Community Continence Program

Kay, 54 Kay, 54 Stopped exercising because she leaks Stopped exercising because she leaks Tired of the odor Tired of the odor Worries people will notice the smell Worries people will notice the smell Would like to restart exercising Would like to restart exercising Won’t because “there’s nothing that can be done” Won’t because “there’s nothing that can be done”

Kathleen, 60 Kathleen, 60 Loves her coffee Loves her coffee Had to stop because could not make hour long drive to work Had to stop because could not make hour long drive to work Urge to go too strong – “could not reach in time” Urge to go too strong – “could not reach in time”

Jodi, 33 Jodi, 33 Leaks urine when she jumps on trampoline with her kids Leaks urine when she jumps on trampoline with her kids Voids frequently during the day Voids frequently during the day May start to leak on the way to the bathroom May start to leak on the way to the bathroom

1 out of 3 women Will develop incontinence

Facts Millions of Americans affected by incontinence Millions of Americans affected by incontinence Incontinence under diagnosed, largely untreated Incontinence under diagnosed, largely untreated Affects all strata of society Affects all strata of society

Incontinence may cause… Social embarrassment Social embarrassment Urinary tract infection Urinary tract infection Increased likelihood of nursing home placement for elderly Increased likelihood of nursing home placement for elderly

Urinary incontinence Increases with age Increases with age By age 70, 40% of women have leakage By age 70, 40% of women have leakage Number 1 reason for admittance to nursing home Number 1 reason for admittance to nursing home

Risk factors for incontinence Increased body mass Increased body mass Cigarette smoking Cigarette smoking Menopause Menopause Prior pelvic surgery Prior pelvic surgery Chronic health conditions: Chronic health conditions: –Diabetes –Multiple sclerosis –Parkinson's

Economic costs of untreated incontinence $19.5 billion in 2000 $19.5 billion in % spent on absorbent products and laundry 70% spent on absorbent products and laundry Dollar amount same as that spent on diseases such as osteoporosis, arthritis, & Alzheimer's Dollar amount same as that spent on diseases such as osteoporosis, arthritis, & Alzheimer's

Patients may delay seeking treatment due to… Age Age Duration and severity of symptoms Duration and severity of symptoms Impact on quality of life Impact on quality of life Discomfort discussing their problem with health care professional Discomfort discussing their problem with health care professional

How the plumbing works Kidneys make the urine Kidneys make the urine Bladder stores the urine until full Bladder stores the urine until full Bladder empties to the outside through the urethra, the urinary pathway Bladder empties to the outside through the urethra, the urinary pathway

Plumbing continued… In normal conditions, the closure pressure of the urethra is higher than the pressure in the bladder, so urine does not leak out In normal conditions, the closure pressure of the urethra is higher than the pressure in the bladder, so urine does not leak out With voiding, the urethra relaxes (urethral pressure lessens), the bladder muscle contracts (bladder pressure increases), and urine is pushed to the outside With voiding, the urethra relaxes (urethral pressure lessens), the bladder muscle contracts (bladder pressure increases), and urine is pushed to the outside

Types of Incontinence Stress incontinence Stress incontinence Urge incontinence Urge incontinence Mixed incontinence (combination of the above two) Mixed incontinence (combination of the above two)

Stress Incontinence Sudden increase in pressure to the bladder Sudden increase in pressure to the bladder Can occur with cough, sneeze, laugh, exercise Can occur with cough, sneeze, laugh, exercise Bladder pressure is higher than urethral pressure, urine leaks out Bladder pressure is higher than urethral pressure, urine leaks out

Stress Incontinence Occurs due to weakening of pelvic support Occurs due to weakening of pelvic support Normally, the pelvic muscles (called levator ani) act as backboard to support bladder and urethra Normally, the pelvic muscles (called levator ani) act as backboard to support bladder and urethra When support weakens, there’s increased mobility of bladder and urethra When support weakens, there’s increased mobility of bladder and urethra With increased mobility, and lack of a strong backboard, urethral pressures are lower With increased mobility, and lack of a strong backboard, urethral pressures are lower

Urge Incontinence “Latch-key Syndrome” “Latch-key Syndrome” “Gotta go” “Gotta go” Leakage develops on the way to the bathroom Leakage develops on the way to the bathroom

Urge Incontinence Bladder has sudden contraction or “twitch” Bladder has sudden contraction or “twitch” With uninhibited bladder contraction, urine is pushed to the outside and leakage occurs With uninhibited bladder contraction, urine is pushed to the outside and leakage occurs Amount leaked may be small or large, can even cause “soaking wet” Amount leaked may be small or large, can even cause “soaking wet”

Urge Incontinence Possible Causes Bladder irritants – certain foods or beverages Bladder irritants – certain foods or beverages Concentrated urine – inadequate fluid intake Concentrated urine – inadequate fluid intake Previous repeated bladder infections Previous repeated bladder infections

Stress Incontinence Treatment Options Kegel exercises – pelvic floor muscle strengthening Kegel exercises – pelvic floor muscle strengthening Pelvic floor therapy – office-based treatment regimen to strengthen pelvic floor muscles with exercise and electrical stimulation Pelvic floor therapy – office-based treatment regimen to strengthen pelvic floor muscles with exercise and electrical stimulation

Stress Incontinence Treatment Options Collagen injections into urethra (increases urethral closure pressure) Collagen injections into urethra (increases urethral closure pressure) Urethral slings – outpatient surgical procedures that restore support to urethra Urethral slings – outpatient surgical procedures that restore support to urethra

Urge Incontinence Treatment Options Dietary modification – avoid bladder irritants (spicy foods, alcohol, caffeine, high acid foods) Dietary modification – avoid bladder irritants (spicy foods, alcohol, caffeine, high acid foods) Kegel exercises – help improve pelvic floor muscle control Kegel exercises – help improve pelvic floor muscle control

Urge Incontinence Treatment Options Medications – “calm” the overactive bladder, reduce uninhibited bladder contractions Medications – “calm” the overactive bladder, reduce uninhibited bladder contractions –Ditropan –Detrol –Sanctura –Vesicare –Enablex –Oxytrol

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