Measures to Improve Continence

  Improve sphincter tone

  Eliminate bladder irritants

  Decrease environmental causes

  Fluid management

  Bladder training

  Toileting programs

 

Improving sphincter tone through the use of Pelvic Muscle Exercises (known as Kegel’s) with or without biofeedback can be used as a management strategy for stress incontinence. A program of specific pelvic floor muscle contraction is developed by a nurse or physical therapist. The proper identification of the muscles to contract results in the urethra closing and an increase in urethral pressure to prevent leakage when the client is “stressed” by a cough, sneeze, laugh or when lifting something.

When taking down the patient’s history, the clinician should seek to identify bladder irritants which may be contributing to their patient’s incontinence--and eliminate them. Some common irritants include: caffeinated beverages, alcohol, artificial sweeteners, citrus juice and citrus fruit, sugar, honey, spicy foods and cigarette smoking. All are irritating to the lining of the bladder.

Take action to eliminate environmental causes of incontinence which may include distance to the toilet and clothing.

People with bladder control problems often believe that the best way to help their situation is to limit their fluid intake. While the intervention will cause less urine to be in the bladder, it will be more concentrated and more irritating to the bladder lining, and will increase their frequency which can result in a bladder infection-a major cause of reversible incontinence. So dispel the myth that restricting fluids will help their problem.

Bladder training with urge suppression techniques can help people with overactive/urge incontinence. An individualized goal of voiding no more often than “x number of hours” is determined. When it is not time yet for the scheduled voiding time, the patient is taught to distract themselves from the urge with some slow deep breathes and thinking about something other than the bathroom. Then the patient will do five quick strong pelvic floor muscle contractions, several times in a row, to lessen the urge to go. The patient is instructed to wait until next scheduled void time or at least wait a few minutes longer. The patient will then will go to the bathroom whether they feel like they have to or not.

Toileting programs are usually for people who need assistance with their ADL’s, or have mobility and /or cognitive impairments. Programs include habit training, scheduled voiding, or prompted voiding.

Other interventions to improve continence may include the use of medications, intermittent self catheterization and surgery.

 

So Who Needs Adult Absorbent Products?

Anyone who experiences any type of persistent incontinence, and has had a clinical assessment to determine the most appropriate product for them.

Anyone with acute incontinence who is being evaluated in order to identify the cause of their new problem.

And since it’s important to control incontinence problems as quickly as possible, patients with possible incontinence issues should schedule a time to meet with their health care provider to discuss them.

 

Available Products

  Pads and panty liners

  Briefs and protective underwear

  Drip collectors for men

  Underpads

  Condom “Texas” Catheter

  Retracted Penis Pouch

  Penile Clamp

  Female External Collection Device

Pads and panty liners are used when incontinence amounts are slight or light, which is usually the case in stress incontinence.

Briefs and protective underwear are used when episodes and amounts of urine lost are considered to be moderate to heavy, or when “accidents” come unexpectedly. A liner can be inserted for added protection.

Drip collectors are pouches that slip over and around the penis to contain small amounts of urine leakage. They are secured with an adhesive strip to the underwear, or can be kept in place with a snug pair of underwear.

Underpads are used to protect bedding and other furniture.

A condom catheter has a containment device for those with functional and total incontinence. One- or two-piece, and self- or non-adhesive features are available. A daily skin care assessment is required with their use, and extra care should be taken with those who are not circumcised.

Another option is the Retracted Penis Pouch. This pouch can be used when the penis has decreased in length due to aging, making a condom catheter ineffective. It works like a one-piece ostomy pouch with adhesive. The penis is then placed inside and the pouch is attached to a drainage bag.

A penile or Cunningham clamp is used to prevent urine leakage. It is placed half way down the shaft and then is clamped shut--but not too tightly. It is recommended that it be released every 1-2 hours. It’s important to assess the condition of the skin, and the patient must be instructed to notify their caregiver immediately if their skin around the device is broken, or turns pale, red, blue.

Female external collection devices are pouches that attach to the skin with adhesive or straps. They resemble a one-piece urostomy bag.

 Rick Fields-Gardner