URINARY DYSFUNCTION

Definitions
• Enuresis
• Noturnal enuresis
• Nocturia
• Increased day time frequency- >7
• Urgency-compelling desire to pass urine
• Normal desire to void
• Hesitancy-describes difficulty in initiating flow.
• Dysuria
• Post void residual
 Lower urniary tract dysfunction
• Storage -abnormal bladder sensations,
frequency, urgency and leakage of urine
• Voiding- a slow or intermittent stream,
hesitancy at the start of micturition, terminal
dribble
• Post micturition symptoms-a feeling of
incomplete emptying, and post micturition
dribble
• How do you define continence?
• normal ability of a person to store urine and
faeces temporarily, with conscious control
over the time and place of micturition and
defaecation.
• Fundamental to the well-being of individuals
 Incontinence
• the involuntary or inappropriate passing of
urine or faeces, or both, that has an impact on
social functioning or hygiene.
• A sign or symptom
• May be temporary associated with transient
cause ( infection, unconsciousness) persistent
cause (trauma in childbirth, stroke)
 Types of incontinence
• Extraurethral incontinence
• Detrusor overactivity incontinence
• Urodynamic stress incontinence
• Nocturnal enuresis
• Giggle incontinence
• Functional incontinence
 Extraurethral incontinence
• Loss of urine through channels other than the
urethra is called extraurethral incontinence.
Cause:
• Congenital abnormality
• Fistulae between vagina and urethra/bladder
as a result of trauma such as hysterectomy.
Management:
- Requires reconstructive surgery
 Detrusor over activity
incontinence/urge incontinence
• Most common
• Complains of urge incontinence- leakage
preceded by urgency
• Detrusor activity –neurogenic /idiopathic
Management:
- Predisposition to falls and fracture
- Pharmacotherapy to reduce detrusor activity
- bladder retraining, scheduled toileting
- PFM strengthening
 Urodynamic stress incontinence
• Incontinence on stress, increased IAP
• Urine of leakage, involuntary spurt or dribble
on increase in IAP (coughing)
• Urethral sphincter incompetence
• Mixed incontinence=involuntary
leakage+urgency with effort, sneezing,
coughing
 Urodynamic stress incontinence
Cause:
- Prolapse of urethra/bladder due to damaged
supporting structures
- PFM weakness (trauma, nerve to levetor ani,
stretching from overuse, prolonged sitting)
Management:
-biofeedback with or without stimulation
- PFM exercises
 Nocturnal enuresis
• Bed wetting, incontinence during sleep(after 5
years)
• Social and psychological cause
• Common in children
Management:
- Specialist care
- Change diet (reduce caffiene, cola drinks,
chocolate)
- Antidiuretics
 Giggle incontinence
• Girls in particular go through a giggling phase
around puberty, if not before.
• A few find this results in embarrassing leakage of
urine.
• There is often a positive family history of this
problem.
• It is thought that giggle incontinence is caused by
detrusor overactivity induced by laughter
Management:
- PFM exercises
 Functional incontinence
• This section includes all cases where there is
involuntary loss of urine resulting from a
deficit in ability to perform toileting functions
secondary to physical or mental limitations.
 Physiotherapy assessment methods
• Interview
• Urinalysis (using strips, PTs should take proper training for
reading strips)
• Bladder diary (frequency/volume chart)
• Pad test (takes 1 hour to complete- a difference of 1g in
starting and post test weight of pad)
• Paper towel test- patient holds a coloured paper towel
against the perineum and coughs strongly three times.
Paper towel changes colour if any leakage occurs
• Perennial and vaginal assessment –specialized training
• Biofeedback
• PFM assessment – different ways
• Perioniometer- changes in activity in the region
of the vagina. For PFM.
• The educator –for PFM
• EMG equipment
• Quality of life questionnaire
• VAS- The patient is asked to place a cross at the
appropriate point on a 10 cm line, one end of
which is marked, for example, ‘no leakage’ at the
other end ‘always wet’
• US of bladder
Bladder diary