1. Occupational Therapy’s Role
In Incontinence

2. 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

3. 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

4. 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 cc 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

5. 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

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

7. Behavioral Changes Fluid Intake Fiber intake Medications
Restroom habits
Exercises

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

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

10. 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

11. 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!

12. 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

13. General Techniques to Address
Environmental changes
Bladder retraining
Exercises

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

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

16. 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

17. 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

18. 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

19. 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

20. 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

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

22. 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

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

24. 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

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

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