GTJ215/3 Medical-Surgical Nursing II

CARE OF PATIENTS
WITH INCONTINENCE

p
Dr. Dariah Mohd Yusoff
23 May 2017
NSL2, PPSK, USMCK
What is normal bladder and bowel control?
1. Pass urine 4-6 times during the day
and once over night

2. Open bowel between once per day to

3 times per week

3. Bowel are soft and formed

4. Bowel are easy to pass

5. No blood in urine/stools

6. Feeling in control - no rush to the

toilet or no leak before getting in toilet
 3

Stool chart
At some point in our toilet-trained lives over
(conservatively) of people in this room will have experienced
of an inability to control their urine or faeces by the time we
die.

This is incontinence. Many of us will not call it that. We will

call it as an accident or a leakage.

Many of us will try and hide it from our family, friends and
the community.

All of us can be helped but the majority will never seek help*
- remains UNDERREPORTED & UNDERTREATED
 Incontinence is a significant health
issue
It is the involuntary loss of urine and/or faeces

It occurs across the human lifespan

It is recognised as a health issue in Australia since 1998

Has been identified as a population health issue by the

World Health Organisation (WHO) since 2002

Still underdeveloped in Malaysia

 Incontinence

1. Urinary incontinence

2. Fecal/anal/bowel incontinence
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Urinary Incontinence
 Learning objectives:

1. Defines urinary incontinence (UI)

2. States the common types of UI
3. List clinical manifestations of each
type of UI
4. Describe the impact of UI
5. Discuss the management of UI
 Definition of UI

Involuntary loss of urine which is

objectively demonstrable and a social
or hygienic problem.
The International Continence Society (Abrams, Cardozo & Fall,
2002)
 Who is incontinence?
Almost anyone common at all ages

Increase with age and disability

1:10 > 65 years old

Majority live at home & lead normal lives

More common in women*

 Under reported -Why?
It is poorly understood, hard to verbalise and rarely discussed

It is seen as an inevitable consequence of ageing

It is seen as an inevitable consequence of childbirth

It is seen as irreversible

It is not seen as an issue that they should bother the doctor

about

People do not know help is available

Health Professionals do not raise it with their patients

 Continence only in a socially acceptable place

Incontinence in the wrong place (in clothing,

in bed or onto the ground, or into the wrong
receptacle (Norton 2001)

failure to do so evokes feelings of

disgust, an emotion linked to
protection from disease
Common types of UI in women

1. Stress urinary incontinence (SUI)

2. Urge urinary incontinence (UUI)

3. Mixed urinary incontinence (MUI)

 SUI
Definition
Involuntary leakage upon effort or exertion, or on
sneezing or coughing; loss of urine upon increased
abdomen pressure
Causes;
A loss bladder neck support nerve, muscle and tissue
urethral sphincter incompetence

Most common type in women young and

middle-aged women
SUI
 UUI
Definition
Involuntary leakage of urine immediately preceded or
accompanied by urgency; sudden sensation of a need to
pass urine with inability to get to a toilet before involuntary
leakage

Causes:
Bladder infection, high concentration of urine, neurology
dysfunction uncontrolled bladder contraction

The person may experience urgency

with or without leakage

Usually with frequency and nocturia

 MUI
Definition
Involuntary leakage associated with urgency
as well as with exertion, effort, or increase
abdominal pressure, causing symptoms of
both conditions

Causes
An overactive detrusor in combination with an
incompetent urethra

Commonly affects older populations

The prevalence of UI

Prevalence rate:
9-22% over the whole population

20-71% of women in general global population

36 65% in pregnant women

11 30% in postnatal women

 Risk factors of UI in women

1. Medication
2. Genitourinary operation
3. Obesity
4. Multi parity
5. Pregnancy
6. Vaginal delivery
7. Episiotomy*
8. Weakness of urethra due to trauma
9. Other medical diseases
10. Menopause
11. Aging
12. Constipation
 Issues of UI
Health care professionals and the public have
misconceptions about UI

Lack of in-depth knowledge

Ignore UI as a disease less attention

UI sufferers reluctant to seek treatment and cope

with UI alone worsen Quality of Life
(all aspects of well being)
 Negative impacts of UI
Influences quality of life (QoL)

1. Decreased psychosocially wellbeing

Affects religious and sexual functions

2. Physical discomfort walking, dancing and swimming,

concentration and performance in work

3. Indication for nursing home care

4. Economic burden individual, family & country

- up to 2% of health care budget in USA
 Factors influence the impacts
1. Age
Younger aged affects; more

2. Type of incontinence
MUI and UUI affects most - harder to predict and to
control

3. Severity of incontinence
Worsen in severe cases
 Management of UI
1. Multidisciplinary health professionals
2. Primary health care settings
3. Management should cover;
Regular screening for UI
Health education
Continence promotion
Access to specialist and tertiary care (if necessary)

4. Treatment options
Conservative therapies
Pharmacological intervention
Combinations of the above
Surgical intervention
 Conservative therapies
1. Behavioral therapy (bladder training, electrical
stimulation, vagina cone etc.)

2. Pelvic floor muscle exercise (PFME)

3. Combinations

PFME is the 1st choice

- Effective first line treatment

- Appropriate for patient who reluctant/ not fit

surgery
Pelvic Floor Muscle Exercise
(PFME)
 Urogenital Anatomy
Locate the muscle
 27

Pelvic floor muscle

The main muscle of pelvic floor
LEVATOR ANI
 Pelvic Floor Muscle Exercise (PFME)
Known as Kegel exercise in 1940s

Repetition of contraction and relaxation of pelvic floor

muscle

How does PFME help?

1. Strengthen the muscles
2. Give support improve bladder control and
improve/stop urine leakage

*Principle the more usages and exercises, the

stronger the pelvic floor muscles will be
 30

Lets do the exercise !

1. Slow squeeze

2. Fast squeeze
 PFME
1. Lie down, sit or stand with legs apart,
but make sure your thighs, bottom and
stomach muscles are relaxed
2. Imagine as if you are trying to hold
urine and back loud wind
3. Squeeze and pull up the muscles as
tightly as possible
4. Hold the squeeze for at least five
seconds, and then relax for at least ten
seconds
5. Do these exercises between 3 5
different times a day

Continence Foundation of Australia, 2011 MORE INFO: http://www.continence.org.au/pages/pelvic-

floor-muscle-exercises.html
 32

Perform PFME correctly

 Tips to keep bladder in control
1. Drink 1.5 to 2 liter/day unless advices due to
certain health problems
2. Avoid:
i. taking diuretic drug after 4 pm
ii. alcohol and caffeinate drinks
iii. Constipation
iv. Smoking
3. Void normally: 5-8 times/day and once at night.
Go to the toilet whenever you feel the bladder is
full.
4. Perform PFME correctly everyday
5. Modify the toilet easy and safe to use
6. Keep the toilet lights on (night time)
7. Use an easy ware clothing
 Other aspects for consideration
1. Seek professional helps
Hospitals, Clinics, Community clinics
2. Use of continence products diapers etc.
3. Skin care perineal part
4. Manage the odour
5. Strategies for socialize
6. Emotional support
7. Special attention to:
Blood in urine/stools
Dark urine/stools
Loosing weight