tips for bladder incontinence

25 Tips Occupational Therapists Can Use for Bladder Incontinence

No one likes to readily admit if they are having bladder incontinence problems. For many, it is viewed as a shameful and taboo topic and it can be hard to know who to turn to for help in this department.

It is commonly known that occupational therapists target the ADL of toileting. It is less commonly known that occupational therapists can assist our patients with their bowel and bladder management.

It is important to note that as occupational therapists, we should not consider bladder incontinence a normal part of aging. It is something that we can target and address in order to improve our patients’ quality of life, well-being and reintegration into all their occupations.

Incontinence Statistics

In the US, more than 13 million people are suffering from incontinence. Roughly 45% of patients that see OT through home health services are experiencing incontinence. These statistics emphasize the importance of OTs addressing this (1). 

Around 40-60% of stroke survivors will go on to develop a bladder or bowel problem, and after one year only 15% of people continue to experience incontinence (2).

On average, women wait 6.5 years from the onset of symptoms before they receive a diagnosis for their bladder problems (3). Furthermore, two-thirds of women and men have never had a discussion or received treatment from their doctor about bladder health. This further emphasizes the need for occupational therapists to ask their patients about their bladder. 

female incontinence

Why is Working on Bladder and Bowel Continence So Important?

Incontinence will impact nearly every person’s ADLs/occupations. Think about it:

  • Rest & sleep: Are you truly able to rest and sleep if you experience nocturia (frequent urination at night), or have to frequently visit the toilet while trying to rest. There may also be a fear of sharing a bed with a loved one due to the possibility of urinating in the bed. 
  • Leisure: Your patient may not be engaging in their premorbid leisure interests out of fear of soiling themselves during the leisure task. Furthermore, their leisure interest may cause them to leak. Ex: jumping while exercising and horse riding.
  • Social participation: No one wants to be soiled while interacting with others. Our patients may be fearful of there being an odor, or there being an embarrassing incident. As a result of this, many unfortunately socially isolate themselves. 
  • Work/education: Being fearful of obtaining work, or going into the office due to the risk of loss of bladder control. 

10 Continence Assessment Questions: 

  1. Prior to your (insert condition) did you have any problems with your bladder?
  2. Currently, are you able to feel when you need to urinate? 
  3. When you feel the urge to urinate, can you hold your urine or does it come out before you get to the toilet? 
  4. Do you sometimes wet yourself when coughing/sneezing or jumping?
  5. Have you had a urinary tract infection recently?
  6. How many bladder accidents do you have in a day?
  7. Are you reliant on a continence pad or diaper, and can you identify when your nappy is soiled and needs to be changed?
  8. When you go to the toilet do you urinate easily or do you need to wait a while before you start urinating? 
  9. How many times a day do you currently urinate? 
  10. How many times a night do you go to the toilet? 

6 Types of Bladder Incontinence: 

  • Frequency urination: Needing to relieve bladder very often (examples of underlying problems could be sensation difficulties, sphincter control difficulties, hyper-reflexic/spastic bladder)
  • Functional incontinence: The client has difficulty getting to the toilet on time due to physical difficulties with mobility or hand function which results in a bladder accident.
  • Urge incontinence: Getting a sudden intense and uncontrollable need to pass urine and not being able to hold in urine long enough to reach the toilet, resulting in a bladder accident. (Can be linked to many conditions)
  • Stress incontinence: Urine leaking as a reaction to a sneeze, cough, lifting something heavy or jumping (Weak pelvic floor muscles)
  • Urinary retention: Unable to completely empty bladder (Areflexic/flaccid bladder, weak pelvic floor muscles)
  • Nocturnal incontinence/enuresis: Needing to empty bladder several times at night or having a bladder accident at night (could be due to any of the above reasons)

5 Tips for Lifestyles Changes for Bladder Management:

  1. Avoid drinking liquids that can irritate the bladder: caffeine, sugary drinks, juices, and carbonated drinks. Try to drink water only and lots of it! Reducing the amount of water drunk results in more concentrated urine, which irritates the bladder mucosa and results in an increase in frequency and urgency (4).
  2. Avoid drinking liquids up to 2 hours before going to sleep
  3. Losing weight assists in reducing the force on the bladder and pelvic floor
  4. Timed voiding regimens: go to the toilet every 2-3 hours. This is recommended whether your patient needs the toilet or not. The purpose of this is to increase their awareness of bladder sensations. Over time, as bladder sensation improves, increase the intervals between voiding.
  5. Can use bladder diary to document times and if possible volume of urine voided. Also, record bladder accidents in diary. You can recommend your patient uses a bladder diary like this one.

If your client is still unable to maintain bladder control while following schedule and still having frequent bladder accidents, then there may be further complications and visiting a urologist and a pelvic floor therapist is advised. 

pelvic floor specialist for incontinence

5 Training Techniques Tips for Bladder Management:

When a patient with continence difficulties issues the urge to go to the toilet they frequently become anxious, rush to the toilet, and occasionally end up wetting themselves. This behavior actually contributes to incontinence. When your patient has the urge to urinate, it’s crucial to instruct them to try and attempt the following to help maintain continence:

  1. Tell yourself “I can wait”
  2. Use deep breathing or a mental activity to distract yourself, such as counting backwards or performing simple math sums.
  3. Do a once off pelvic floor contraction and hold it for 10 seconds
  4. Do not rush to the toilet or pull your clothes down in a hurried manner, but try to get yourself there in a relaxed manner
  5. Make sure to reward yourself when you successfully delay urination until you reach the toilet. For example, tell yourself, “I did it! I managed to wait until I reached the toilet.”

Initially you will go to the toilet as soon as you feel the urge (in a calm manner), but with practice and guidance from your occupational therapist, you’ll be able to extend the interval between having the urge and actually using the restroom.

With time this will improve your urge incontinence, and you will no longer have the anxiety of having to rush to the toilet as soon as you feel the urge to go (4).

10 Education Tips and Exercises for Bladder Management:

  1. Pelvic floor exercises can assist in improving your patient’s bladder continence. 
  2. To comprehend which muscles they are tightening, it is crucial to always educate them on the pelvic floor by first showing them a picture of it.
  3. Make them feel at ease about their bladder incontinence by telling them statistics of how common it is, but remind them that it is not a normal part of aging and it can improve. 
  4. Instruct your patient to do a pelvic floor contraction by imaging they are holding in urine/wind (they must never practice it while urination on the toilet). Tell them to imagine they are lifting UP and squeezing in their pelvic floor muscles. Ideally practiced on an empty bladder.
  5. ‘Fast’ pelvic floor contractions will help to improve stress incontinence 
  6. ‘Long holding’ exercises can help improve urge incontinence. 
  7. As your patients continue practicing they will be able to sustain the contraction for a longer period of time. 
  8. It can be done in sitting or lying depending on what is easier for your patient. Educate them on not moving or contracting their legs, buttocks or abdomen, it is only the pelvic floor muscles. 
  9. You can advise your patient to use a mirror to check if they are doing it correctly or doing the pelvic floor contraction around a finger (for women). This provides biofeedback. 
  10. When doing a pelvic floor contraction as a man they will see the base of their penis lift and their testicles rise. 

4 Helpful Tips for Living with Bladder Incontinence

  1. Select the right clothing. Wear clothing that’s easy to take on and off, such as elasticated pants without buttons and zips and avoiding long tops that may interfere when attempting to remove pants.
  2. Modify your home. Make sure your bathroom is easily accessible and adapted to your needs, such as use of rails, commodes and raised toilet seats. Utilizing urine bottles can also assist. 
  3. When going out make sure you are aware of where the bathrooms are, and if sitting in a restaurant try to position yourself a bit closer to the bathroom. 
  4. Products that can help: There are a number of products that can help you stay dry and comfortable. These include pads, liners, pants, mattress protectors and absorbent underwear. 

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We know this article was jam packed with information, but we really hope that it will be of value to both you and your patients experiencing incontinence.

Do not be shy to address this topic with your patients, because the truth is many other health care practitioners are avoiding or neglecting this topic, especially in a fast paced rehab or hospital setting.

Use these 25 tips to help your patient with their bladder incontinence, and you will help them greatly improve their quality of life. And if you find that you or your patient need additional help, you can also refer them to your local pelvic floor OT or PT clinic for further assessment.

References

  1. K. Covell-Pierson, “Are you addressing incontinence at home? An OT’s guide”, 04/20/2018, URL: https://www.medbridgeeducation.com/blog/2018/04/addressing-incontinence-home-ots-guide/, Accessed on: 3/17/2023. 
  2. Stroke Association, “Continence problems after stroke”, 04/12, URL: https://www.stroke.org.uk/sites/default/files/continence_problems_after_stroke.pdf, Accessed on: 03/17/2023. 
  3. Phoenix Physical Therapy, “Urinary Incontinence in Women”, URL: https://phoenixpt.com/statistics/#:~:text=On%20average%2C%20women%20wait%206.5,bladder%20control%20problem(s).&text=Stress%20urinary%20incontinence%2C%20the%20most,adult%20women%20in%20the%20U.S., Accessed on: 03/17/2023. 
  4. Understanding Continence Promotion: Effective Management of Bladder and Bowel Dysfunction in Adults, Future Learn: Association for Continence Advice, URL: https://www.futurelearn.com/courses/understanding-continence-promotion, Accessed on: 03/17/2023. 

 

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