URINARY INCONTINENCE and FAECAL INCONTINENCE

URINARY INCONTINENCE

Definition
UI is the involuntary loss of urine that is objectively demonstrable and a social or hygienic problem.
International Continence Society

Types of Urinary Incontinence

Transient UI (Acute) Established UI (Chronic)
Urge UI Stress UI Mixed UI Overflow UI Functional UI

Transient Incontinence
Lower urinary tract pathology Precipitated by reversible factor 1/3 Community dwelling 1/2 Hospitalized incontinent aged patients Causes: Delirium, UTI, Meds, Psychiatric disorders, UO, Stool impaction Restricted mobility

Causes of Transient (Acute) Incontinence

D I A P P E R S Delirium Infection Atrophic Vulvovaginitis Psychological Pharmacologic agents Endocrine, excessive UO Restricted Mobility Stool impaction

Source: Resnick NM. Urinary incontinence in the elderly. Med Grand Rounds. 1984;3:281-290.

Established Incontinence
URGE STRESS OVERFLOW Functional incontinence

Urge Incontinence
Other Names: detrusor hyperactivity, detrusor instability, irritable bladder, spastic bladder

Most common cause of UI >75 years of age Abrupt desire to void cannot be suppressed Usually idiopathic Causes: infection, tumor, stones, atrophic vaginitis or urethritis, stroke, Parkinsons Disease, dementia

Stress Incontinence
Most common type in women < 75 years old Occurs with increase in abdomenal pressure; cough, sneeze, etc. Hypermotility of bladder neck and urethra;
associated with aging, hormonal changes, trauma of childbirth or pelvic surgery (85% of cases)

Intrinsic sphinctor problems; due to

pelvic/incontinence surgery, pelvic radiation, trauma, neurogenic causes (15% of cases)

Overflow Incontinence
Over distention of bladder Bladder outlet obstruction; stricture, BPH,
cystocele, fecal impaction

Non-contractile baldder (hypoactive detrusor or atonic bladder); diabetes, MS,

spinal injury, medications

Functional Incontinence
Does not involve lower urinary tract Result of psychological, cognitive or physical impairment

Alvi Incontinence
Clinical: 1. Liquid stool / not yet established, seep out. 2. Discharge of fecal matter has been formed, 1x or 2x per day on clothes or in bed.

FAECAL INCONTINENCE

faecal incontinence due to constipation

Constipation if it lasts a long time cause blockage / impaction of hard fecal mass (skibala). Skibala will clog the holes under the anus and cause large changes in ano-rectal angle. Blunted the ability of the sensor, can not distinguish between flatus, liquid or feces. As a result, liquid stool would seep out

Symptomatic faecal incontinence

May be a clinical presentation of various pathological disorders that can cause diarrhea. Some causes of diarrhea that resulted in symptomatic alvi incontinence include gastroenteritis, diverticulitis, proctitis, colitis, ischemic, ulcerative colitis, carcinoma of the colon / rectum. Other causes such as metabolic disorders, such as diabetes mellitus

Neurogenic faecal incontinence

Disruption caused by inhibiting function of the cerebral cortex during the stretch / distention of the rectum. Distention of the rectum, will be followed by the internal sphincter relaxation

Faecal incontinence due to loss of anal reflex

Occurs due to loss of anal reflex, muscle weakness accompanied by a shift of latitude. In this type, there is a reduction of units of motor function in the muscles of the sphincter and the pubo-rectal. This situation led to the loss of anal reflex, decreased sensation in the anus with decreased anal tone.