Incontinence: Risks, Causes and Care

Transcription

1 Welcome To Incontinence: Risks, Causes and Care Presented by Kamal Masaki, MD Professor and Chair Department of Geriatric Medicine John A. Burns School of Medicine, UH Manoa September 5, :00 11:00 a.m.

2 Your Participation Join audio: Choose Computer audio to use VoIP Choose Phone Call and dial in using the information provided Questions/Comments: Submit questions and comments via the Questions panel. Note: Today s presentation is being recorded. Attendees can access the recording at Evaluation: surveymonkey.com/r/nxgjh SN

3 Certificate of Completion Requirements: 1. Register for the webinar 2. Submit payment 3. Complete the Evaluation ( GJHSN) and attest to your attendance; this link will also be sent to registrants in a follow up 4. Once all requirements are completed, your Certificate of Completion will be sent to you via the address you provide on the Evaluation form. Please allow 30 days for processing. If you have not received it within that timeframe, feel free to an inquiry to lhenning@hah.org. Mahalo! One (1) Nursing contact hour is available for the live webinar session AND the archived session (which will be accessible for one year). Go to for more information. One (1) Social Work continuing education unit is available for the live webinar session only; it is not in effect for archived materials.

4 Incontinence: Risks, Causes and Care Kamal Masaki, MD Department of Geriatric Medicine John A. Burns School of Medicine University of Hawaii

5 Learning Objectives Know what it is and how common it is Normal changes of aging Risk factors for incontinence Types transient and established Tests and Treatments Prevention and Complications for elderly

6 What is Urinary Incontinence? Urethra Involuntary loss of bladder control Causes leakage of urine Small or large quantities Occasionally or several times a day Can affect your daily activities and quality of life It s a symptom of many conditions, not a disease

7 How Common Is It? 15-30% of older people living in the community 60-70% of older people living in nursing homes Twice as many women than men until age 80, then equal Annual costs over $60 billion in U.S.

8 Bladder and Urethra Detrusor Muscle (Bladder) Empty Contracts Storage Relaxes Urethra Internal Sphincter Relaxes Contracts External Sphincter Voluntary control

9 Normal Urination Bladder stores urine First urge to void when bladder fills to ml Normal bladder capacity is ml Normal voiding bladder pressure increases until it exceeds urethral resistance Controlled by brain and spinal cord

10 Normal Urination

11 Normal Aging Changes Bladder capacity decreases Residual volume increases (incomplete emptying) Involuntary bladder contractions common (40-75% of elderly people with incontinence) Urine output shifted to later in the day Women atrophic vaginitis after menopause Men prostate enlarges

12 Risk Factors Age Overweight Female gender, pregnancy and childbirth (especially multiple pregnancies) Females drop in estrogen hormone level at menopause (taking hormones doesn t help) Males prostate problems Overall health diabetes, high blood pressure, smoking, diseases of brain or spinal cord

13 Types of Urinary Incontinence First step transient versus established Transient implies it s reversible Established incontinence can be more challenging

14 Transient Incontinence DIAPPERS Delirium Infection Atrophic vaginitis Pharmacologic Psychologic Endocrine Restricted mobility Stool Impaction

15 Transient Incontinence DIAPPERS Delirium acute confusion (common in hospital in elderly) Infection of bladder elderly may present atypically Atrophic vaginitis (women after menopause) Pharmacologic (medications) very common, especially new medications

16 Transient Incontinence DIAPPERS Psychologic especially depression Endocrine diabetes, high calcium levels Restricted mobility fracture, stroke, Parkinson s disease, restraints, environmental barriers Stool Impaction constipation

17 Transient Incontinence Common Medications Diuretics increase urine volume Cough/cold meds (over-the-counter) Heart and Blood Pressure meds Sedatives and anti-depressants Narcotic pain medications Alcohol

18 Established Incontinence Types Stress incontinence Urge incontinence Overflow incontinence Obstruction Detrusor weakness Functional Mixed

19 Stress Incontinence Weak pelvic muscles Sphincter failure associated with increase in intra-abdominal pressure Small amount of urine leaks when pressure is put on bladder (eg. exercise, coughing, sneezing, laughing, lifting) More common in women, especially after menopause

20 Urge Incontinence Involuntary contractions of bladder associated with strong sense of urinary urgency and associated loss of urine Sudden urge to urinate and can t hold it Brain tells bladder to empty even when it isn t full Bladder irritation (infection, stones, tumors) Common in diabetes, Alzheimer s disease, Parkinson s disease, multiple sclerosis, stroke

21 Overflow Incontinence Small amounts constantly dribble out of a bladder that is always full (doesn t empty properly) Outlet obstruction (eg. enlarged prostate in men weak urine stream) Weak bladder damage to bladder muscle or damage to nerves that control the bladder (eg. diabetes, multiple sclerosis, Parkinson s disease, spinal cord injury)

22 Functional Incontinence Normal bladder control Difficulty walking, so can t get to the bathroom in time (eg. arthritis, stroke, Parkinson s disease) Alzheimer s disease forget to go or can t find toilet Environmental barriers Hospital restraints

23 Should you tell your doctor? Most people with incontinence don t seek medical help Under-reported due to embarrassment, or because people think nothing can be done, or think it s normal aging There is a lot that can be done please ask your doctor for help!

24 Tests History Duration, volume, frequency of symptoms Precipitating factors especially diet, fluid intake Medications Protective devices pads and diapers Voiding Diary very helpful! Quality of life establish goals of care

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26 Tests Physical Exam Cognitive status, depression Functional assessment Environmental assessment Abdominal, pelvic, rectal exam Neurologic exam

27 Tests for Incontinence Blood tests kidney function, calcium, glucose Basic urine test Urine culture if needed Post-void residual volume Urodynamic studies Refer to specialist if necessary: Men Urologist Women Uro-gynecologist

28 General Treatment Treat underlying conditions Eliminate contributing medications if possible Environmental assistance no barriers Portable devices bedside commode, bedpans, urinals, toilet raised seats Trial of regular timed toileting set schedule, slowly increase time in between

29 Treatment of Incontinence Stress Incontinence: Kegel exercises (pelvic muscles) Biofeedback or electrical stimulation Medications to increase urethral resistance Surgery or injections

30 Treatment of Incontinence Urge Incontinence: Behavioral therapy bladder training with increased intervals Medications to decrease involuntary contractions and relax bladder (watch for side effects!)

31 Treatment of Incontinence Overflow Incontinence: Obstructive relieve obstruction (eg. prostate enlargement) Weak bladder medications to stimulate bladder to contract (often don t work) Double voiding to empty bladder better Medications to relax internal sphincter May need catheterization (last resort)

32 Prevention Lifestyle changes: Lose weight if obese Stop smoking, stop drinking alcohol Diet less caffeine (coffee, soda), avoid spicy foods, sugar, acid Prevent constipation Avoid heavy lifting Timing of liquid intake and medications

33 Prevent Complications People limit their activity due to fear of incontinence, depression, social isolation Poor sleep Falls with fractures Skin rash, bedsores, infections Pads and diapers absorbent and protect skin (cost is a factor) Skin care products barrier creams, cleansers, frequent washing, disposable wipes

34 Summary of Treatment Goal: relieve the most bothersome symptoms Stepwise treatment: Lifestyle Changes Behavioral Therapy Drugs Surgery

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36 Thank You! Questions?

37 On behalf of the Healthcare Association of Hawaii and Dr. Kamal Masaki, thank you for attending today s webinar: Incontinence: Risks, Causes and Care Evaluation: /r/nxgjhsn Please share your feedback with us. Your comments enable us to better plan and execute educational sessions that meet your needs.