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

1. URINARY INCONTINENCE
PRESENTED BY -
MR BHUNESHWAR DAYAL MISHRA
(BPT 4TH YEAR)
Welcome in the perfect Physio Tutorial YouTube channel

2. Introduction
Incontinence is the inability to control the passage of urine.
Urinary incontinence, the involuntary loss of bladder control
and general bladder weakness.
This can range from an occasional leakage of urine to a
complete inability to hold any urine.
Incontinence is most common among elderly.
Women are more likely than man to have urinary incontinence.
Children and infant are not considered incontinent, but merely
untrained.

4. Etiology and Risk factors of Urinary incontinence
Bed rest – e.g. recovering from surgery.
Increased urine amounts, like with poorly controlled
diabetes (polyuria).
Alcohol .
Overactive bladder.
Mental confusion.
Pregnancy .
Prostate infection or inflammation.
Stool impaction from severe constipation, causing pressure
on the bladder

5. Urinary tract infection or inflammation .
Weight gain.
Polyuria (excessive urine production).
Caffeine or coca beverages also stimulate the bladder. .
Certain medicines such as diuretics, antidepressants,
tranquilizers, antihistamines for allergy etc.
Alzheimer’s disease .
Multiple sclerosis .
Parkinson’s disease.
Stroke and spinal cord injury.

6. Bladder cancer .
Bladder spasms .
Depression .
Large prostate in men .
Nerve or muscle damage after pelvic
radiation .
Pelvic prolapse in women .
Problems with the structure of the
urinary tract .
Weakness of the sphincter

7. Types of urinary incontinence
1.Stress incontinence
2.Urge incontinence
3.Reflex incontinence
4.Overflow incontinence
5.Incontinence after trauma or
surgery

9. Clinical manifestations of urinary incontinence
1. SENSORY SIGN: -
Odor of urine or feces in the room .
Soiling of undergarments or bed linens
Irritation of perineal area .
Accidents while engaged in physical activity, sneezing,
laughing.
2. EMOTIONAL SIGN:-
Anger
Decline in Social Activity .
Desire for Attention

10. Diagnostic evaluations
Urinalysis and urine culture .
Residual urine measurement.
Vaginal and anal examination.
Urodynamic studies .
Serum electrolytes, calcium levels and BUN/creatinine levels.
Spinal MRI .
Ultrasonography.
Cystourethrography.
Interavenous pyelograpgy (IVP).
Fleuroscopy and video urodynamics
Uroflowmetery, cystometer and urethral pressure profilometery(UPP) .
Electromyography (EMG)

11. Management of urinary incontinence
1. Behavioural techniques :-
Bladder control training.
Scheduled toilet trips .
Biofeedback.
Pelvic floor muscle exercises.
Fluid and diet management
2. Drug therapy :-  Anticholinergic agent ,
 Antispasmodics ,
 Topical estrogen ,
 Tricyclic antidepressants ,
 Alpha- adrenergic blockers , Alpha – adrenergic
agonists.

12. 3.Medical devices :- Urethral inserts.
Pessaries .
Catheters.
Clamps and compression rings for man .
Electrical stimulation devices
4. Surgical treatment for urinary incontinence
Artificial urinary sphincter.
Sling procedures.
Bladder neck suspention
Laproscopic bladder suspension
procedure
Retropubic colposuspension
Bladder augmentation
Neuromodulation

13. Physiotherapy management
PT assessment :-
Subjective information
Pelvic floor muscle function and strength -
0 - no contraction
1 - flicker
2 - weak squeeze, no lift
3 - fair squeeze, definite lift
4 - good squeeze with lift
5 - strong squeeze with a lift

14. Palpation -
P - power,
E - endurance, the time (in seconds) that a maximum
contraction can be sustained
R - repetition, the number of repetitions of a maximum
voluntary contraction
F - fast contractions, the number of fast (one second)
maximum contractions
ECT - every contraction timed, reminds the therapist to
continually overload the muscle activity for strengthening
Mnemonics :- PERFECT

15. PT management
PFMT (pelvic floor muscles training) also known as kegel
Exercises.
Electrical stimulation.
Pre - operation • Keep lungs clear of fluid and prevent chest
infection.
Chest physiotherapy (Breathing exercises).
• Help maintain muscles tone and promote the return of blood
in veins to heart.
Limb physiotherapy (Circulatory exercises) •
Bed mobility

17. Post - operation • Clear lungs and prevent chest
infection ,
• Support abdomen with soft pillow , take 4 to 5
deep slow breaths then 1 deep cough.
• Reduce muscle weakness and pain on the
incision site o posterior basal and lower costal
breathing, concentrating on the affected side .
• Improve coughing, chest expansion, breathing
pattern .

18. . • Patient education ,
•Posture awareness
• Advice patient to continue exercises as taught
• Improve muscle tone and promote the return of
blood in veins to heart - Circulatory exercise.
• Progression for bed mobility
• Ambulate patient around bed site
• Patient education Posture awareness Continue,
exercising 3x/day Avoid heavy weight lifting

19. THANK YOU