Instructions
Take Another Course
|
Pelvic Floor Muscle Exercises
Kegel or pelvic floor muscle exercises have been used since the 1940’s and are helpful for people with overactive bladder, urge or stress urinary incontinence. The goal of these exercises is to inhibit involuntary detrusor contractions and suppress involuntary voiding. Success is enhanced when the exercises are used with the biofeedback techniques shown on this slide. Our physical therapy and urology or urogynecology colleagues can help with this. Clients can learn these exercises without the benefit of biofeedback. First, it is important to have clients learn which muscles to exercise. Belly, thigh and butt muscles stay relaxed, and exercising the wrong muscles can make problems worse. Second, clients need to be disciplined to do these exercises up to 50 times a day--although not all at one time. Teach your clients about the ways to find the muscles to work on when doing Kegel exercises.
Successful training is all about finding the right muscle
Once they know the muscle to work, have them start by contracting these muscles for a slow count of three and relaxing for a slow count of three. The length of time for the contraction/relaxation will increase to 6-8 seconds as the clients’ muscles become stronger. Teach them to do these exercises while standing, sitting and lying down. For the first two weeks, have them do 15 exercises in all three positions three times a day. Five quick contractions (the quick flicks or the knack that was previously mentioned) can be done when clients experience a strong sense of urgency, or prior to an activity that causes a stress incontinence episode. Your clients will need continued validation from you that these exercises can be of benefit since results may not be seen for a couple of months.
Toileting Programs
•Bladder
training
•Prompted
voiding
•Habit
training
The last non-pharmacological treatment options to discuss are toileting programs. The type of program selected will be based on individualized assessments of the clients’ physical and cognitive abilities. Bladder training, sometimes referred to as bladder retraining or bladder drill, involves a scheduled voiding program with a gradual and progressive increase in the timing between voiding episodes. Wyman (2005) described the goals of bladder training as: to correct faulty habits of frequent urination, to improve control over urgency, to lengthen voiding intervals to 3-4 hours, and to increase bladder capacity. (Wyman, J. Behavioral Interventions for the Patient with Overactive Bladder, JWOCN. Supplement 1.2005;32:511-515)
Additional Voiding Techniques
Urge suppression techniques as well as relaxation strategies are used with this toileting program. In order for this program to be successful clients need to be cognitively intact and have the ability to recognize the sensation of urge. Prompted voiding is a behavior modification program that requires caregiver commitment. It is frequently used in the long term care setting and involves five steps. 1. Check: caregiver checks resident on regular basis by offering the opportunity to use toilet and to check if dry or wet. 2. Talk: discusses bladder control problem and asks if they know if they are wet or dry. Caregiver confirms resident’s report and provides praise if dry and mild disappointment if wet. 3. Prompt: resident is asked in a very persuasive, unrushed manner, to use the toilet whether wet or dry. 4. Praise: caregiver praises resident for being dry or making an attempt to use the toilet. The resident should be told of the next prompted voiding time. 5. Correct: if the resident was wet the caregiver will inform the resident that the expectation is to stay dry. Rick Fields-Gardner |
.h3.jpg)
