Physical Examination of Urinary Incontinence in the Elderly

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Physical Examination of Urinary Incontinence in the Elderly

Urinary incontinence is the inability to hold urine. Urinary incontinence is one of the manifestations of the disease are often found in geriatric patients. It is estimated that the prevalence of urinary incontinence ranges between 15-30% of elderly people and 20-30% in geriatric patients who were hospitalized suffered incontinence of urine, and urine incontinence likely to rise 25-30% at the age of 65-74 years.


Urinary incontinence problem is the number of events increased two times higher in women than men. This disorder is more common in women who have given birth than had never given birth (nulliparous).

Changes due to the aging process affects the lower urinary tract. Such changes predispose the elderly to experience incontinence, but does not cause incontinence. So incontinence is not a normal part of the aging process.

The purpose of the initial evaluation is to ensure the existence of urinary incontinence and identify the causes temporary, patients need to be evaluated further, and patients can start treatment without the need for sophisticated tests.

History of the disease should be emphasis on symptoms in detail in order to be determined the type of incontinence, pathophysiology and trigger factors.

1. The length of time and the characteristics of urinary incontinence.
The timing and amount of urine when experiencing urinary incontinence and when dry (continental).
Fluid intake, type (coffee, cola, tea) and a number.
Other symptoms such as nocturia, dysuria, frequency, hematuria and pain.
Accompanying events such as coughing, surgery, diabetes, drugs.
Changes in the function of the colon or bladder.
2. Treatment of urinary incontinence before and the results

The medical history should pay attention to issues such as diabetes, heart failure, venous insufficiency, cancer, neurological problems, stroke and Parkinson's disease. This includes a history of the urogenital system such as abdominal and pelvic surgery, childbirth, or urinary tract infection. Evaluation of both medicines purchased by prescription or bought over the counter are also important. Diverse drugs is associated with urinary incontinence such as sedative hypnotics, diuretics, anticholinergics, adrenergic and calcium channel blockers. Usually there is a connection to the time between the use of drugs with the onset or worsening of urinary incontinence who have chronic incontinence.


Physical Examination

The goal is to identify the triggers physical examination of urinary incontinence and help establish pathophysiology. In addition to general physical examination should always be carried out, examination of the abdomen, genitalia, rectum, neurological function, and pelvis (in women) is necessary.
Abdominal examination must recognize the existence of a full bladder, pain, mass, or a history of surgery.
Skin conditions and anatomic abnormalities should be identified when examining genitals.
Examination of the rectum is mainly done to obtain the obstipation, and evaluation of sphincter tone, perineal sensation, and reflexes bulbocavernosus. Prostate nodules can be identified at the time of examination of the rectum.
Pelvic examination to evaluate mucosal atrophy, atrophic vaginitis, mass, muscle tone, pelvic prolapse, and the cystocele or rectocele.
Neurological Evaluation partially obtained during examination of the rectum when the examination sensation perineum, anus tone, and refles bulbocavernosus. Neurological examination also need to evaluate diseases that can be treated as spinal cord compression and Parkinson's disease.
Physical examination should also include an assessment of functional and cognitive status, pay attention to whether the patient is aware of the desire to urinate and using the toilet.


Examination of Urine Incontinence

1. Diagnostic tests in urinary incontinence

According Ouslander, diagnostic tests on the incontinence needs to be done to identify potential factors that lead to incontinence, identifying client needs and determine the type of incontinence.

Measuring residual urine after urination, done by:
After urinating, attach the catheter, urinary catheter out through measured or using ultrasonic inspection of the pelvis, when the rest of the urine more dari100 cc means inadequate emptying of the bladder.

Urinalysis
Carried out on a clean urine specimen to detect the presence of factors that contribute to the occurrence of urinary incontinence such as hematuria, polyuria, bacteriuria, glycosuria, and proteinuria. Advanced diagnostic tests need to be followed when diagnosed early evaluation is not yet clear. Further tests are:
Additional laboratory tests such as urine culture, blood urea nitrogen, creatinine, calcium, glucose cytology.
Urodynamic tests: to know the anatomy and function of the lower urinary tract.
Urethra pressure test: measuring the pressure in the urethra when at rest and dynamic.
Imaging: tests for urinary tract upper and lower parts.

2. Investigations

Simple urodynamic test can be performed without the use of expensive tools. Remnants of urine after urination need is estimated at physical examination. Specific measurements can be performed with ultrasound or urinary catheterization. Leakage of urine when pressure is applied can also be done. The evaluation should also be done when the bladder is full and there is insistence urge to urinate. Asked to cough while being checked in the lithotomy position or standing. Leakage of urine can often be seen. Information that can be obtained include the first moment there is a desire to urinate, presence or absence of uncontrollable bladder contractions, and bladder capacity.

3. Laboratory

Electrolytes, urea, creatinine, glucose, and serum calcium assessed to determine kidney function and the conditions that cause polyuria.

4. Note urination (voiding record)

Note voiding was conducted to determine the pattern of urination. This record is used to record the time and the amount of urine when experiencing urinary incontinence and urinary incontinence, and symptoms associated with urinary incontinence. Recording the pattern of urination is done for 1-3 days. The records can be used to monitor therapeutic response and can also be used as a therapeutic intervention as it can sensitize patients the factors that trigger urinary incontinence.

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