INCONTINENC

N U R I Z Z AT I B I N T I Y U S N I
FS 393/10
J U LY 2 0 1 0

HISTORY
Concomitant symptoms of fecal
incontinence or pelvic organ prolapse.
pain with a full bladder, and history of
urinary tract infections (UTIs).
difficult deliveries, grand multiparity,
forceps use, and large babies.
Spinal and CNS surgery.
Lifestyle issues, such as smoking, alcohol
or caffeine abuse, and occupational.

CAUSES
STRESS INCONTINENCE
1. Pelvic floor muscles are weak or damaged
2. Urethral sphincter (the ring of muscle that keeps the
urethra closed) is damaged
3. nerve damage during childbirth
4. increased pressure on tummy, for example because
pregnant or very overweight
5. a lack of the hormone oestrogen in women (less
oestrogen is produced after the menopause)
6. certain medications

URGE INCONTINENCE

1. neurological conditions, which affect the brain

and spinal cord, such as Parkinsons disease or
multiple sclerosis
2. conditions affecting the lower urinary tract
(urethra and bladder), such as urinary tract
infections (UTIs) or tumours in the bladder
3. drinking too much alcohol or caffeine

 OVERFLOW INCONTINENCE
1. an enlarged prostate gland, in men
2. bladder stones
3. constipation

COMMON PRECIPITATING FACTORS

Pregnancy and vaginal delivery
Repeated lifting of heavy objects
Prolonged coughing
Obesity
Repeated straining during urination or
bowel movement
Menopause

CLASSIFICATION

Stress incontinence
Urge incontinence
Mixed incontinence
Overflow incontinence

SIGNS AND SYMPTOMS

Stress: Urine leakage associated with increased
abdominal pressure from laughing, sneezing,
coughing, climbing stairs, or other physical
stressors on the abdominal cavity and, thus, the
bladder
Urge: Involuntary leakage accompanied by or
immediately preceded by urgency
Mixed: A combination of stress and urge
incontinence, marked by involuntary leakage
associated with urgency and also with exertion,
effort, sneezing, or coughing

STRESS INCONTINENCE
Triggers of stress incontinence are
predictable: typically, patients report
involuntary urine loss during coughing,
laughing, and sneezing. Incontinence
worsens during high-impact sports activities
such as golf, tennis, or aerobics. Leakage is
more common while standing than while
lying down.
Little urine is lost, unless the condition is
severe. Typically, affected patients use thin
to medium-thickness pads. The number of
pads used ranges from 1-3 per day.

URGE INCONTINENCE
which is often a very sudden and rapid event
that occurs without any warning. Urge
incontinence is a type of uncontrolled urine
loss that cannot be prevented. In this
situation, the entire contents of the bladder
are lost rather than a few drops of urine.
Examples of situations that may precipitate
urge incontinence include turning a key in the
door, washing dishes, or hearing running
water. Urge incontinence may also be
triggered by drinking too much water or
drinking coffee, tea, or alcohol.

MIXED INCONTINENCE
Patients with mixed incontinence exhibit
symptoms of both stress incontinence and
urge incontinence.

The symptoms of urge incontinence may

unwittingly be confused with the symptoms
of stress incontinence and vice versa. In this
situation, the symptom complex most
unbearable to the patient is treated first.

OVERFLOW INCONTINENCE
Overflow incontinence occurs when the
bladder is overdistended and reaches its
limit of compliance.

Symptoms of overflow incontinence may

mimic those of mixed incontinence.
Patients lose a small amount of urine
when intra-abdominal pressure is
increased.

MEDICATIONS

Cholinergic or anticholinergic
drugs
Alpha-blockers
Over-the-counter allergy
medications
Estrogen replacement
Muscle relaxants
Diuretics

DIAGNOSIS

Cotton swab test

Cough stress test
Measurement of postvoid residual (PVR)
urine volume
Cystoscopy
Urodynamic studies

TREATMENT
Stress incontinence - Surgery, pelvic floor
physiotherapy, anti-incontinence devices,
and medication.
Urge incontinence - Changes in diet,
behavioral modification, pelvic-floor
exercises, and/or medications and new
forms of surgical intervention.
Mixed incontinence - Anticholinergic drugs
and surgery.
Overflow incontinence - Catheterization
regimen or diversion.

MANAGEMENT
Stress incontinence: Pelvic floor
physiotherapy, anti-incontinence devices, and
surgery
Urge incontinence: Changes in diet,
behavioral modification, pelvic-floor
exercises, and/or medications and new forms
of surgical intervention
Mixed incontinence: Pelvic floor physical
therapy, anticholinergic drugs, and surgery
Overflow incontinence: Catheterization
regimen or diversion

WHAT DO I NEED TO DO TO PREVENT

WORSENING OF STRESS URINARY
INCONTINENCE?
Do:

Keep body weight within healthy limits. By doing so, the

weight of the abdominal contents pressing against the
pelvic floor is lessened and prevents the pelvic floor from
weakening further.

Eat a diet rich in fibre and drink between 1.5 - 2 oz of fluids

per day.

Seek early treatment for prolonged cough, and stop

smoking preferably.

Tighten up your pelvic floor before lifting heavy objects,

changing positions, coughing or sneezing - this can be
taught by our hospital physiotherapists.

Pelvic floor exercises especially during and after deliveries.

Don't:
Lift heavy objects repeatedly.
Strain when moving your bowels.

PHYSIOTHERAPY TREATMENT
Pelvic Floor Exercises are prescribed to
strengthen the pelvic floor muscles and
may involve the use of vaginal cones and
biofeedback.
Electrical Stimulation Therapy makes use of
electrical currents to strengthen pelvic floor
muscles. It may be recommended if pelvic
floor exercises have reduced effect.
Bowel Movement Retraining teaches
passing motion without straining the pelvic
floor muscles.

EXERCISE

PELVIC FLOOR EXERCISES.(KEGEL EXERCISE)

1. Pretend you are trying to stop the flow of urine.

2. Hold the squeeze for 10 seconds, then rest for 10 seconds.
3. Do 3 or 4 sets daily.
. BIOFEEDBACK.
1. Using monitors, the biofeedback instructor feeds you information
about bodily processes, including when your bladder and urethral
muscles contract.
. DEVICES.
1. doctors may prescribe a device called a pessary that is inserted
into the vagina to reposition the urethra and reduce leakage.
. INJECTIONS AND SURGERY.
1. securing the bladder with a "sling
2. a piece of tissue or other material that holds up the bladder to
prevent leakage.

THANK YOU