Promotion and management of incontinence: Part 1

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Delivered in a 40-minute bite-sized webinar by Lola Kehinde RGN BSc MA MBA

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About Lola:

Lola Kehinde is a registered nurse and works for C3 as an Associate in nursing. She has a

B.Sc. (Hons) in Health Studies from the University of Greenwich, an M.A in Medical Ethics and Law from Keele University and an MBA from the University of Hertfordshire.

As an associate at C3 Lola is working on Nurses for Healthier Communities, building a network of nurses who are passionate about healthy living and are willing to share their knowledge and offer practical and emotional support to each other and their communities. She supports nurses by expanding their understanding of social determinants of health, identifying the areas – such as genetics, behaviours, environmental and physical influences, medical care, and social factors – that affect their lives, health, and that of their communities. Utilising her nursing skills to develop and support nurses to use their professional skills and cultural understanding, especially those from Black, Asian, and other minority heritage, to improve the health outcomes of their communities.

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Automatic video captions available. maintainingand managing Incontinence A webinar on maintaining a healthy bladder and bowels Lola Kehinde, QNIFriendlyReminders While waiting for others to come in, here are some rules and reminders to keep in mind. Turn off your camera and 1 microphone. Feel free to type your questions 2 in the chat box. Questions will be entertained at the 3 live Q&A after the presentation.Learning Whatwe'lldiscuss Agenda What is Incontinence Who does it affect Why it is importance What are the causes of incontinence related to incontinenceof the organs Whatis Incontinence? Is a symptom and not a disease.It’s affects an individuals physical, physiological and social well being and is associated with a significant reduction in quality of life. Incontinence is of two types – Urinary incontinence Fecal incontinenceDefining Incontinence The International Continence Society defines urinary incontinence (UI) as the involuntary leakage of urine Abrams et al. Citation2002) Faecal incontinence, is the unintentional loss of solid or liquid stool, Bharucha et al 2022 https://doi.org/10.1038/s41572-022-00381-7 Prevalence In women, moderate and severe symptoms have a prevalence ranging from about 3% to 17%. Severe incontinence has a low prevalence in young women, but rapidly increases at ages 70 through 80. In men, the prevalence of incontinence is much lower than in women, about 3% to 11% overall, with urge incontinence accounting for 40% to 80% of all male patients. Nitti 2001 Prevalence increases with age (but it is not a part of normal aging) 25-30% of community dwelling older women 10-15% of community dwelling older men 50% of nursing home residents; often associated with dementia, fecal incontinence, inability to walk and transfer independently NHS spends around £80 million per year on product costs. (NHS England 2018) Urinary Incontinence is Often Under-Diagnoses and Under-Treated Only 32% of primary care physicians routinely ask about incontinence 50-75% of patients never describe symptoms to physicians 80% of urinary incontinence can be cured or improved Effect of incontinence on quality of life Social stigma - leads to restricted activities and depression Medical complications - skin breakdown, increased urinary tract infections Institutionalization - incontinence is the second leading cause of nursing home placementLife often revolves around toilets First concern when go anywhere new Horror of queues Avoid places and activities in case no toilet available (cinema, planes etc…) Chained to the toiletcontinence Risk factor Age Gender Obesity Smoking Race Exercise Previous surgeryUrinary incontinence can be caused by everyday habits, underlying medical conditions physical problems Anatomy of the bladder It is a hollow , distensible muscular organ situated in the pelvic capacity posterior top the public symphysis. Folds of the peritoneum hold the urinary bladder in position Urinary bladder capacity averages 400mls -800mls Structure of the urinary bladder The superficial layer of urinary bladder is adventitia. In the floor of the urinary bladder is a small triangular area called trigone The two posterior corners of the trigone contain the two ureteral openings; the opening into the urethra, the internal uretheral orifice, lies in the anterior corner. Structure of the urinary Bladder The three layers of the urinary bladder deepest is the mucosa, it composed of transitional epithelium and an underlying lamina propria. Rugae are also present to permit expansion of the urinary bladder Structure of the urinary bladder The mucosa is the intermediate muscularis, also called the detrusor muscle, which consists of three layers of smooth muscle fibres. - the inner longitudinal -Middle circular -and outer longitudinal layers What does the pelvic floor muscle do? Group of muscle on either side external sphincter. Support bladder in conjunction with external sphincter. Forms hammock slung from each side of pubic bone to sacrum and coccyx. Urethra, rectum and vagina pass through pelvic floor.Anatomy of Micturition Detrusor muscle External and Internal sphincter Normal capacity 300-600cc First urge to void 150-300cc CNS control Pons - facilitates Cerebral cortex - inhibits Homonal effects - estrogen Peripheral Nerves in Micturition Parasympathetic (cholinergic) - Bladder contraction Sympathetic - Bladder Relaxation Sympathetic - Bladder Relaxation (β adrenergic) Sympathetic - Bladder neck and urethral contraction (α adrenergic) Somatic (Pudendal nerve) - contraction pelvic floor musculatureNext session will be the types, causes, management of urinary incontinence Any Question?Thanksforjoining!