REHABILITASI MEDIK UTK

GANGGUAN MIKSI LANSIA

dr. NURUL ULYANI, SpKFR

(kuliah geriatri FK UNIZAR)

GANGGUAN MIKSI LANSIA

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Anatomi otot dasar panggul

m. levator ani
o Mrpkn Otot penyangga
utama organ2 pelvis
Trdiri dari : otot
pubococcygeus,
puborectalis,
iliococcygeus,
coccygeus.
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o M. levator ani :
2/3 serabut otot tipe I (slow-twicth) berfx
mempertahankan tonus otot saat istirahat
1/3 serabut tipe II (fast-twitch) berfx saat
kontraksi yang cepat dan kuat

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Perineal membrane (diafragma urogenital)

o Lapisan tipis dibawah diafragma pelvis,
trdiri dari membran jar ikat dan lapisan
otot (compressor urethra dan
urethrovaginal spincther)

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 m. bulbocavernosus
o Lapisan pelvic floor yg paling distal, berfx
seksual, tidak menyokong organ pelvis

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Neuroanatomi kandung kemih

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kandung kemih & jar disekitarnya pd wanita

Neuroanatomi-fisiologi fx miksi
PERIFER :
1. Simpatis : pengisian Kandung Kemih /KK
(filling/storage)
2. Parasimpatis : pengosongan KK
(voiding/emptying)
3. Somatic :external spinchter
SENTRAL
4 loop di otak, brainstem dan spinal cord
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Inervasi perifer Kandung Kemih

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Inervasi perifer KK..

1.
2.

Afferents : from detrusor stretch receptors,sphincter,

perineum, genitalia
Efferents:
a. Parasympathetic S2 S4
Receptors : Cholinergic muscarinic
( at body of the bladder )
b. Sympathetic : T11 L2
Receptors : Alpha adrenergic ( at sphincter)
Betha adrenergic ( at body of the
bladder

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RECEPTORS INSIDE
THE BLADDER :

Cholinergicmuscarinic
Betha - adrenergic
Alpha - adrenergic
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INERVASI SENTRAL KK :
Loop 1 (nuklei cortiko-pontin-mesensefalik) :
Asal : Lobus frontalis
Sifat : inhibisi thd Sacral Micturition Center(SMC)
Pengisian KK
Kalau rusak ( Stroke, Parkinson ) hiperefleksia
detrusor, tanpa disinergia spingter Inkontinensia Urin

Loop 2 (Nuklei Pontin-mesensefalik-sakral) =

Pontine Micturition Center ( PMC )
Fungsi:koordinasi detrusor dengan spingter
Kalau rusak dibawah PMC dan diatas SMC ( SCI )
hiperefleksia detrusor + Detrusor Spingter Disinergia (DSD)
KK otonomik
IU

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INERVASI SENTRAL KK..

Loop 3 ( Nuklei Pelvic-Pudendal) = SMC/
Sacral Micturition Center
Fungsi: 1. Mengintegrasikan stimuli dari Loop 1
2. Meneruskan Parasimpatis S2 - S4 Sacral
Micturition Reflex
Kalau rusak KK Arefleksik / Atonia Retensi Urin
IU overflow

Loop 4 ( Korteks motoris

Spingter eksterna

N. Pudendus
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Inervasi
sentral KK

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Fisiologi proses miksi

Terdiri dari 2 fase :
filling (storage) phase (pengisian KK) :
tekanan intra vesika meningkat perlahan
stimulasi reseptor simpatis (beta adrenergic)
di body KK relaksasi detrusor, dan
stimulasi alfa adrenergic di basis
vesika&uretra kontraksi inhibisi sistem
parasimpatis (manghambat kontraksi
bladder/vesika)
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Fisiologi proses miksi..

voiding / emptying phase (pengosongan
KK)
KK penuh ingin miksipenurunan
aktivitas otot spincther & penurunan
tekanan di uretra menghilangnya reflek
inhibisi dr spincther mechanism ke SMC
kontraksi otot detrusor
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Perubahan fisiologi proses miksi

pada lansia

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Perubahan fisiologi proses miksi

pada lansia.....

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Perubahan fisiologi proses miksi

pada lansia.....

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DIAGNOSIS

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Klasifikasi fungsional inkontinensia urin

Type of
failure

Failure
to store

Bladder factor

Hiperactivity
Decresed
compliance

Failure Areflexic
to empty Hypocontractility

Outlet factor

Denervated pelvic floor

Bladder neck descent
Intrinsic bladder neck
spincther failure
Detrusor spincther
dissinergy
Non relaxing voluntary
spincther
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Mechanical
obstruction(mis BPH)

DIAGNOSIS ..
PEMERIKSAAN FISIK
Pemeriksaan umum
Pemeriksaan neurologis( konsentrasi
pada root S2 - S4)
Pemeriksaan abdomen, genitalia, vagina

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Myotom Sakral 2-3-4 :

Plevic floor muscle, externa
urethral& anal spincther, hip
extensor, lateral rotator
Ankle plantar fleksor,
lumbrical, interossei

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 Dermatom S2-3-4

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Pemeriksaan genitalia
Inspeksi
Lihat vulva/vagina :
tanda2 iritasi, pelvic
organ prolaps

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Pemeriksaan genitalia..
Pemeriksaan otot dasar panggul
Palpasi manual

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Pmx otot dasar panggul dgn 1

jari

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Pmx otot dasar panggul dgn 2

jari

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Ring of continence

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Derajat kekuatan
otot dasar
panggul

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 PEMERIKSAAN PENUNJANG
Lab. Urodinamik. radiologis

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PENATALAKSANAAN
RETENSI URIN
KATETERISASI
Indwelling/kontinyu
Berkala (clean intermitten cath)
Supra pubik
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PENATALAKSANAAN...
INKONTINENSIA URIN
Terapi perilaku
Latihan otot dasar panggul
Farmakoterapi
Operasi/Bedah

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TERAPI PERILAKU
TIMED VOIDING / MIKSI TERJADWAL
- normal miksi 6-8x/24 jam
- pasien diminta miksi sesuai jadwal
-sulit pd px dg gangguan kognisi
BLADDER DIARY: mencatat intake cairan
(jenis,jumlah), waktu dan volume miksi
ALAT PENAMPUNG ; popok, kondom
kateter, kateter menetap
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Membuat bladder diary

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LATIHAN OTOT DASAR

PANGGUL
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Prinsip umum latihan

Overload : strength & endurance otot bisa
meningkat apabl otot bekerja lebih keras drpd
beban yg biasa
-strengthening : high resistance-low repetition, 3-4
set, 8-12 repetisi
- endurance : low resistance-high repetition, short
rest,mis 4 detik.
Specificity : otot yg dilatih kuat
Maintenance
Reversibility

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Latihan otot dasar panggul

Posisi : berbaring/duduk/berdiri
Latihan nafas :inspirasi dada
mengembang, otot perut relaks, ekspirasi
dada kempis, otot perut kontraksi
Kencangkan otot dasar panggul (seperti
saat menahan BAK, saat ekspirasi)
Latih kontraksi panjang (10 detik) dan
kontraksi pendek2 dan cepat
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 Kuliah OAB: dr Bayu SpKFR-Kcompany name

 Kuliah

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OAB: dr Bayu SpKFR-K

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Kuliah OAB: dr Bayu SpKFR-K

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Contoh latihan otot dasar panggul

(Kegels exercise)
Initially - Tighten the pelvic floor muscles for count of six and relax for
six seconds. Each contraction cycle should last 12 seconds or 5
contractions a minute. Repeat 25 times. Do this 3 times each day - total
75 contractions.
Week 2 - Tighten the pelvic floor muscles for 6 seconds every 12
seconds (5 per minute) for 10 minutes, 50 contractions. Do this 3 times
each day - total 150 contractions.
Week 3 - Tighten the pelvic floor muscles for 6 seconds every 12
seconds (5 per minute) for 15 minutes, 75 contractions. Do this 3 times
each day - total 225 contractions.
Weeks 4-24 - Tighten the pelvic floor muscles for 6 seconds every 12
seconds (5 per minute) for 20 minutes, 100 contractions. Do this 3 times
each day - total 100 contractions.
After 24 months - Continue maintainence at 10 minutes three times a
day or 15 minutes twice a day, total of 150 contractions a day.

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STIMULASI

LISTRIK

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Electrotherapy/ stimulasi listrik

is the application of electrical current to
provoke nerve activity and to stimulate
function in different organ systems.
The aim of electrical stimulation within the
pelvic floor region is to induce skeletal
muscle training, remodel smooth muscle
and or connective tissues and to modulate
bladder, bowel, or sexual dysfx
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Terima kasih

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