URINARY INCONTINENCE

PENGENALAN

Nota kali ini, Min akan gabungkan dalam bahasa inggeris dan malay untuk membantu pemahaman anda ye. Nota ini diolah dari kelas Womens Health sewaktu DEGREE PHYSIOTHERAPY di UiTM. Credit to Roslina Dahlan dan Wan Hasyila Wan Omar.

– The International Continence Society (ICS) define that incontinence as the complaint of any involuntary leakage of urine (Hunskaar et al.,2003).

Ini bermaksud ketidak upayaan sistem pundi kencing kita untuk menahan kencing. Tiba- tiba je air kencing keluar tanpa disedari.

– Urinary incontinence is more common in women than in men and affects women of all ages(Bø, Talseth, & Holme, 1999).

– Prevalence rates in women between 15 and 64 years of age vary from 10% to 30% (Bø, Talseth, & Holme, 1999).

– Incontinence is a common and distressing problem after childbirth. Three months after delivery 2030% of women have urinary incontinence and about 4% have faecal incontinence (Glazener et al., 2001).

(Kesukaran menahan kencing berlaku pada ibu selepas kelahiran bayi. Ada yang selepas beberapa bulan bersalin dan ada juga beberapa tahun kemudian terutama di usia 40an ke atas).

NORMAL CONTINENCE IN WOMAN

– Normal continence in women is a complex coordination between the bladder, urethra, pelvic muscles, and surrounding connective tissues.

– Storage of urine is under voluntary control and modulated by the pontine micturition centre.

– The bladder is compliant through the range of physiological bladder filling (empty to capacity, typically 500–600 mL) and accommodates increasing urinary volume without increasing bladder pressure.

– This mechanical distension is unparalleled in any other organ and is accomplished by specialised function of the detrusor smooth muscle and neurological modulation.

– The urethra is 3–4 cm long and maintains sufficient pressure to prevent urine passage during times of physiological increases such as cough or physical activities.

Sepatutnya, urethra dapat mengekalkan tekanan untuk mengelakkan air kencing keluar secara tiba tiba tanpa kita sedari semasa melakukan aktiviti fizikal seperti mengangkat barang atau batuk atau bersin.

– The skeletal muscle in the female urethra (rhabdosphincter) is composed of small, type I fibres located predominantly in the middle third region of the urethra.

– Urethral smooth muscle is deposited in longitudinal and circular layers.

– Both skeletal and smooth muscles contribute to resting tone, whereas skeletal muscle responds to rises in intra-abdominal pressures.

– Pelvic muscles are major contributors to continence. Levator ani contraction pulls the vagina forward toward the pubic symphysis, creating a backstop for the urinary tract. This stable backstop compresses the two walls of the urethra, thus preventing leakage of urine during cough or similar intra-abdominal increases.

– Voiding begins with relaxation of the urethra, followed by activation of the spinal reflex pathways that is coordinated by the pons.

– Increases in parasympathetic transmissions to the bladder initiate detrusor contraction, whereas these same pathways act to inhibit sympathetic and pudendal outflow to the urethra, maintaining urethral relaxation.

– Detrusor contraction raises the intravesical pressure sufficiently to allow the bladder from emptying. (Norton & Brubaker, 2006)

TYPE OF INCONTINENCE

1-Stress incontinence: Leakage with coughing, sneezing, lifting, sexual relations or anything that can pressure on bladder. Usually small drop but can be severe.

(Air kencing tiba tiba keluar sewaktu batuk, bersin, angkat barang, hubungan seksual atau aktiviti yang menekan pundi kencing)

2- Urge incontinence: Usually associated with the frequency of urination, need to urinate frequently at night an intense urge to urinate with very little of warning. Problem with nerve and muscle.

(Kerap kencing, terutamanya pada waktu malam dan rasa nak kencing tu tak boleh tahan, nak keluar sangat sangat dah. Xde rasa- rasa je, ni memang nak keluar. Hihi. Macam tu la kut dalam Malay untuk mudah faham)

3- Overflowed incontinence: Occur when bladder can not fully empty. Caused by blockage or narrowing of the urethra(eg. Prostate in men, scar tissue or prolapsed bladder.

4- Mix incontinence: Common condition include combination of one or more above.

What Factors Increase the Risk of Developing Urinary Incontinence?

1- Pregnancy, Mode of Delivery, and Parity

– Episiotomy, vacuum extraction, fetal weight, and sphincter rupture, the risk of having stress incontinence 5 years postpartum was increased in women who developed stress incontinence during the first and in women who developed stress incontinence during the first 6 weeks postpartum.

– Pregnancy involved stretching and damage to the pelvic fascia, levator musculature and nerves innervating the pelvis viscera.

– Increased parity also appears to be independently associated with urinary incontinence.

– Cesarean sections and vaginal deliveries has higher rates of stress incontinence (Holroyd-Leduc & Straus, 2004).

– Spinchter injuries occur in 0.5% to 6% of vaginal deliveries (Leppert & Peipert, 2003).

– Damage to the innervation of the pelvic floor as well as direct trauma to the endopelvic fascia, levator ani muscle and pelvic diaphragm during vaginal delivery (Holroyd-Leduc & Straus, 2004).

– Forceps delivery was associated with a higher risk of stress incontinence compared with spontaneous vaginal delivery (Holroyd-Leduc & Straus, 2004).

– Urge incontinence was increased in patients who had forceps delivery, episiotomy and longer second stage of labor (Santoro, Wieczorek, & Bartram, 2010).

2- Aging

– Younger women tend to report more stress incontinence symptoms, whereas older women tend to report more urge symptoms.

– This may be due to the effect of urogenital atrophy on lower urinary tract.

– Menopause: absence of estrogen that is beneficial in promoting continence.

3- Hysterectomy

– A systematic review found that hysterectomy was associated with developing urinary incontinence in women aged 60 years or older but not in women younger than 60 year.

Urge and mixed incontinence predominate in older women, whereas stress incontinence predominates in younger women.

– It has been suggested that distrupting the musculofascial attachment of the cervix to the cardinal uterosacral ligament complex will lead to relaxation and develop of the stress incontinence.

– The distrupting of the autonomic nervous innervation of the bladder during dissection of the cardinal uterosacral ligament complex can lead to the urge incontinence.

5- Body Mass Index (BMI)

– Many studies have found that increasing (BMI) is associated with increasing rates of urinary incontinence.

– Women with BMI between 26 and 30 have up to a 50% increase incontinence compared to women with a BMI below 25.

– Obese women with BMI above 30 have a twofold increase incontinence compared to women with a BMI below 25.

– The increasing abdominal girth increases the intra-abdominal pressure, which causes increased stress and strain on the viscera, nerve and muscle of the pelvic floor.

– A digital (finger) rectal examination is done to check for problems with organs or other structures in the pelvis and lower belly.

– During the examination, the doctor gently puts a lubricated, gloved finger of one hand into the rectum.

– Doctor may use the other hand to press on the lower belly or pelvic area.

PHYSIOTHERAPY TREATMENT

1.PELVIC FLOOR MUSCLE TRAINING

– Can help strengthen the muscles in the pelvic floor, giving more control over bladder.

– In a Cochrane review (2006) with 13 trials involving 714 women (375 PFMT, 339 controls), women who did PFMT were more likely to report they were cured or improved than women who did not.

– Overall, PFMT recommended in 1st-line conservative management for women with urinary incontinence.

tekan coccyx (tulang sulbi) ke tilam bahasa mudahnya dalam 5-10 saat. Tanya fisioterapis anda. Senaman kemut (tahan kencing sewaktu tak rasa nak kencing: senaman ini paling efektif!)