Urinary incontinence (UI) affects over 13 million Americans of all ages.1 in 4 are women ages 30-59 and 50% or more of elderly living at home or in long­ term care (LTC) facilities are incontinent. In a recent study it was estimated that approximately 25.6% of men and 48.4% of women long term care settings were affected resulting in significant quality of life and dignity concerns. Treating and managing UI is an interdisciplinary team effort. It is crucial for nursing and therapy to join together in promoting an effective continence program for facility residents. Statistics indicate a need for structured programs to decrease episodes if treatable incontinence and recent outcome studies demonstrate a real life improvement for those residents who receive therapy and with interdisciplinary care team (IDT) involvement and programs.
Quality Issues Associated with UI
Decreased quality of life: psychological, personal care, medical
• Loss of self-esteem /dignity
• Altered or negative body image, decreased sense of well being
• Embarrassment, anger, frustration, fear (of how others perceive them)
• Restriction of social activities and isolation
• Depression and guilt
• Loss of skin integrity, pressure ulcers
• Increased risk of falls
• Increased UTIs, infections
IDT Intervention Strategies may include:

Scheduled Toileting and Habit Training

The primary goal of this type of intervention is to anticipate the resident’s toileting needs and avoid wetness. The goal is to get the resident to a commode prior to need to void: upon rising in the AM, after meals, after naps, and before bedtime. The resident is taken to the toilet or placed on a bed pan at regular intervals; usually matching their regular voiding habits. A scheduled toileting program should be individualized and based on a voiding diary. There should not be an attempt to delay voiding or to resist urges with this type of plan. A typical toileting schedule is usually every 3 to 4 hours and the simplest program for nursing staff to perform regardless of a resident’s cognitive status. The ultimate goal is for regular voiding to become routine and reduce the number of incontinent episodes.

Bladder Retraining
The goal of bladder retraining is to delay voiding and to utilize urge inhibition techniques for resisting and inhibiting the sensation of urgency. The resident is encouraged to void on a schedule that usually starts with a short interval and then increases in in time (delaying voiding and “training” the bladder) and increasing the amount of urine the bladder can comfortably hold. The resident is taught to resist the urge to void in-between scheduled
times, using relaxation/inhibition techniques, distractions, and pelvic floor strengthening exercises. Intervals are progressively increased as the resident begins to “train” the bladder. This approach is most appropriate for urge incontinence, and may also improve stress incontinence. The resident must be able to follow simple directions to be successful with this type of program (difficult for the cognitively impaired resident). A typical bladder retraining program may takes up to 3-6 weeks.

With the above strategies it is also important to ensure that a good restorative bowel and bladder program is in place for the residents in your facility. For more information on setting up a functional bowel and bladder program, please contact your Clinical or Program Manager with Functional Pathways.

Cherie Rowell, COTA/L
Director of Clinical Services
Functional Pathways