Occupational Therapy’s Role In Incontinence

Objectives Get 3-in-one solutions for incontinence, back pain, & balance Improve outcomes Incorporate “Roll for Control” into your own agency Gain gross overview of mechanics of the pelvic floor and how it impacts continence issues

Definition of Urinary Incontinence Involuntary loss of urine that is sufficient to be a problem The inability to go to the bathroom you want when and where

Incontinence is NOT NORMAL Incontinence is not an inevitable part of growing older or a part of being a woman It’s NORMAL to void every 3-4 hours Bladder holds 300-600cc of Urine Normal night time voiding for individuals UNDER age 65 – 0-1 times during night Normal night time voiding for individuals OVER 65 – 1-2 times during the night

The impact UI has on a person’s Quality of Life Decrease social interactions Reduces recreational activity Decreases productivity Sexual problems Poor sleep which may increase depression

Behavioral Changes The health care professional can assist a patient experiencing urinary incontinence with behavioral changes.

Behavioral Changes Fluid Intake Fiber intake Medications Restroom habits Exercises

Why increase WATER intake If patient is dehydrated urine becomes Concentrated Increases irritation to bladder wall Increases spasms Increases leaking

Monitor FLUID intake Eight -8 oz glasses of water a day (30cc/kg) Decrease bladder irritants

Bladder Irritants Some foods and beverages are thought to contribute to bladder leakage. Their effect on the bladder is not always understood. Eliminating on or all of the items listed may improve urine control. Alcoholic beverages Carbonated beverages Caffeine soda/coffee/tea Milk or milk products Citrus juices Tomatoes Highly spiced foods Sugar/honey/corn syrup Chocolate Artificial sweeteners

Why increase FIBER intake Goal: prevent constipation/stool impaction A mass of fecal matter Compress on bladder wall Changes bladder neck Results in retention or leaking ***Disimpaction can provide AMAZING results!

Gradually increase FIBER 14 grams fiber/ 1 ¼ cup Natural is the best and easiest: Bran, Prunes and Flax seed Caution: Flax seed interacts with Coumadin Examples: Benefiber, Metamucil, Citrucel, and Fibercon

General Techniques to Address Environmental changes Bladder retraining Exercises

Mobility Assess Pathway to restroom Vision Fear of falling Issues with clothing Alter restroom to accommodate the individual needs

Mobility Fear of falling while going to bathroom so he/she holds urine Leads to urine leaking from full bladder

Positioning self on toilet To assist with bladder neck angle Feet flat on the floor Pants around ankles not inhibiting the knees Anterior pelvic tilt

Double Void Use the restroom and then wait 30 seconds and attempt to void again. Assist with emptying bladder completely so don’t have the urge to go right away again

Pelvic Muscle Exercises Kegals Roll for Control WHY DO PELVIC MUSCLE EXERCISES? Just like every other muscle in the body it weakens over time, if you don’t use it you lose it

Why the CONCERN? Mobility issues leads to fear of falling while going to BR so pt. compensates by holding urine, which leads to urine leakage from a full bladder on the way to BR

CONCERN Now the patient begins drinking less to reduce the number of trips to the BR and develops constipation, as well as a UTI which now precipitates increased urgency and dehydration

CONCERN The pt. now develops BP fluctuations due to inadequate fluid intake and is ultimately at risk for FAINTING OR FALLING.

Good Advice for everyone Use the toilet every 2-4 hours during waking hours Relax, take a deep breath in and out Do not push or force your stream Sit with garments at ankles, feet flat on the floor Double void if you feel your bladder isn’t empty Do not get into the habit of urinating “just in case” if you recently voided

Good Advice for everyone . . . Good water intake Avoid bladder irritants Prevent constipation

Who are good referrals? Cognitively intact patients Open and willing to try behavioral techniques to assist with UI Treatment is directed at improvement not cure *** Remember UI did not develop over night usually takes 3-4 weeks to see results

Thanks to: Allana Seppelt at HealthEast for her “Incontinence 101” Janet Hulme, MA PT for her “Roll for Control” program ©

Patti Teachout OTR/L HealthEast Home Care Adrienne Guelker OTR/L Integrated Home Care