Urinary Incontinence in Older Adults

Posted by e-Medical PPT
Urinary incontinence is defined as the involuntary leakage of urine
Some definitions have required that this be considered a ‘social or hygienic problem’
More widely accepted definitions assume all incontinence fits this criteria
However, the degree of bother to the patient and caregivers is an important consideration

Overactive bladder’ = OAB
Characterized by urinary urgency and frequency
May or may not be associated with incontinence
‘Overactive bladder wet’ =  + leakage of urine
‘Overactive bladder dry’ =  urgency and frequency without leakage

Urinary incontinence (UI) may be chronic (established) or transient (temporary)
This module and the ACOVE Indicators focus primarily on chronic UI

Effects of Urinary Incontinence
Urinary Incontinence has significant negative impact on both overall and health-related quality-of-life (QoL)
Social isolation
Psychological distress
Increased caregiver burden
Skin inflammation / breakdown
Sleep disturbance
? Increased risk urinary tract infection (UTI)
Limitation or avoidance of sexual activity

Physiology of Micturition
Complex series of coordinated events
Bladder filling and storage of urine
Comprehension of bladder sensations
Physical activity associated with normal voiding
 Mobility to reach toilet facilities
 Transfers on and off toilet
 Ability to adjust clothing appropriately
Voiding process with adequate emptying
Completion of voiding, re-dressing, transfer off of the toilet

Storage of urine
Requires the bladder to fill at low pressures
No unstable bladder contractions
Adequate stretch of bladder detrusor muscle (compliance)
Closed external urinary sphincter
Normal bladder capacity ~ 300 – 500 mL
First sensation of filling ~ 150 – 200 mL
Sensation of need to void ~ 200 – 400 mL...

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