DIAPPERS: Transient Causes of Urinary Incontinence and other contributing factors

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1 DIAPPERS: Transient Causes of Urinary Incontinence and other contributing factors D Delirium Acute confusion alters one s ability to anticipate and meet own needs. Delirium may occur from drugs, surgery, or acute illness. I Infection Urinary tract infection A Atrophy Thin dry, friable vaginal and urethral mucosa due to Hypo-estrogenization in older female is associated with irritating symptoms (burning on urination, urgency, frequency) P Pharmaceuticals Drugs including sedatives, hypnotics, alcohol, anticholinergic, antihistamine, narcotics, loop diuretics. P Psychological condition Depression impairs one s motivation and desire to manage self-care or be concerned about incontinence. Fear of odor, embarrassment, obvious leakage, and unpredictable urine leakages can lead to marked alternation in social activities, relationships with others, and loss of social support. E Excess urine output Excess urine output resulting large fluid intake, caffeinated beverages endocrine problems CHF, Peripheral edema R Restricted mobility Poor mobility, arthritic pain, poor use of assistive device S Stool Impaction Narcotic use can lead to severe constipation and fecal impaction that obstruct the bladder neck, leading to urine retention and/or overflow incontinence Adapted from Resnick NM. Geriatric Incontinence. Urol Clin North Am 1996; 23:55

2 Kegel Exercises: A How to Guide WOMEN Kegel exercises can help prevent or control urinary incontinence and other pelvic floor problems. These exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine, and rectum. How to Perform Kegel Exercises: Find the right muscles. To identify your pelvic floor muscles, stop urination in midstream. If you succeed, you ve got the right muscles. Once you ve identified the muscle, you can do the exercises in any position, although you might find it easiest to lie down at first. Perfect your technique. Tighten your pelvic floor muscles, hold the contraction for 5 seconds, and then relax for 5 seconds. Try it 4 or 5 times in a row. Work up to contracting the muscles for 10 seconds at a time, relaxing for 10 seconds in between. Maintain your focus. For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs, or buttocks. Avoid holding your breath, and instead breathe freely. Repeat 3 times a day. Aim for at least 3 sets of 10 repetitions a day. Source: Urinary incontinence in women. National Institute of Diabetes and Digestive and Kidney Diseases.

3 Kegel Exercises: A How to Guide MEN How Can Men Perform Kegel Exercises? Halfway through urination, try to stop or slow down the flow of urine. Don t tense the muscles in your buttocks, legs, or abdomen, and don t hold your breath. When you can slow down or stop the flow of urine, you ve successfully located these muscles. To Perform Kegel Exercises: Contract these muscles for a slow count to five. Release the muscles to a slow count of five. Repeat 10 times. Do a set of 10 Kegels daily, three times a day. When you are first starting, it might be easier to do the Kegel exercises laying down, so your muscles aren t fighting against gravity. After a few weeks, increase the time until eventually you re contracting the muscles for a slow 5 or 10 seconds, and do the exercises standing up. That puts more weight on the muscles, boosting your workout and improving your control. Remember not to tense your buttock, legs, or stomach muscles while you re doing Kegels. Source: Urinary incontinence in men. National Institute of Diabetes and Digestive and Kidney Diseases.

4 Behavior Modification for Managing Transient Urinary Incontinence Bladder Training Directions Goals: Increase amount of time between emptying your urinary bladder and amount of urine your bladder can hold. Diminish the leakage and sense of urgency associated with incontinence. Bladder training requires a fixed voiding schedule, whether or not the urge to urinate is present. If urge occurs before the assigned time, urge suppression techniques such as relaxation and pelvic floor exercise can be used. As success is achieved the interval is lengthened in increments of 30 minutes until patient remains comfortable for 3-4 hours. Timing can be individualized to suit each patient s need or desire. Keeping a bladder diary (activity of patient s bladder) is very important. This helps to determine the correct place to start the training and monitor your progress. Instructions for Bladder Training 1. Empty bladder as soon as you get up in the morning. This starts your schedule. 2. Urinate at the specific times agreed on. 3. Wait the full amount of time (agreed time) before you urinate again. 4. Be sure to empty your bladder even if you do not feel the urge to urinate. 5. Follow the schedule during AWAKE HOURS ONLY. At night, urinate if you need to. * Important: If urge to urinate is felt before scheduled time use: Urge Suppression Techniques Sit or stand (Freeze) Perform 3-5 quick strong pelvic contractions (Squeeze) Take 5 deep breaths (Breathe) Grace Umejei, BSN, RN, CWOC

5 Behavior Modification for Managing Transient Urinary Incontinence Distraction Techniques Count backward from 100 by 7 Recite a poem from memory Try passive self-statement; I am the boss, not my bladder. If urge is suppressed adhere to your scheduled time. If urge cannot be suppressed and you must go, slowly make your way to the bedside commode or bathroom. Then continue with your schedule. Repeat this process every time the urge to urinate occurs. Once this initial goal is reached, increase 15 minutes between each urination until you reach a 4 hour voiding interval. It should take your hospitalization period and practice on discharge to accomplish and sustain this goal. Lifestyle Modification Tips: Watch how much you drink Avoid foods and drinks that bother the bladder such as caffeine, carbonated drinks, artificial sweeteners and spicy foods. Watch your weight Stop smoking Try to stay regular, eat fiber and drink enough to maintain normal bowel activity. Grace Umejei, BSN, RN, CWOC

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7 Bladder Diary Key: D Diaper BSC-Bedside Commode P- Bed Pad BP-Bed pan PU- Pull Ups T- Toilet Time interval 12-1 AM Prompt Voided Continent Incontinent Incontinence Products Toileting Device Intake Type Cognition or Willingness 1-2 AM 2-3 AM 3-4 AM 4-5 AM 5-6 AM 6-7 AM 7-8 AM 8-9 AM 9-10 AM AM AM 12-1 PM 1-2 PM 2-3 PM 3-4 PM 4-5 PM 5-6 PM 6-7 PM 7-8 PM 8-9 PM 9-10 PM PM AM Plan: Offer toileting every 3 hours during the day and every 4 hours at night.

8 Two Choices of Incontinence Training Plans Prompted Voiding Description: RN/PCT/Patient responsibility Prompt patient on scheduled (every three hours during the day, and every four hours at night) to report continence status and to toilet Provide positive feedback for maintenance of continence Goal: To keep the patient dry and to increase the patient s awareness of incontinence status and participation in bladder program. Guidelines: Determine patient s usual voiding frequency via bladder diary Place patient on voiding schedule: at each schedule time, ask patient to report continence status. Verbally reward patient for dryness and offer the opportunity to toilet-verbally reward willingness to attempt toileting and also praise successful toileting. Scheduled Voiding Description: RN/PCT/Patient responsibility Every two hours while awake every four hours at night Patient is taken to the toilet (or bedside commode) on schedule and cued to void Indications: For a patient with reduced sensory awareness of bladder filling, who is unable to accurately determine wetness or dryness and unable to take responsibility for selftoileting but who IS able to follow instructions with assistance. Goal: Prevent over-distention of the bladder Keep the patient dry by toileting frequently enough to prevent incontinence. Guidelines: Toilet every two hours while awake OR Toilet upon arising