1. UNIVERSITI TEKNOLOGI MARA
PUNCAK ALAM CAMPUS
FACULTY OF HEALTH SCIENCES
DIPLOMA IN PHYSIOTHERAPY (HS114)
INCONTINENCE OF BLADDER AND
BOWEL
LECTURER: CIK AIMAN NADIA AKMAR BINTI RAHMAN
NO STUDENT’S NAME MATRIX NUMBER
1. MOHD KHAIRI BIN MOHD AMIN 2011417444
2. ADLIN HANI BINTI MAZLAN HANAFI 2011445252
3. NAZATUL AINA BINTI AZIZLAN 2011446786
4. NUR ALIA NABILAH BINTI RASHID 2011475332

2. DEFINITION
- Bladder Incontinence -
• Urinary incontinence means there is loss of bladder
control which leads to unintentional passing of urine
• There are several types of bladder incontinence
which are:
 Stress incontinence – occurs during certain activities like
coughing, sneezing, laughing
 Urge incontinence - leakage of urine which involves a
strong and sudden need to urinate
(American College of Obstetricians and Gynecologists, 2011)

3.  Mixed incontinence – combination of both stress and urge
incontinence symptoms
 Overflow incontinence – loss of small amounts of urine
when the bladder does not empty all the way during
voiding
(American College of Obstetricians and Gynecologists, 2011 & NHS Choices, 2013)

4. DEFINITION
- Bowel Incontinence -
• Bowel incontinence is the inability to control the
bowel movements, resulting in the involuntary
passage of stools
• Types:
 Urge bowel incontinence – sudden need to defecate, with
little time to reach a toilet
 Passive incontinence or soiling – experience of no
sensation before leakage of stools
(American College of Obstetricians and Gynecologists, 2011 & NHS Choices, 2013)

5. ETIOLOGY
• Bladder incontinence:
 Stress incontinence
- weakening of urethral sphincter and pelvic floor muscles
- pregnancy
- childbirth
- age
- obesity
- menopause
- surgical procedures, e.g. hysterectomy
(Medical News Today, 2013 & The Browning Pelvic Pain & Organic Dysfunction Treatment Center, 2010)

6.  Urge incontinence
- overactivity of the detrusor muscles
- cystitis
- central nervous system (CNS) problems
- an enlarged prostate
 Overflow incontinence
- an obstruction or blockage to the bladder
- an enlarged prostate gland
- a tumor pressing against the bladder
- urinary stones
- constipation
(Medical News Today, 2013)

7. • Bowel incontinence
 Rectum problems
- constipation
- diarrhoea d/t infection or irritable bowel syndrome,
Crohn’s disease, ulcerative colitis
 Sphincter muscles problem
- the muscles are weakened or damaged d/t childbirth,
complication of rectal surgery
(NHS Choices, 2013)

8.  Nerve damage
- decreased awareness of sensation of rectal fullness
- d/t diabetes, multiple sclerosis, stroke, spina bifida
 Health condition – dementia or severe learning
ability, rectal prolapse
 Weakness of pelvic floor muscles - puborectalis
(NHS Choices, 2013)

9. PATHOLOGY BLADDER AND BOWEL
INCONTINENCE

10. BLADDER INCONTINENCE

11. Incontinence of the bladder occurs when those pelvic
muscles that involves in urination get traumatized, either
overstretched or tear, that leads to weakness of the muscles.
As time goes by, the muscles become weaker until at certain
point, they cannot support the bladder anymore.
When there is high pressure from the abdominal such as
coughing, sneezing, lifting or pushing heavy things, the
bladder forces urine past the urethral sphincter causing
incontinence to occur.
(The American College of Obstetricians and Gynecologists, 2011)

12. BOWEL INCONTINENCE

13. Bowel function is controlled by few factors: anal sphincter
pressure, rectal storage capacity and rectal sensation. Anything
that interferes with these factors can result in incontinence.
Fecal incontinence occur when there is direct trauma to the
sphincter muscles (internal and external) such as chronic
constipation or obstetric trauma.
The sphincter muscles stretched, weaken and not strong enough to
maintain the continence and stool will leak out.
Patients with impaired continence will also decreased thermal and
electrical sensitivity to stimuli.
(Satish S. C. R., 2010)

15. CLINICAL FEATURES
BOWEL INCONTINENCE
1) Constipation
2) Diarrhea
3) Abdominal pain
4) Lower back pain
5) Bloating
6) Stomach cramp
7) Loss of appetite
8) Insomnia
(Vorvick, 2011)

16. CLINICAL FEATURES
BLADDER INCONTINENCE
STRESS INCONTINENCE OCCURS WHEN:
1) Cough
2) Sneeze
3) Laughing
4) Lifting heavy objects
5) Vigorous exercise
6) Have sexual intercourse
7) Standing in prolonged time
(Vorvick, 2011)

17. URGE INCONTINENCE OCCURS :
1) Frequent urination, in a day and at nighttime
2) Loss of urine without meaning to urinate
3) Sudden and urinary urgency
OVERFLOW INCONTINENCE OCCURS:
1) Bladder never feels empty
2) Frequent urination, in a day and at nighttime
urinate
1) Inability to void when when the urge is felt
2) Urine dribbles even after voiding
(Vorvick,2011)
(Remedy’s health Communities, 2011)

18. DOCTOR MANAGEMENT
• Medication
- Anticholinergics (medication to calm an overactive
bladder)
- Topical estrogen.
- Anti depressant
-Imipramine
- Duloxetine
• Medical device
– Urethral insert (FemSoft insert)
– Pessary
(Urinary incontinence: Incontinence products to help keep you dry, 2011)

19. • Surgery
- Sling procedures
- Bladder neck suspension
- Artificial urinary spinchter
(Urinary incontinence: Incontinence products to help keep you dry, 2011)

20. PHYSIOTHERAPY MANAGEMENT
• Pelvic floor muscle exercises
- Kegel exercises
• Electrical stimulation
(Berghmans, 2010)

21. Physiotherapy treatment
Pre - operation
• Keep lungs clear of fluid and
prevent chest infection.
o Chest physiotherapy
(Breathing exercises)
• Help maintain muscles tone
and promote the return of
blood in veins to heart.
o Limb physiotherapy
(Circulatory exercises)
• Bed mobility
Post - operation
• Clear lungs and prevent chest
infection
o Support abdomen with soft
pillow , take 4 to 5 deep slow
breaths then 1 deep cough.
• Reduce muscle weakness and
pain on the incision site
o posterior basal and lower costal
breathing, concentrating on the
affected side
• Improve coughing, chest
expansion, breathing pattern
o ACBT
o Triflow meter 5x hourly during
awake time

22. • Patient education
o Posture awareness
o Advice patient to continue
exercises as taught
• Improve muscle tone and
promote the return of blood
in veins to heart
o Circulatory exercise
• Progression for bed mobility
• Ambulate patient around
bed site
• Patient education
o Posture awareness
o Cont exercising 3x/day
o Avoid heavy weight lifting

23. REFERENCES
• Anonymous, (2011). About incontinence - types of incontinence - fecal or bowel
incontinence. The Simon Foundation for Continence. Retrieved June 26, 2013
http://www.simonfoundation.org /About _Incontinence
Types_Incontinence_Fecal_Bowel_Incontinence.html
• Anonymous, (2013). What I need to know about bowel control. National Digestive
Disease Information Clearinghouse. Retrieved June 24, 2013
http://www.digestive.niddk.nih.gov/ ddiseases/pubs/bowel control_ez/
• Haas E.(2009). Fecal incontinence, Colorectal Surgical Associates. Retrieved June
25, 2013 http://www.houstoncolon.com/fecal-incontinence/causes-texas/
• Forciea, M.A. Geriatrics Secrects. 2nd ed. Philadelphia, PA. 2000
• Medical News Today. (2013). What is urinary incontinence? What causes urinary
incontinence? Retrieved June 24, 2013, from
http://www.medicalnewstoday.com/articles/165408.php

24. • NHS Choices. (2013). Bowel incontinence. Retrieved June 24, 2013, from
http://www.nhs.uk/Conditions/Incontinence-bowel/Pages/Causes.aspx
• Pickles, B. Physiotherapy with Older People. Canada. 2003
• Sandip P. V., (2009). Urinary incontinence. Retrieved June 22, 2013
http://emedicine.medscape.com/ article/452289-overview#aw2aab6b2b4aa
• Satish S. C. R., American Journal Gasteroenterology. Diagnosis and Management
of Fecal Incontinence. 2010; 1585-1604.
http://s3.gi.org/physicians/guidelines/FecalIncontinence.pdf. Retrieved June 25,
2013.
• The American College of Obstetricians and Gynecologists. (2011). Urinary
incontinence. Retrieved June 24, 2013, from
http://www.acog.org/~/media/For%20Patients/faq081.pdf?dmc=1&ts=20130623T
0447075241

25. • The Browning Pelvic Pain & Organic Dysfunction Treatment Center. (2010).
Incontinence- loss of bladder or bowel control. Retrieved June 24, 2013, from
http://ppodsyndrome.com/441/ incontinence-loss-of-bowel-control/
• Tortora GJ., Derrickson B. Principle of anatomy and physiology. 13th ed. Riverstreet,
Hoyoken,NJ.John Wiley & Sons. 2011
• Vorvick. L J. Urinary Incontinence. Sept 19,2011. Medline Plus. http:// www.
Nlm.nih.gov/medlineplus/ency/article/003142.htm. Retrieved on June 23,2013.
• Remedy’s Health Communities. Overflow Incontinence. 2013. http:// www.
Healthcommunities.com/overflow-incontinence/overview-of-overflow-
incontinence-shtml. Retrieved on June 27,2013.