Incontinance a difficult problem

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INCONTINENCE

• By C Spain.

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What is incontinence?

• Incontinence is the inability to control either
  the passage of urine and/or faeces from the
  bladder or the bowel.
• As urinary incontinence is more common then
  faecal incontinence we shall concentrate on that
  form of incontinence.
• This can range from an occasional leakage of
  urine to a complete inability to hold any urine
  your bladder at all.

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The urinary system

• Overall function of the system
• 1. Eliminates most of the waste products of
  metabolism.
•  But it must also retain (reabsorb) molecules
  essential for normal body function (e.g. glucose
  and amino acids)
• This elimination of waste products plus
  reabsorption of essential materials is
  accomplished by nephrons located in the kidneys
  (each kidney has about one million nephrons).
•        

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• 2. regulation of body fluids
•         3. balance of the pH and electrolyte
• composition of body fluids.
•         4. production of hormones, including
• renin, which is important in
• regulation of blood pressure.

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The urinary system
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The bladder
The Trapezium.
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The main types of urinary incontinence.

• There are four main types of urinary
  incontinence. They are---

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TYPES OF INCONTINENCE

• Stress incontinence.
• This occurs during certain activities like
  coughing, sneezing, laughing, or exercise.

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TYPES OF INCONTINENCE

• Urge incontinence.
• This involves a strong, sudden need to urinate
  followed by instant bladder contraction and
  involuntary loss of urine. You dont have enough
  time between when you recognise the need to
  urinate and when you actually do urinate

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Types of incontinence

• Overflow incontinence.
• This happens when small amounts of urine leak
  from a bladder that is always full. A man can
  have trouble empting his bladder if an enlarged
  prostate is causing a blockage. Diabetes and
  spinal cord injury can also cause this type of
  incontinence.

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Types of incontinence

• Functional incontinence.
• This happens in many older people who have normal
  bladder control. They just have a hard time
  getting to the toilet in time because of
  arthritis or other disorders that make moving
  quickly difficult.

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Signs and symptoms..

• The main symptom of urinary incontinence is
  leakage of urine
• This leakage can be frequent and heavy, or it can
  be small and rather rare. For an active person
  who loses a large amount of urine each time, even
  one episode per week may be too much.

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Other common symptoms include

• A strong desire to urinate, whether or not the
  bladder is full, often occurring together with
  pelvic discomfort or pressure.
• Urinating more than once in a two-hour period, or
  more than seven times a day.
• The need to get up and urinate at least twice
  during sleep.
• Painful urination.
• Bedwetting or urinating whilst asleep.

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Causes of incontinence.

• Incontinence may be sudden and temporary, or
  ongoing and long term.
• Causes of sudden or temporary incontinence
  include---

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Causes of temporary incontinence.

• Urinary tract infection or inflammation
• Prostate infection or inflammation
• Faecal stool impaction from severe constipation,
  causing pressure on the bladder.
• Side effects of some medications

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Causes of temporary incontinence.

• Poorly controlled Diabetes
• Pregnancy
• Weight gain
• Short term bed rest for example recovering from
  an operation
• Mental confusion.

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Causes that may be more long term would
include---

• Spinal injuries
• Urinary tract anatomical abnormalities
• Neurological conditions like multiple sclerosis
  or stroke
• Weakness of the sphincter, the circular muscles
  of the bladder responsible for opening and
  closing it this can happen following surgery for
  example prostrate surgery
• Pelvic prolapse in women often related to having
  had multiple

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Causes that may be more long term would include---

• pregnancies.
• Large or enlarged prostrate in men.
• Depression or Alzheimers disease.
• Nerve or muscle damage.
• Bladder cancer.
• Bladder spasms.
• An acquired brain injury.

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Problems with incontinence .

• (In groups look at the problem of incontinence
  and ways this problem would impede on your life.)

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Ways to help

• There are medications to help with this
  condition, but it depends on the cause as most of
  them work on the muscles surrounding the bladder.
• H R T can help with women
• Antibiotics can help if the incontinence is
  caused by an infection.

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Other methods include---

• Regulate your bowels to avoid constipation-Try
  increasing fibre in your diet.
• Quit smoking to reduce coughing and bladder
  irritation, Smoking also increases your chances
  of getting bladder cancer.
• Avoid alcohol and caffeine, which can over
  stimulate your bladder.

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• Lose weight if you need to.
• Avoid foods and drinks that may irritate your
  bladder, like spicy foods, carbonated drinks, and
  citrus fruits or juices.
• Keep blood sugars under control if you suffer
  from diabetes.

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Incontinence can be Cured

• There are many different kinds of treatment
  depending on the cause. Firstly it is important
  to make sure that there isn't a urine infection
  (cystitis) as this can sometimes cause temporary
  incontinence and is easily treated.
• If the main complaint is stress incontinence,
  pelvic floor exercises may be helpful. These have
  to be practised daily and a cure rate of up to
  70 may be expected.
• If these fail or are inappropriate, surgery is
  the next step. Conventional major surgery may
  achieve a success rate of 85 to 90 but there is
  usually a 4-6 day stay in hospital and some
  discomfort from the abdominal wound with an
  eventual return to work after 4 to 6 weeks.

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Facts

• Urinary incontinence affects 13 million people in
  the UK
• It is more common in women than men.
• It occurs in 10 to 25 per cent of women under 65
  years old.
• It occurs in 15 to 30 per cent of women older
  than 60 who do not live in nursing homes.
• Among nursing home residents, incontinence is
  even more common, affecting more than 50 per cent
  of female residents.

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Thank you

• Mr C Spain 2007
• 
  Thanks to valley home care for
  help.