Inkontinensia urine

ditinjau dari
ginekologi

Benny Hasan
Subbagian Uroginekologi Rekonstruksi
Lab/SMF Obstetri-Ginekologi
FKUP/RSHS

Micturition Reflex
Brain

Direction of
nerve impulse

Spinal cord

Bladder

Pelvic floor

Bladder Control System

bladder muscle

bladder

urine

Urethra closed

Sphincter Muscles
Squeezed Shut

bladder muscle

bladder

urine

Urethra open

Sphincter Muscles
Relaxed

Normal Control of
Urination

Inkontinensia urine
Hubungannya

dengan ginekologi
seberapa besar masalahnya
bagaimana pengelolaannya

Problems Associated with

Lack of Bladder Control
Physical
Psychological
Social
Sexual
Occupational/Financial

Physical Problems
Limitation or stopping of
physical activities
Discomfort due to dampness
Unpleasant odour
Skin rashes/ ulcers
Confinement in nursing
homes
Falls
Insomnia
Dehydration

Psychological Problems
Loss of independence
feels tied to home
Fear of embarrassment
Loss of dignity & self esteem
Depression
Feeling of being a burden
Suicide
Affects career

Social Problems
Reduction in social
interaction/
increased social
isolation
Alteration of travel
plans (e.g. plan
around availability
of toilets)
Cessation of some
hobbies

Sexual Problems

Avoidance of
sexual contact

Occupational/Financial
Problems
Absence from work
Job loss
Change of job
Poor relationship with
employers/ employee
Financial loss

Vicious Circle of
Bladder Control Problems
Isolation

Guilt

Social, domestic,
physical, sexual
and psychological
problems

Absence
from work

Depression

Insidensi ?

20 - 50 % wanita penah mengalami

inkontinensia urine
10%
Keluhan menetap

Hubungan kejadian inkontinensia

urine dengan paritas

Paritas

Hubungan inkontinensia
urine dengan umur
%

Umur

Penyebab inkontinensia urine yang

berhubungan dengan ginekologi

Fistula urogenital
stres inkontinensia
Instabilitas kandung kemih

Jenis yang paling

sering !!!!

Stress
inkontinensia

Kandung kemih
hiperaktif

FAKTOR RISIKO !!!

USIA. RAS,
PERSALINAN
MENOPAUSE
kelemahan DASAR PANGGUL

Stress Incontinence
Stress incontinence occurs when a
small amount of urine escapes
while the person coughs,
coughs sneezes,
sneezes
laughs,
laughs jumps or lifts something
heavy.
heavy

Faktor yang
mempertahankan kontinensi

Faktor penyokong urethra

Bladder neck yang baik
Sfingter urethra yang baik

patofisiologi
P Intra abdominal

P intravesikal

P inthra urethra

Mekanisme penutupan oleh sfingter

urethra interna merupakan mekanisme
pasif

Seluruh komponen sfingter urethra interna

terpengaruhi oleh
hormon estrogen

Stress Incontinence
(a) Continent woman

(b) Woman with stress

incontinence

External
urethral
sphincter
Sudden increase in intra-abdominal pressure

VU

Etiology ?
U
Sudut UV

VU

Kerusakan diafragma pelvis

akibat proses reproduksi
akan menyebabkan
kelemahan / kerusakan
urethra
sistokel
prolapsus uteri

HIPERAKTIF
KANDUNG KEMIH

Jenis inkontinensia urin kedua terbanyak

Overactive Bladder
Definition:

Overactive bladder is a chronic condition

in which the bladder starts to contract
too early when it is filling with urine.

Diagrammatic
Representation
of Overactive Bladder

Pressure

Bladder pressure
> urethral pressure

Symptoms of
Overactive Bladder
Frequency
Urgency

Bladder pressure
> urethral pressure

Urge
Incontinence

Frequency
Going to the toilet often (more than
eight times in a 24-hour period)

Urgency
A strong and sudden desire to urinate

Urge Incontinence
Urge incontinence
occurs when there is a
very strong urge to pass
urine and which cannot
be held back, resulting in
the person wetting
himself on the way to the
toilet
Image source: Society for Continence (Singapore)

Cause of Overactive
Bladder
In the majority of cases, the underlying
cause is unknown.
unknown
In some patients, the cause may be a
neurological deficit.
Multiple sclerosis
Stroke
Parkinsons Disease
Spina Bifida
Spinal cord damage

Who Manages Patients with

Overactive Bladder ?
General practitioners (GPs)
Nurses/ continence advisors
Geriatricians
Urologists
Gynaecologists
Others
E.g. paediatricians, neurologists,
physiotherapists and psychologists

Treatment Options
Overactive Bladder

Drug therapy
Bladder training techniques
Intermittent self-catheterization
Incontinence pads and
protective equipment
Surgery

Overflow Incontinence
Overflow incontinence happens when
urine leaks from an overfilled bladder.
bladder

Overflow Incontinence

Mixed Incontinence
Mixed incontinence occurs when a
person has both the symptoms of
urge incontinence and stress
incontinence.
incontinence

Mixed Incontinence

Sudden increase
in intra-abdominal
pressure
Uninhibited detrusor
contractions

Diagnosis ?

Penata laksanaan
1.

Koservatif

Latihan otot dasar panggul

medikamentosa

pesarium
2. Operatif