rate 25 ml/s
• Male > 60 years max flow rate 15 ml/s
• Female is higher by 5-10 ml/s and increased in stress
incontinence when outlet resistance is minimal.
28.
29.
30.
31. Characteristic flow pattern
• Fast bladder= stress UI, DO
• Prolonged flow= BOO, DU
• Intermittent flow= BOO, DU compensated with abdominal
straining.
• Flat plateau= urethral structure
• NB: error occur with total volume <150 ml or >400ml
• NB: free flow vs. non free flow
32. • a normal flow rate can be present in the early stages of
obstruction as a consequence of a compensatory
increase in voiding pressure by hypertrophied detrusor
which will maintain of an apparently normal flow rate.
Ultrasound scan of the bladder will show a thickened
bladder wall and cystoscopy will confirm the bladder out
flow obstruction due to BPH or stricture urethra despite of
a normal flow rate
33. Ultrasound cystodyanamogram
• Ultrasound scan of urinary tract is combined with a flow
rate to provide more practical information of bladder
function. This investigation is performed routinely to all
patients with lower urinary tract symptoms
34.
35. Urethral pressure measurement
• Research tool
• Urethral pressure measurement and the Urethral Pressure Profile are techniques used to
provide information about the ability of the urethra to prevent leakage.
• Urethral pressure can be measured with balloon catheters, membrane catheters, perfusion
techniques, or micro-transducers
36.
37. • The urethral pressure profile (UPP) is another procedure
commonly used to measure the competency of the
urethral sphincter (outflow resistance).
• Urethral pressure profile (UPP) -- indicates the
intraluminal pressure along the length of the urethra with
the bladder at rest.
• Pressure transmission ratio (PTR) -- is the increment in
urethral pressure on stress as a percentage of the
simultaneously reported increment in vesical pressure.
38. • Maximum urethral pressure (MUP) -- is the maximum pressure of the
measured profile.
Maximum urethral closure pressure (MUCP) -- is the difference
between the maximum urethral pressure and the intravesical
pressure.
• Functional urethral length -- is the length of the urethra along which
the urethral pressure exceeds the intravesical pressure
• the anatomic urethral length is the total length of the urethra.
•
39. Valsalva Leak Point Pressure
VLPP
• Measures the lowest
abdominal pressure
required during a stress
activity (such as
coughing) that would
cause the urethra to
open and, therefore,
leak.
40. Cystometry
• continuous measurement of the pressure/volume
relationship of the bladder to assess sensations, detrusor
activity, bladder capacity and bladder compliance.
• All three pressure,1)Bladder pressure, 2)Abdominal
pressure and3) detrusor pressure is recorded
simultaneously during the test.
• Video Cystometry : the bladder can be filled with contrast
media, thus allowing the simultaneous screening of the ,
bladder and outflow tract during filling and voiding
41. • Bladder sensation is assessed by recording the volume at
which the patient experiences: the first sensation of
bladder fullness the first desire to void, and a strong
desire to void and urgency.
45. stepped approach
1- Conservative Treatments:
•Dietary Modification and Weight Loss:
• restriction or elimination of
dietary caffeine
acidic foods and beverages, including citrus fruits and juices
Alcohol
fluid intake
• Decreasing late-afternoon or evening fluid intake is often advocated for
elderly patients with nocturia.
• Weight loss may also be helpful for some patients, particularly women
with stress UI.
46. Nonpharmacologic Behavioral
Therapy• Bladder retraining:
• Timed voiding.
• urgency control when urgency occurs, sit or stand quietly, focus on
letting urge pass, do muscle contraction when no longer urgent walk
slowly to the bathroom and void.
• When no incontinence for 2 d, increase voiding interval by 30-60 min
until voiding every 3-4 h.
• prompted toileting for cognitively impaired individuals: ( ask if patient
needs to void, take them to toilet) starting at 2 to 3 hour intervals
during day; encourge patients to report continence status; praise
patients when continent and responds to toileting.
• Pelvic Floor Muscle Exercises (+ Biofeedback training)
(Kegel‘s) exercises-isolate pelvic muscles (avoid thigh, rectal ,
buttocks contractions, 3-4 times/wk for at least 15-20 wk. vaginal
weights are an alternative for strengthening pelvic muscles
47.
48. Pessaries
may benefit women with vaginal or uterine prolapse who
experience retention or stress UI.
DHIC:
Treat urge first with behavioral methods; may add detrusor
muscle relaxing medications but follow postvoid residual;
clean intermittent self-catheterization if needed
49. Nocturnal Frequency :
Two voidings per night is probably normal for older adults.
If between bedtime and awaking, the patient voids more than
one third of his or her total 24-hr output , this is excessive fluid
excretion.
All patients should restrict fluid intake 4 h before bedtime.
If stasis edema is present , patient should wear pressure graded
stockings.
a potent , short acting loop diuretic can be used in the afternoon
or early evening to induce a diuresis before bedtime, eg,
bumetanide 0.5-1.5 mg titrated to achieve a brisk diuresis.
Evaluate for other factors contributing to volume overload or
diuresis (eg, HF, poorly controlled diabetes).
50. Pharmacologic Therapy
• Eliminate medications causing UI if possible.
• Benefit of topical postmenopausal estrogen therapy in
urge and possibly stress UI are limited.
• Medications as Oxybutynin, Tolterodine, Trospium can be
used but with common adverse effects as constipation,
dry mouth, delirium , dyspepsia and headache, also
should be used with caution in patients with liver
dysfunction.
53. Catheter
• Catheter should be used only for chronic urinary retention,
to protect pressure ulcers and when requested by patients
or families to promote comfort ( eg, at end of life).
54. Pads and Absorbent Products
• they do not cure incontinence and are generally not
regarded as an ideal form of therapy.