Inkontinensia urine

ditinjau dari
ginekologi
 Inkontinensia urine
Hubungannya dengan ginekologi
seberapa besar masalahnya

bagaimana pengelolaannya
Problems Associated with

Lack of Bladder Control

• Physical
• Psychological
• Social
• Sexual
• Occupational/Financial
 Insidensi ?

20 - 50 % wanita penah mengalami

inkontinensia urine

10%
Keluhan menetap
Hubungan kejadian inkontinensia urine
dengan paritas

Paritas
Hubungan inkontinensia
urine dengan umur

Umur
Penyebab inkontinensia urine yang
berhubungan dengan ginekologi

 Fistula urogenital
 stres inkontinensia

 Instabilitas kandung kemih

 Jenis yang paling
sering !!!!

Stress Kandung kemih

inkontinensia hiperaktif
 FAKTOR RISIKO !!!

USIA. RAS,
PERSALINAN
MENOPAUSE
kelemahan DASAR PANGGUL
 Stress Incontinence

Stress incontinence occurs when a

small amount of urine escapes while
the person coughs,
coughs sneezes,
sneezes
laughs,
laughs jumps or lifts something
heavy.
heavy
 Faktor yang
mempertahankan kontinensi

 Faktor penyokong urethra

 Bladder neck yang baik
 Sfingter urethra yang baik
 Mekanisme penutupan oleh sfingter
urethra interna merupakan mekanisme
pasif

Seluruh komponen sfingter urethra interna

terpengaruhi oleh
hormon estrogen
 Stress Incontinence
(a) Continent woman (b) Woman with stress
incontinence

External
urethral
sphincter

Sudden increase in intra-abdominal pressure

Kerusakan diafragma pelvis
akibat proses reproduksi
akan menyebabkan
kelemahan / kerusakan
urethra

 sistokel
prolapsus uteri
 HIPERAKTIF
KANDUNG KEMIH

Jenis inkontinensia urin kedua terbanyak

 Overactive Bladder

Definition:

Overactive bladder is a chronic condition in

which the bladder starts to contract too early
when it is filling with urine.
 Diagrammatic
Representation
of Overactive Bladder

Bladder pressure
Pressure > urethral pressure
 Symptoms of
Overactive Bladder
Frequency

Urgency Bladder pressure Urge

> urethral pressure Incontinence
 Frequency
Going to the toilet often (more than
eight times in a 24-hour period)
 Urgency

A strong and sudden desire to urinate

 Urge Incontinence

Urge incontinence occurs

when there is a very
strong urge to pass urine
and which cannot be held
back, resulting in the
person wetting himself
on the way to the toilet

Image source: Society for Continence (Singapore)

 Cause of Overactive
Bladder
• In the majority of cases, the underlying
cause is unknown.
unknown
• In some patients, the cause may be a
neurological deficit.
• Multiple sclerosis
• Stroke
• Parkinson’s Disease
• Spina Bifida
• Spinal cord damage
Who Manages Patients with
Overactive Bladder ?
• General practitioners (GPs)
• Nurses/ continence advisors
• Geriatricians
• Urologists
• Gynaecologists
• Others
• E.g. paediatricians, neurologists,
physiotherapists and psychologists
Treatment Options —
Overactive Bladder
• Drug therapy
• Bladder training techniques
• Intermittent self-catheterization
• Incontinence pads and
protective equipment
• Surgery
 Overflow Incontinence

Overflow incontinence happens when

urine leaks from an overfilled bladder.
bladder
Overflow Incontinence
 Mixed Incontinence

Mixed incontinence occurs when a

person has both the symptoms of
urge incontinence and stress
incontinence.
incontinence
Mixed Incontinence

Sudden increase
in intra-abdominal
pressure

Uninhibited detrusor
contractions
Diagnosis ?
 Penata laksanaan

1. Koservatif
 Latihan otot dasar panggul
 medikamentosa
 pesarium
2. Operatif
 TERIMA KASIH