INCONTINENCE

M.Indumathi,M.sc-1st year
Med-surg Depart.
INCONTINENCE
Unable to retain the
natural discharge or
evacuation of urine
or feces.
What will you learn in the upcoming minutes?

What is happening to bladder ?

How will get evaluated?

Therapy with medication
Others Forms of interventions
ANATOMY
TERMS TO KNOW:
URGE
VOID
Anatomy Review
Bladder: stores urine
Urethra: tube that allows urine to pass
Urethral sphincter: muscle surrounding the
urethra that hold the urine
Brain signals are key to coordinating the
function of these anatomical structures
 What is happening to bladder?

1. Autonomic nervous system control

– Nerve coming from the spinal cord and go directly to the
bladder
– When bladder gets fuller, signals are sent to the brain

2. Central nervous system

– Voluntary control to choose when to void

 Both can be altered by aging or

neurological disease
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 Normal Voiding Cycle
Emptying
Bladder pressure

Filling & storage phase phase

Normal desire
First sensation to void
Bladder filling to void Bladder filling
DEFINITION
- BLADDER INCONTINENCE/URINARY
INCONTINENCE -

• Urinary incontinence means there is loss of

bladder control which leads to unintentional
passing of urine
TYPES OF INCONTINENCE

• There are several types of bladder

incontinence which are:
 Stress incontinence – abdominal pr. occurs
during certain activities like coughing,
sneezing, laughing etc.
 Urge incontinence –Inability to hold the
flow of urine,when feeling the urge to void
TYPES
Mixed incontinence – combination of both stress
and urge incontinence symptoms

Overflow incontinence – retention with overflow

of small amounts of urine.

Urgency is a sudden desire to void

Frequency is passing of urine seven or

more/day or being awoken from sleep more than
jif once a night to void.
What is urinary
incontinence

What is stress
incontinence
ETIOLOGY
• Bladder incontinence:
 Stress incontinence
- weakening of urethral sphincter and
pelvic floor muscles
- pregnancy
- childbirth
- age
- obesity
- menopause
- surgical procedures, e.g. hysterectomy
 Urge incontinence
- overactivity of the detrusor muscles
- cystitis
- central nervous system (CNS) problems
- an enlarged prostate
 Overflow incontinence
- an obstruction or blockage to the bladder
- an enlarged prostate gland
- a tumor pressing against the bladder
- urinary stones
- constipation
BLADDER INCONTINENCE
PATHOPHYSIOLOGY
Incontinence of the bladder occurs when those pelvic
muscles that involves in urination get traumatized,
either overstretched or tear, that leads to weakness of
the muscles.

As time goes by, the muscles become weaker until at

certain point, they cannot support the bladder
anymore.

When there is high pressure from the abdominal

such as coughing, sneezing, lifting or pushing
heavy things, the bladder forces urine past the
urethral sphincter causing incontinence to occur.
 CLINICAL FEATURES

STRESS INCONTINENCE OCCURS WHEN:

1) Cough
2) Sneeze
3) Laughing
4) Lifting heavy objects
5) Vigorous exercise
6) Have sexual intercourse
7) Standing in prolonged time
URGE INCONTINENCE OCCURS :
1) Frequent urination, in a day and at
nighttime
2) Sudden urination and urinary urgency

OVERFLOW INCONTINENCE OCCURS:

1) Bladder never feels empty.
2) Inability to void when the urge is felt
3) Urine dribbles even after voiding
 How will I get evaluated?

“Hello, incontinence helpline – Can

you hold?”
INVESTIGATIONS
• Physical examination- to identify pelvic
muscle prolapse.
• Urine culture & sensitivity—to identify
Infections.
• Pad test
• Measure Postvoidal Residual Volume by
bladder ultrasound or urethral catheter .
• Urodynamic studies
Uroflowmetry-- Bladder outlet obstruction
Cystometry -- Detrusor/bladder contraction
activity

• Cystogram – to visualize the bladder.

• Cystoscopy
– Tumors, stones
 What is
cystogram
MANAGEMENT
Medication
- Anticholinergics (medication to calm an
overactive bladder)

- Anti depressant
-Imipramine
- Duloxetine
- Topical estrogen.
-alpha & beta adrenergic antagonist
-phenylpropanolamine
Medical device
– Urethral insert (FemSoft insert)
– Pessary
– external condom
drainage(men)

Surgery
- Sling procedures
- Bladder neck suspension
- Artificial urinary spinchter
(Urinary incontinence: Incontinence products to help keep you dry, 2011)
ARTIFICIAL URETHRAL SPHINCTER
PESSARY
SLING PESSARY
 NURSING DIAGNOSIS

Impaired skin
integrity Ineffective
Stress
related to coping
incontinence
constant related to
related to contact of inability to
weak pelvic urine with control urine
floor muscle perineal leakage
tissues.
 Nursing management

1.Pelvic floor exercise:

1. Helps strengthen the
muscles of the pelvic Bladder
Relaxatio
floor – improves bladder n

stability

2. Helps suppress the

feeling of urgency
Contraction

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2.Bladder training:
Scheduled voiding at set times during the
day
Active use of muscles to prevent urine
loss
Keep own input and output chart

33
3.BEHAVIOUR MODIFICATION :

1. Drink less than 5 glasses/day (40 oz)

2. Stop drinking after dinner
3. Elevate legs
4. Timed voiding
5. Regular pelvic floor exercises

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Kegel exercise for men and women:

Find your pelvic floor muscles.

Squeeze your pelvic floor muscles as hard as
you can and hold them (squeeze 3-5 sec
and relax for 5 sec).
Do sets of repetitions of squeezing (start with 5
repetitions: squeeze, hold, relax).
Increase lengths, intensity, and repetitions
every couple of days.
Perform Kegel exercises 3-4x during the day.

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