How Can Your Nurse How Can Your Nurse Advisor Help You?Advisor Help You?

How Can Your Nurse How Can Your Nurse Advisor Help You?Advisor Help You?

Presented by (insert name of presenter here)

Role of NursesRole of NursesRole of NursesRole of Nurses

• Help to recogniserecognise patients who have problems maintaining continence

• Offer helphelp and adviceadvice to patients and relatives

How to Recognise Patients How to Recognise Patients with an Overactive Bladderwith an Overactive BladderHow to Recognise Patients How to Recognise Patients with an Overactive Bladderwith an Overactive Bladder

• Symptom assessment• Medical history• Physical examination • Urinalysis• Bladder diary• Pad test• Referral for medical

evaluation and treatment

Symptom AssessmentSymptom AssessmentSymptom AssessmentSymptom Assessment

• In total, how many times do you go to the toilet in a 24-hour period?

• How often do you go to the toilet during the day?

• How often do you wake to go to the toilet during the night?

• How often do you feel a strong and sudden desire to urinate?

• If you fail to go to the toilet in time, how much urine do you usually leak?

• Do you leak urine when you laugh, cough, sneeze, jump or run?

Medical HistoryMedical HistoryMedical HistoryMedical History

Other questions that your doctor/nurse might ask:

• History of previous surgery or radiotherapy involving the pelvic region

• Medications currently taking

• Main symptoms (complaints)

• Duration of symptoms

Physical ExaminationPhysical Examination Physical ExaminationPhysical Examination

• Abdomen exam

• Rectal exam

• Pelvic exam

UrinalysisUrinalysis UrinalysisUrinalysis

To rule out urinary tract urinary tract infectioninfection

Bladder DiaryBladder Diary Bladder DiaryBladder Diary

Helps patientsHelps patients record details of:

• Bladder symptoms• Type/amount of drinks taken• Time/amount of urine passed

Bladder DiaryBladder DiaryBladder DiaryBladder Diary

Date: Monday 19 March

Time Drinks(types andamount)

Amountof urinepassed

(ml)

Did you feel astrong and

sudden desire tourinate ( if yes)

If leakage occurs,amount of urine

leaked

SSmmaallll MMeeddiiuumm LLaarrggee8:00 am Tea, 2 cups

8:30 am 150 ml 10:00 am Coffee, 1 mug 11:15 am 200 ml

12:00 pm 100 ml

1:00 pm 100 ml

2:00 pm Cola, 1 can

2:30 pm

Pad TestPad TestPad TestPad Test

A supplementary test used to confirm urine leakage and quantify the degree of urine loss.

Pad TestPad TestPad TestPad Test

Method:Method:

• Drink 500 ml of fluid as quickly as possible

Pad TestPad TestPad TestPad Test

Method (cont’d):Method (cont’d):• Perform a series of physical tasks in

a 1-hour period• Walking

• Climbing stairs • Coughing vigorously • Running on the spot

Pad TestPad TestPad TestPad Test

Method (cont’d):Method (cont’d):

• The pad is re-weighed.• A weight gain of more than 1 g

signifies that the patient is incontinent.

Pad TestPad TestPad TestPad Test

Referral for FurtherReferral for FurtherEvaluation and TreatmentEvaluation and Treatment

Referral for FurtherReferral for FurtherEvaluation and TreatmentEvaluation and Treatment

Patients are considered for referral if:

• Symptoms do not respond to initial treatment within 2-3 months

• Blood in urine without infection on urine test

Referral for FurtherReferral for FurtherEvaluation and TreatmentEvaluation and Treatment

Referral for FurtherReferral for FurtherEvaluation and TreatmentEvaluation and Treatment

• Symptoms suggestive of bladder obstruction

• Evidence of unexplained neurologic or metabolic disease (e.g. renal failure, diabetes insipidus)

Management of Management of Overactive BladderOveractive Bladder

Management of Management of Overactive BladderOveractive Bladder

• Drug therapy • Bladder training• Incontinence pads and protective devices • Bladder self-catheterization • Pelvic floor exercises• Biofeedback• Review diet and food intake• Skin care and cleanliness• Surgery

Bladder TrainingBladder TrainingBladder TrainingBladder Training

A behavioural approach to the treatment of the overactive bladder, which is often used in combination with drug therapy.

Bladder TrainingBladder TrainingBladder TrainingBladder Training

Aims:Aims:

• Increase the time intervals between bladder emptying.

• Increase bladder capacity by teaching patients to resist and suppress the urge to pass urine.

Bladder Training:Bladder Training:Frequency/Volume RegulationFrequency/Volume Regulation

Bladder Training:Bladder Training:Frequency/Volume RegulationFrequency/Volume Regulation

Incontinence Pads and Incontinence Pads and Protective EquipmentProtective Equipment

Incontinence Pads and Incontinence Pads and Protective EquipmentProtective Equipment

Absorbent pads

Dribble pouch

Reusable underpants designed to carry disposable absorbent pads

All-in-one briefs

Chair and bed pads

Incontinence Pads and Incontinence Pads and Protective EquipmentProtective Equipment

Incontinence Pads and Incontinence Pads and Protective EquipmentProtective Equipment

These do not treatdo not treat the cause of the problem.

• At best, they are a passive form of management for only one of the symptoms (i.e. urge incontinence).

Incontinence Pads and Incontinence Pads and Protective EquipmentProtective Equipment

Incontinence Pads and Incontinence Pads and Protective EquipmentProtective Equipment

Ideally, incontinence pads should be used only as a temporarytemporary or supplementarysupplementary measure while the results of drug therapy or bladder training come into effect.

Bladder CatheterizationBladder CatheterizationBladder CatheterizationBladder Catheterization

• For some patients, drug therapy and bladder training will not be will not be adequateadequate to manage their symptoms.

• For example, patients with a spinal cord injury may be unable to empty their bladder completely.

Bladder CatheterizationBladder CatheterizationBladder CatheterizationBladder Catheterization

Pelvic Floor ExercisesPelvic Floor ExercisesPelvic Floor ExercisesPelvic Floor Exercises

Also known as Kegel exercisesKegel exercises.

Pelvic Floor ExercisesPelvic Floor ExercisesPelvic Floor ExercisesPelvic Floor Exercises

Aim:Aim:

To strengthen the pelvic floor muscle and increase overall muscle tone.

Pelvic Floor (Female)Pelvic Floor (Female)Pelvic Floor (Female)Pelvic Floor (Female)

Pelvic floor

Pelvic Floor (Male)Pelvic Floor (Male)Pelvic Floor (Male)Pelvic Floor (Male)

Pelvic floor

Pelvic Floor ExercisesPelvic Floor ExercisesPelvic Floor ExercisesPelvic Floor Exercises

Locate pelvic floor muscles

Squeeze pelvicfloor musclesas tightly aspossible for afew seconds(maximum of10 seconds)

Relax completely for atleast 10 seconds

Repeat, asrecommendedby physician/

continenceadvisor

BiofeedbackBiofeedbackBiofeedbackBiofeedback

Aim:Aim:

Helps patient identify the correct muscle for performing Kegel exercises

BiofeedbackBiofeedbackBiofeedbackBiofeedback

Source: Biofeedback Instrument Corporation

Review Diet and Fluid IntakeReview Diet and Fluid IntakeReview Diet and Fluid IntakeReview Diet and Fluid Intake

Some patients will try to reduce the risk of leakage by restricting their fluid intake.

Review Diet and Fluid IntakeReview Diet and Fluid IntakeReview Diet and Fluid IntakeReview Diet and Fluid Intake

However, drinking too little results in concentrated urine, which itself can irritate irritate the bladderthe bladder.

Review Diet and Fluid IntakeReview Diet and Fluid IntakeReview Diet and Fluid IntakeReview Diet and Fluid Intake

Therefore, it is important that patients are encouraged to drink appropriate amount of fluids.

Review Diet and Fluid IntakeReview Diet and Fluid IntakeReview Diet and Fluid IntakeReview Diet and Fluid Intake

ReduceReduce consumption of:

• Caffeine (i.e. tea andcoffee)

• Carbonated soft drinks

• Alcoholic drinks

Skin Care and CleanlinessSkin Care and CleanlinessSkin Care and CleanlinessSkin Care and Cleanliness

Tips:Tips:

• The skin around the perineum and groin needs to be cleaned whenever the area becomes soiled with urine and faeces.

Skin Care and CleanlinessSkin Care and CleanlinessSkin Care and CleanlinessSkin Care and Cleanliness

Tips:Tips:

• Do not over powder as this will cause caking.

Skin Care and CleanlinessSkin Care and CleanlinessSkin Care and CleanlinessSkin Care and Cleanliness

Tips:Tips:

• Do not use alcohol based products which will cause over-drying of the skin.

Good Bladder HabitsGood Bladder HabitsGood Bladder HabitsGood Bladder Habits

Step 1Step 1: Maintain appropriate fluid intake

Step 2Step 2: Practice good toilet habits

Step 3Step 3: Maintain good bowel habits

Step 4Step 4: Exercise of pelvic floor muscles

Step 1Step 1Step 1Step 1

Maintain appropriate fluid intakeMaintain appropriate fluid intake• 6 - 8 glasses of water per day, unless

contrary to doctor’s advice.

• Limit intake of caffeine, i.e. coffee, soft drinks or tea

• Limit intake of alcohol as it increases urine production

Step 2Step 2Step 2Step 2

Practice good toilet habitsPractice good toilet habits• Allow plenty of time to empty the bladder

• Ensure bladder is completely empty each time urine is passed

• Avoid going to the toilet “just in case” as this results in the bladder developing a smaller capacity

Step 3Step 3Step 3Step 3

Maintain good bowel habitsMaintain good bowel habits

• Maintain regular bowel movements and avoid constipation

Step 4Step 4Step 4Step 4

Exercise pelvic floor musclesExercise pelvic floor muscles

• Exercise pelvic floor musclesregularly

• Keep weight down • Obesity puts an additional stress on the

pelvic floor muscles

ControlControl

ConfidenceConfidence

FreedomFreedom

Thank You!Thank You!