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Urinary Incontinence

By Efris Kartika Sari

It is estimated that between 210.000335.000 adults in Scotland have significant


problems with urinary continence (5-9% of
the adult population).
Urinary incontinence affects people of all
ages but is particularly common among the
elderly

Definition
Urinary incontinence is the complaint of any
involuntary leakage of urine.
There are several types of urinary
incontinence.

Stress incontinence is the involuntary loss


of urine through an intact urethra as a
result of a sudden increase in
intraabdominal pressure (sneezing,
coughing, or changing position).
Urge incontinence is the involuntary loss of
urine associated with a strong urge to void
that cannot be suppressed. An uninhibited
detrusor contraction is the precipitating
factor.

Reflex incontinence is the involuntary loss


of urine due to hyperreflexia in the absence
of normal sensations usually associated
with voiding.
Overflow incontinence is the involuntary
loss of urine associated with overdistention
of the bladder. Such overdistention results
from the bladders inability to empty
normally, despite frequent urine loss.

Functional incontinence refers to those


instances in which lower urinary tract
function is intact but other factors, such as
severe cognitive impairment (eg,
Alzheimers dementia).
Iatrogenic incontinence refers to the
involuntary loss of urine due to extrinsic
medical factors. One such example is the
use of alpha-adrenergic agents to lower
blood pressure.

Risk Factors

Urinary incontinence, especially in the


elderly, can be worsened or caused by
underlying diseases, especially conditions
that cause polyuria, nocturia, increased
abdominal pressure or CNS disturbances.
The conditions include: cardiac failure
chronic renal failure, diabetes, chronic
obstructive pulmonary disease, and
neurological disorders.

Assessment and Diagnosis


Voiding diaries: semi-objective method of
quantifying symptoms, such as frequency of
urinary incontinence episodes.
Urinalysis: reagent strip (dipstick)
urinalysis may detect infection, proteinuria,
haematuria and glycosuria.
Post-voiding residual (PVR) volume (also
known as residual urine, bladder residual) is
the amount of urine that remains in the
bladder after voiding.

Urodynamics: generally used as a collective


term for all tests of bladder and urethral
function (i.e. uroflowmetry, and invasive
tests, including multichannel cystometry,
ambulatory monitoring and videourodynamics)

Pad testing: a well-designed continence pad


will contain any urine leaked within a period
of time and this has therefore been used as
a way of quantifying leakage.
Imaging (USG, MRI): improves our
understanding of the anatomical and
functional abnormalities that may cause UI.

Treatment
Fluid management
Standardized voiding frequency
Pelvic muscle exercise (kegel exercises)
Transvaginal or Transrectal Electrical Stimulation:
often used with biofeedback-assisted pelvic
muscle exercise training and voiding schedules.
Neuromodulation via transvaginal or transrectal
nerve stimulation of the pelvic floor inhibits
detrusor overactivity and hypersensory bladder
signals and strengthens weak sphincter muscles.

Drugs: antimuscarinic (i.e. oxybutynin,


solifenacin), and medication foe undelying
disease (i.e. antibiotic for UTI).
Surgery i.e. burch colsosuspension, mid
urethral slings, single incision slings, bulking
agents.

The open Burch colposuspension aims to


approximate the lateral tissues of the
vaginal vault to the pectineal ligament by
means of insertion of several, interrupted,
non-absorbable sutures.
Mid-urethral slings: the development of
synthetic mesh materials and devices to
allow minimally invasive insertion.

Single-incision slings: the basis of providing


mid-urethral support, using a variety of
modifications to a short macroporous
polypropylene tape.
Bulking agents: injection of a bulking agent
into the submucosal tissues of the urethra is
thought to increase the coaptation of the
urethral walls, in turn leading to increased
urethral resistance and improved
continence.

Nursing management is based on the


premise that incontinence is not inevitable
with illness or aging and that it is often
reversible and treatable.
For behavioral therapy to be effective, the
nurse must provide support and
encouragement.

If pharmacologic treatment is used, its


purpose is explained to the patient and
family.
If surgical correction is undertaken, the
procedure and its desired outcomes are
described to the patient and family.