Urinary Incontinence

Incontinence of the bladder (loss of urine) is

a common problem among older adults.
It is a symptom rather than a disease in
itself.
Women are particularly affected by urinary
incontinence, and because many find it
embarrassing to discuss, the problem often
goes untreated.

Case Study
B.K. is a 57-year-old woman (height 65 inches, weight 64 kg) who
has progressive difficulty with bladder control during the daytime. W
hen she feels like she needs to use the toilet, she is sometimes
unable to get to the bathroom on time. She has experienced a few
accidents and is deeply embarrassed. W hen she exercises or
coughs, she loses small amounts of urine. Her home drugs include
alendronate 70 mg weekly for osteoporosis, loratadine 10 mg daily
for allergies, calcium carbonate 600 mg twice daily, vitamin D 1000
units daily, and ibuprofen 200 mg once daily for osteoarthritis. She
is a lifelong smoker and does not drink alcohol. She consumes 1 cup
of regular coffee with each meal. She complains of some
osteoarthritis pain and her pain scale rating is 2/10.

Types of Incontinence

Stress Incontinence
Results from multiple pregnancies, obesity,
or surgery
triggered by laughing, sneezing, coughing,
or straining of abdominal muscles to the
point that the intra-abdominal pressure is
greater than the ability of the sphincters to
resist
Small amounts of urine are lost in
occasional or frequent episodes.

Treatment:
Kegel exercises with or without
biofeedback.

Urge Incontinence
related to birth defects, spine or nerve
damage, immobility, prostate problems,
overactive bladder, or cancer
sudden and unexpected need to void with
moderate to large amounts of urine lost.

Treatment:
Kegels exercise
Combining the pelvic floor strengthening
exercises with timed voiding, lengthening
the amount of time between voiding until
more normal voiding patterns are
achieved.

Overflow Incontinence
with birth defects, spinal cord injury or
nerve damage, multiple sclerosis, or
loss of bladder muscle tone
Post surgery
side effect of medications.
small to moderate amounts of urine
spilling over from a full bladder and

Treatment:
If it is a result of a side effect of the
medication, discontinue or change the
medication
bladder may be scanned to check
postvoid residual urine.
PVR (postvoid residual) catheterization
- This is done by performing a straight

Reflex incontinence
related to spinal cord injury, developmental
disability, congenital defect, dementia, or
other brain injury, reflex incontinence gives
no warning prior to the incontinent episode.
large amount of urine is lost and emptying
may be complete

Functional incontinence
inability to get to bathroom facilities
due to functional reasons such as
obesity, clutter that blocks the path to
facilities, or immobility.

Treatment:
a commode may need to be placed
nearer to the bedside at night to avoid
nocturia incontinence at night
modify lifestyle