Bladder Retraining for Bladder Retraining for Overactive BladderOveractive Bladder

Thursday, November 17, 2011Thursday, November 17, 2011

Presented by Jeannine McCormick, RN, MSN, CRNPPresented by Jeannine McCormick, RN, MSN, CRNP

Objectives & GoalsObjectives & Goals

To equip individuals with the self-mastery tools To equip individuals with the self-mastery tools of retraining their bladdersof retraining their bladders

Empower individuals to be their own healthcare Empower individuals to be their own healthcare advocates through health educationadvocates through health education

To understand and embrace the concept of To understand and embrace the concept of “combination therapy” in which multiple “combination therapy” in which multiple interventions are used in unison to manage and interventions are used in unison to manage and even alleviate symptomseven alleviate symptoms

Urge Incontinence (UUI): leakage due Urge Incontinence (UUI): leakage due to a sudden urge to urinateto a sudden urge to urinate

Most common cause:Most common cause:

Overactive bladderOveractive bladder

(OAB)(OAB)

OAB is characterized OAB is characterized

by urinating more than by urinating more than

8 times/day. 8 times/day. Astellas Pharmaceuticals

Urge IncontinenceUrge Incontinence

Possible Causes of OAB/Possible Causes of OAB/

Urge Incontinence:Urge Incontinence: Nerve damage caused by abdominal Nerve damage caused by abdominal

trauma, pelvic trauma, or surgery trauma, pelvic trauma, or surgery Diabetes Diabetes Drug side effects Drug side effects Neurological disease and SCI Neurological disease and SCI

(e.g., multiple sclerosis, Parkinson's (e.g., multiple sclerosis, Parkinson's

disease, stroke, spinal cord lesions)disease, stroke, spinal cord lesions)NIDDK

Overactive Bladder TreatmentOveractive Bladder Treatment

Behavioral Behavioral Dietary ChangesDietary Changes Fluid ManagementFluid Management Pelvic Muscle Exercises (Kegel exercises)Pelvic Muscle Exercises (Kegel exercises) BiofeedbackBiofeedback Bladder RetrainingBladder Retraining

Pharmacological (Drug Therapy)Pharmacological (Drug Therapy) InvasiveInvasive

Percutaneous tibial nerve stimulation (PTNS)Percutaneous tibial nerve stimulation (PTNS) Sacral nerve stimulation (SNS)Sacral nerve stimulation (SNS) BotoxBotox

Brain & Sphincter FunctionBrain & Sphincter Function Urine is made by the kidneys and

flows into the bladder where it is stored.

As the bladder fills and stretches, a message goes to the brain that it is time to urinate.

The brain sends a message down to the sphincter muscle whether or not it is a good time and place to go.

The sphincter’s tension releases and The sphincter’s tension releases and the bladder muscle contracts to the bladder muscle contracts to empty itself of urine through the empty itself of urine through the urethra to the body’s outlet. urethra to the body’s outlet.

Urinary Systems – Male & Female

Urinary AnatomyUrinary Anatomy

The urinary system is composed of two kidneys, two The urinary system is composed of two kidneys, two ureters, a bladder, and a urethra. ureters, a bladder, and a urethra.

KidneysKidneys- remove waste from - remove waste from the blood, produce urine. the blood, produce urine. UretersUreters- move urine from the - move urine from the kidneys to the bladder. kidneys to the bladder. BladderBladder- stores urine until it - stores urine until it flows out of the body through the flows out of the body through the tube-like tube-like urethraurethra. . The sphincter-The sphincter- circular muscle circular muscle that controls the activity of the urethra. that controls the activity of the urethra.

Think of the bladder as a balloon and Think of the bladder as a balloon and the sphincter as the knotthe sphincter as the knot

The bladder is an elastic The bladder is an elastic muscle that stretches to muscle that stretches to hold urine being sent hold urine being sent from the kidneys via from the kidneys via ureters.ureters.

The sphincter muscle The sphincter muscle remains tightly shut, remains tightly shut, preventing urine from preventing urine from leaking out.leaking out.

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The sphincter and the bladder are The sphincter and the bladder are perfectly coordinatedperfectly coordinated

When full, the bladder When full, the bladder signals the brain, and the signals the brain, and the brain in turn signals the brain in turn signals the sphincter to relax and sphincter to relax and open. The bladder then open. The bladder then contracts and squeezes contracts and squeezes all the urine out. Then all the urine out. Then the sphincter closes the sphincter closes tightly so the refilling can tightly so the refilling can resume.resume.

The Good NewsThe Good News

Controlling the bladder and sphincter muscle is hard to do and may get more difficult as we get older.

Success for those experiencing symptoms of urge incontinence and urgency associated with overactive bladder (OAB).

Is Bladder Retraining for You?Is Bladder Retraining for You?Do these symptoms describe you?Do these symptoms describe you?

Urge Incontinence is the urgent need to pass urine without warning and the inability to get to the toilet in time. "When I have to go...I have to go...“

Overactive Bladder (OAB) is represented by urgency, frequency exceeding eight times in 24 hours, and awakened at night two or more times in order to urinate.

How to Prepare for an Appointment How to Prepare for an Appointment to discuss Bladder Retrainingto discuss Bladder Retraining

If you think that you have urge incontinence, stress urinary incontinence, symptoms of both, or OAB, make an appointment with your healthcare provider.

For at least two days before your healthcare provider’s appointment, complete a "Uro-Log" (Voiding Diary). http://www.nafc.org/uploads/pdf/OnlineUroLog.pdf

Take the completed forms and this Bladder Retraining pamphlet to your appointment to find out if the healthcare provider thinks you will be helped by bladder retraining.

Always consult your healthcare provider before trying anything recommended in this or any other publication that speaks to general health issues.

A Six Week Program to Retrain your Bladder

You Will Need:You Will Need: a “NAFC Continence Chart” from NAFC’s Bladder

Retraining pamphlet - available here: http://www.nafc.org/online-store/consumer-leaflets-and-pamphlets/general-audience/bladder-retraining/

a pencil or pen a clock a kitchen or pocket timer determination to stick with it

Week OneWeek One

Urinate when you first get up in the morning. Urinate when you first get up in the morning. Empty your bladder as completely as you can and put a check Empty your bladder as completely as you can and put a check

( ) in the gray column beside the hour you used the toilet. Now ✓( ) in the gray column beside the hour you used the toilet. Now ✓set your timer for one hour. set your timer for one hour.

When the timer sounds, go to the toilet, even if you do not feel When the timer sounds, go to the toilet, even if you do not feel the need to empty your bladder. If you urinate, put a check ( ) ✓the need to empty your bladder. If you urinate, put a check ( ) ✓in the gray column. If not, leave it blank. Then set the timer for in the gray column. If not, leave it blank. Then set the timer for one hour.one hour.

When the timer sounds, go to the toilet, even if you do not feel When the timer sounds, go to the toilet, even if you do not feel the need to empty your bladder. If you urinate, put a check ( ) ✓the need to empty your bladder. If you urinate, put a check ( ) ✓in the gray column. Set the timer again for one hour. Continue in the gray column. Set the timer again for one hour. Continue this through the day until you go to bed.this through the day until you go to bed.

Learning to Control the UrgeLearning to Control the Urge

When you feel the urge to urinate before the timer sounds, try to distract yourself. Think about a very complex task:

balancing your checkbook naming the streets through your city to a mall on the other

side of town remembering all the words to a favorite song, nursery

rhyme, or hymn  Think about something especially fun:

vacationing on an exotic island lying in a hammock in the shade watching the sunset over the ocean

Week TwoWeek Two

Urinate when you first get out of bed in the morning. Put a check ( ) in the gray column beside the time you ✓

used the toilet. Now set a timer or clock for 1½ hours. When the

timer sounds, go to the toilet. If you urinate, put a check ( ) in the gray column beside the time. If not, ✓leave it blank.

 Set your timer or alarm clock for 1½ hours. When the timer sounds, go to the toilet. If you urinate, put a check ( ) in the gray column. Continue this all day. ✓

Week Three through SixWeek Three through Six

In weeks three through six, you will increase the time between urination to one hour 45 minutes in week three, two hours in week four, two hours and 15 minutes in week five, and anywhere between 2½ and three hours in week six, depending on individual progress.

Compare continence charts each week to review improvement.

Tips for SuccessTips for Success

If you find that complex mental tasks or relaxing thoughts do not make the urge to urinate go away, you may try the following: Squeeze the muscles that hold back a bowel movement and

hold back urine until the urge passes — then relax. Roll up a bath towel and keep it on a firm chair. Sit on this

roll when you have a strong urge to urinate. Place a rolled towel between your legs and push it up against

your body Believe that you will be successful. Follow the program’s directions Give bladder retraining a full 6 to 8 weeks, and do not give up if

your progress stops for several days or if you have a setback.

Don’t be Discouraged by SetbacksDon’t be Discouraged by Setbacks

Your bladder control problems may be worse when you are tired. when you have your mind on many things. when you feel tense and nervous. when you have a cold or stomach flu. on cold, rainy, windy days. right before a menstrual period (for women).

Mixed Incontinence: a combination Mixed Incontinence: a combination of stress and urge incontinenceof stress and urge incontinence

Symptoms of one type of incontinence may be more Symptoms of one type of incontinence may be more severe than the other.severe than the other.

Canadian Continence Foundation

More Ideas for SuccessMore Ideas for Success Behavioral:

Avoid alcoholic beverages, coffee and tea. Drink plain water as much as possible. Drink normal amounts of fluid evenly throughout the day. Six to eight glasses of water. Establish regular bowel habits. If you are constipated, add fiber to your diet, or use a laxative.

Discuss this with your health professional. Avoid going to the toilet "just in case." This may turn into a bad habit, and lead to frequent

urination.

Pharmacological: Drug therapy may be used in conjunction with behavioral modifications to improve bladder

control.

Invasive: Nerve stimulation is another treatment option. It uses mild electric pulses to stimulate a

sacral nerve in the lower back. This nerve influences the bladder and surrounding muscles that control urinary function.

ResourcesResources

To purchase a Bladder Retraining Pamphlet visit: To purchase a Bladder Retraining Pamphlet visit: http://www.nafc.org/online-store/bladderretraining

To purchase a Uro-Log Voiding Diary visit: To purchase a Uro-Log Voiding Diary visit: http://www.nafc.org/online-store/urologhttp://www.nafc.org/online-store/urolog

To become a member of NAFC visit: To become a member of NAFC visit: http://www.nafc.org/support-nafc/ http://www.nafc.org/support-nafc/

Support NAFCSupport NAFC

“Like” us on Facebook at http://www.facebook.com/BladderHealth

Donate Subscribe to our newsletter and forward to friends By following NAFC on Twitter:

http://twitter.com/#!/BladderHealth Ask your doctor to support us by becoming a

professional member and ordering our patient education materials for all their patients

Become a Member of NAFCBecome a Member of NAFC

Benefits of Becoming a Member:Benefits of Becoming a Member: Patient ReferralsPatient Referrals NAFC Frontline Quarterly NewsletterNAFC Frontline Quarterly Newsletter Quality Care Monthly NewsletterQuality Care Monthly Newsletter Resource Guide – directory of products & services for Resource Guide – directory of products & services for

bladder & bowel controlbladder & bowel control Caregivers Desk ReferenceCaregivers Desk Reference Bulk leaflet discounts for professional membersBulk leaflet discounts for professional members Online Inspire Community Online Inspire Community 1-800-BLADDER to speak with the Health Educator1-800-BLADDER to speak with the Health Educator http://www.nafc.org/support-nafc/ http://www.nafc.org/support-nafc/

Thank you!Thank you!

Thank you for participating in the Bladder Retraining Thank you for participating in the Bladder Retraining webinar. We will now have Jeannine answer some webinar. We will now have Jeannine answer some questions that you had during the presentation.questions that you had during the presentation.

Want Additional Info? Got questions?Want Additional Info? Got questions?Call: 1-800-BLADDER (252-3337)Call: 1-800-BLADDER (252-3337)E-mail: memberservices@nafc.orgE-mail: memberservices@nafc.org

Visit: www.nafc.org Visit: www.nafc.org

This webinar is supported by an This webinar is supported by an educational grant fromeducational grant from