Myth or Fact?

1. Myth or Fact? Women have more incontinence than men?

2. Myth or Fact? Incontinence can happen at any age?

3. Myth or Fact? Incontinence in the elderly is normal?

4. Myth or Fact? • Increased fluid intake leadsto urinary incontinence?

7. How The Kidneys Work • Two reddish brown organs shaped like kidney beans and the size of a fist • Located on either side of the spine under the lower ribs • Remove wastes from the blood and return the clean blood to the body • Wastes are concentrated into urine and flow through a tube, the ureter into the bladder • Usually make 1 to 2 litres daily

8. How The Bladder Works • The bladder is a muscle which is shaped like a balloon • The bladder has 2 functions: • The storage of urine produced by the kidneys • The elimination of urine • The bladder contracts when it is full to empty

9. How The Bladder Works • The sphincter muscle acts like a faucet. When closed it helps prevent urine from leaking. When open the urine can pass out. • The brain and nervous system receive a message when the bladder is full to signal you to empty your bladder.

10. Function of Pelvic Floor Muscles • Support, hold in pelvic contents • bladder, urethra, bowel, vagina and uterus • Closing Force • When tightened, muscles around urethra, vagina and anus place a closing force to stop leakage

11. Bladder Dysfunction • Normally Not Life Threatening • Can Seriously Affect The Quality of One’s Life • Either the Bladder is: • Unable to store urine • Unable to completely empty

12. What is Urinary Incontinence? • Urinary Incontinence is the involuntary loss of urine. • This often results in social or hygienic problems • It is a common condition that can be embarrassing and distressing and may severely affect your quality of life.

13. Acute Urinary Incontinence “Temporary” • A temporary or reversible condition related to an illness or a specific medical problem • Delirium, dehydration • Infection, inflammation • Atrophy • Pharmaceutical, pregnancy, psychological • Endocrine • Restricted mobility, retention (overflow) • Stool impaction

14. Chronic Urinary IncontinencePersistent abnormalities of structure& function • Stress Urinary Incontinence • Cough, laugh, lift • No bladder abnormality • Urge Urinary Incontinence • Key in the door • Mixed Incontinence • Stress and urge • Overflow Incontinence • Obstruction, medications, neurological conditions • Functional Incontinence • Impairment physical &/or mental abilities

15. Factors Contributing to Incontinence • Diet • Constipation • Medication • Pregnancy & Childbirth • Hormonal Changes in Women • Prostate Problems in Men

16. Factors Contributing to Incontinence • Obesity / Overweight • Diabetes • Neurological Conditions • Limited mobility • Chronic Cough • Smoking

17. Some foods and drinks that make the bladder contract more often • Alcohol • Carbonated beverages (with or without caffeine) • Coffee or tea • Medicines with caffeine • Citrus juice and fruits • Tomatoes • Tomato-based products • Highly spiced foods • Sugar • Honey • Chocolate • Corn syrup • Artificial sweetner

18. Regaining Control • Voiding Diary • Bladder Retraining • Timed Toileting • Prompted Voiding • Diet • Personal Care • Pelvic Floor Exercises (Kegel Exercises)

19. Voiding Record / Bladder DiaryImportant Points • Important to know the time and the amount of urine voided • Estimating the amount can be deceiving • The type and amount of fluid consumed • Episodes of leakage or urgency • The use of protective wear

20. Voiding Record / Bladder DiaryImportant Points • Frequency of Toileting • How often? How much does your bladder hold? • Day/ Night • What prompts you to go • Pattern of Fluid Consumption • Type • How much • Characteristics of Leaking • When • How much

21. Bladder Management Program • Bladder Retraining • Individuals with urge incontinence • Timed Toileting • Individuals with Decreased sensory awareness of bladder filling • Prompted Voiding • Individuals who are cognitively impaired • Diet • Individuals with Urge /Mixed Incontinence • Overweight individuals: Even 5 to 10 lbs. weight loss can make a difference

22. Bladder Retraining • Bladder diary to determine usual voiding pattern • Teach Urge Inhibition Strategies to postpone voiding until in the appropriate place and it is an appropriate time interval • Establish voiding schedule based on an appropriate time interval • Void “by the clock” instead of “by the urge” (using inhibition strategies to control urgency and delay voiding)….record all voids and leakages. • When “in control” with established schedule, lengthen the voiding interval by 15 to 30 minutes until a more normal voiding pattern is established

23. Timed Toileting • Bladder diary to determine usual voiding pattern and interval • Timer (eg: watch with an alarm) set at the determined reliable interval • Void according to established schedule • Unlike bladder retraining, the interval between voiding is not lengthened. • The person is directed to void at the scheduled times

24. Prompted Voiding • For cognitively impaired residents. • CHECK: Ask person if they are wet or dry….encourage them to identify their condition • PROMPT: Regardless of the person’s state, staff should prompt them to use the toilet facilities • PRAISE:most important..individuals who attempt to comply need genuine reinforcement

25. Diet • Maintain a balanced diet • Eliminate bladder irritants • Increase fiber to prevent constipation • Increase Fluid intake • Drink more water

26. Personal Care • Wash and wipe from the front to the back • Wash with warm water and pat or blow dry • Avoid • feminine hygiene sprays • bubble bath • baby wipes • Void after having intercourse • White cotton crotch underwear.

27. Incontinence Products • An incontinence product should never be the first line of managementThe professional may advise the use of an incontinence product after a fullassessment indicates it can significantly enhance quality of life

28. Sanitary Napkins • At least 10% of sanitary napkins are purchased for incontinence • Sanitary Napkins are not designed for urine absorption and do not control odor

29. Degree of Protection required • Protection should match need • Light protection- panty-liner (For small loss of urine as when coughing or sneezing) • Moderate protection (thicker pad) • Heavy protection (pad and panty system)

30. Muscle Exercise Program • Improve strength so that muscles are strong enough to prevent urine loss and maintain organs in optimal position • Hold the contraction • Gain control over the muscles so that you can use them quickly to prevent urine loss • Quick squeezes-Urge Suppression techniques

31. KEGEL Exercises • Contract your pelvic floor muscles as if you wanted to hold gas or as if you wanted to stop the urine flow • Hold for 5-10 sec and relax 10 sec, repeat 10 times in a row • Have to do them throughout your day, total of 6-7 sets/day • Be careful not to strain while doing these exercises • To remember to do your Kegel’s or pelvic muscle exercises each day do them during the commercial's of your favourite 30 minute program. They can be done lying down, sitting or standing

32. Urge Suppression Techniques For urgency and frequency to prevent dribbling on your way to the toilet or after you have voided • 1) Stop, sit down and do 5 quick Kegel exercises (1 second each) • 2) Relax your abdominal muscles by taking 3 to 4 deep cleansing breaths. Slowly inhale and exhale • 3) Be positive. Think: “I can hold and wait” • 4) Get up slowly and walk to the bathroom

33. How do I talk to my Doctor? • Do a voiding record for 2-4 days • Make a list of what you had done to help yourself • When making your appointment, ask that enough time be made for counseling • Make a list of questions and space for answers • Ask for a referral to an expert in continence care if you feel the need

34. Physiotherapy Provides • Clinical Evaluation • Education • Self Help Techniques • Bladder Retraining • Scheduled Toileting • Pelvic Floor Muscle Reeducation • Biofeedback • Electrical Stimulation • Exercises