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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia

Continence: A Matter of Dignity

Care of Chronic and Complex UI

By

Marie Mangino, MSN, CRNP, GNP-BCPresident, Vincent Healthcare, Inc.

Wendy W. Fox, MOT, OTR/LAssistant Professor of Occupational TherapyUniversity of the Sciences, Philadelphia PA

Jennifer A. Reinhold, BA, PharmD, BCPSAssistant Professor of Clinical Pharmacy University of the Sciences in Philadelphia

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Review of First Module

“Causes, Signs and Prevention” The first module covered the following

objectives as learner outcomes: List the common causes of urinary

incontinence (UI) Describe the potentially serious

effects of not treating UI Recognize signs of a UTI Discuss effective ways to prevent

or reduce episodes of UI and enhance dignity

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Learning ObjectivesAt the end of “Care of Chronic and Complex Urinary Incontinence” you will be able to:

List the major types of chronic UI and the common signs and symptoms of each

Explain the importance of preventing constipation in older adults with UI

Discuss creative approaches to more complex cases of older adults with UI

Provide care to prevent or reduce episodes of UI and enhance dignity

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Types of Chronic UI

Stress Urge /Overactive

bladder Overflow Functional Mixed

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Stress UI Small amount of urine leakage Loss of urine with increased

pressure in the abdomen from: Coughing Sneezing Laughing Lifting Standing

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Stress UI : How You Can Help?

Set toileting schedule based on a log and stick to it

Expect small leaks; use a liner to feel more secure

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Stress UI : How You Can Help?

Change more frequently Use skin barrier Encourage to maintain

physical activity levelMrs. Levy

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Urgency UI & Overactive Bladder

• Overactive Bladder – bladder spasms that cause a sudden urge to void, often with increased frequency

• Urge UI – the loss of urine that may result from an overactive bladder

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Urge UI Involuntary loss of urine and a

strong urge to urinate that occurs suddenlyMay be incontinent before

getting up or on the way to the bathroom

May be incontinent of a large amount of urine

Mrs. Powell w/walker

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Urge UI/Overactive Bladder:How You Can Help

Encourage person to avoid bladder irritants

Stick to personalized schedule

Watch for signs of need to toilet

Keep urinal or commode handy

Expect heavier wetting with longer period of dryness

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Play video segment titled, “04 Mrs.

Powell.mpg”

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Case of Mrs. Powell Remind the person to avoid

bladder irritants (including sodas, caffeine, and artificial sweeteners)

Avoid drinking alcohol Help by establishing a toileting

schedule and stick to it as much as possible!

Watch for signs of need to toilet Use proper fitting, appropriate

continence products

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Overflow UI Continuous or periodic leakage of small

amounts of urine Tension in bladder forces muscles to leak

small amounts, either continuously or off and on

Caused by either: Blockage at the exit of the bladder Medications that cause weakened bladder

contractions/ urine retention Bladder, nerve, or

muscle damageMr. Stanley

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Overflow UI: How You Can Help

Allow time to stand or sit and take the time needed

Report complaints of discomfort Report inability to urinate for more than 8

hours or frequent urination (more than every 2hrs)

Watch for signs of mental status change Maintain schedule for toileting Report any changes that occur following

changes in medication

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Functional UIDue to chronic functionalimpairment:

Cognitive impairment Physical disabilities Combination

Mr. Clark

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Functional UI: How You Can Help

Cognitively ImpairedMark bathroom doorsUse a toileting schedule that fits the older adultOffer positive support and encouragement

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Functional UI: How You Can Help

Physically ImpairedEncourage clothing that is easy to removeAssist as needed Keep urinal or commode handyReport pain

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Challenging Situations

Dementia Inappropriate

toileting Denial

Unsafe attempts to toilet

Chronic constipation

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The Challenges of Dementia and UI Inappropriate toileting Denial of incontinence

Mr. Clark

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Dementia and UI: How You Can Help

Never judge or disagree, accept the person’s explanation for wet clothing

Focus on Changing and cleaning Dignity and respect

Prompt (remind and encourage) to use the toilet, assist to get there, then prompt again

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Play video segment titled, “05 Mr.

Clark.mpg”

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Case of Mr. ClarkFocus on:

Dignity and respect Changing and cleaning

if needed Prompt (remind and

encourage) to use the toilet, assist to get there, then prompt again

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UI and Unsafe Attempts to Toilet

Due to: Difficulty Walking Poor vision Poor safety

judgment

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Unsafe Attempts to Toilet: How You Can

Help Use individualized

toileting schedule; be there ahead of time. YOU are the reminder!

Do not rely on call bell Do not wait until the

person tries to get up

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Unsafe Attempts to Toilet: How You Can

Help Use safe footwear

Correctly fitting Closed toe and heel Avoid slippers and “slide in” shoes

Use proper eyeglasses when walking; assist person wearing bifocals

Provide a bedside commode or urinal to reduce the need to walk to the bathroom alone

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Chronic Constipation and UI

Presence of stool in the bowel Takes up room in the pelvis

so bladder cannot fill up completely

Causes need to urinate more often

Increases incontinent episodes

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Chronic Constipation and UI: How You Can

Help Report it! Encourage

Fluid intake Activity Foods rich in fiber

Avoid constipating food Avoid constipating

medications

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Objectives Review

Can you now1.List the major types of chronic

UI and the common signs and symptoms of each?

2.Explain the importance of preventing constipation in older adults with UI?

3.Discuss creative approaches to more complex cases of UI in older adults?

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Play video segment titled, “06

Closing.mpg”

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Special Thanks To:Christine W. Bradway, PhD, CRNP,

FAANAssociate Professor of Gerontologic Nursing

University of PennsylvaniaSchool of Nursing

Mary Ann Forciea, MDClinical Associate Professor of Medicine

Director, Primary Care ServicesUniversity of Pennsylvania Health Systems

Nicole ManginoIllustrator