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

6. 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

7.  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

8.  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

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

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

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

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

14.  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.

15. • 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

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

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

18. 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.

19. .

20. Toileting assistance
Dietary and lifestyle
Modifications
BehavioralTraining
Bladder
training

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

22.  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.

23.  Foley cathetor Robinson cathetor

24.  External condom cathetor

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