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How Can Your Nurse Advisor Help You?. Presented by (insert name of presenter here). Role of Nurses. Help to recognise patients who have problems maintaining continence Offer help and advice to patients and relatives. How to Recognise Patients with an Overactive Bladder.

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how can your nurse advisor help you
How Can Your Nurse Advisor Help You?

Presented by (insert name of presenter here)

role of nurses
Role of Nurses
  • Help to recognisepatients who have problems maintaining continence
  • Offer help and adviceto patients and relatives
how to recognise patients with an overactive bladder
How to Recognise Patients with an Overactive Bladder
  • Symptom assessment
  • Medical history
  • Physical examination
  • Urinalysis
  • Bladder diary
  • Pad test
  • Referral for medical evaluation and treatment
symptom assessment
Symptom Assessment
  • In total, how many times do you go to the toilet in a 24-hour period?
  • How often do you go to the toilet during the day?
  • How often do you wake to go to the toilet during the night?
  • How often do you feel a strong and sudden desire to urinate?
  • If you fail to go to the toilet in time, how much urine do you usually leak?
  • Do you leak urine when you laugh, cough, sneeze, jump or run?
medical history
Medical History
  • Other questions that your doctor/nurse might ask:
  • History of previous surgery or radiotherapy involving the pelvic region
  • Medications currently taking
  • Main symptoms (complaints)
  • Duration of symptoms
physical examination
Physical Examination
  • Abdomen exam
  • Rectal exam
  • Pelvic exam
urinalysis
Urinalysis

To rule outurinary tract infection

bladder diary
Bladder Diary
  • Helps patientsrecord details of:
  • Bladder symptoms
  • Type/amount of drinks taken
  • Time/amount of urine passed
bladder diary1
Bladder Diary

Date: Monday 19 March

pad test
Pad Test

A supplementary test used to confirm urine leakage and quantify the degree of urine loss.

pad test1
Pad Test
  • Method:
  • Drink 500 ml of fluid as quickly as possible
pad test2
Pad Test
  • Method (cont’d):
  • Perform a series of physical tasks in a 1-hour period
    • Walking
    • Climbing stairs
    • Coughing vigorously
    • Running on the spot
pad test3
Pad Test
  • Method (cont’d):
  • The pad is re-weighed.
    • A weight gain of more than 1 g signifies that the patient is incontinent.
referral for further evaluation and treatment
Referral for FurtherEvaluation and Treatment
  • Patients are considered for referral if:
  • Symptoms do not respond to initial treatment within 2-3 months
  • Blood in urine without infection on urine test
referral for further evaluation and treatment1
Referral for FurtherEvaluation and Treatment
  • Symptoms suggestive of bladder obstruction
  • Evidence of unexplained neurologic or metabolic disease (e.g. renal failure, diabetes insipidus)
management of overactive bladder
Management of Overactive Bladder
  • Drug therapy
  • Bladder training
  • Incontinence pads and protective devices
  • Bladder self-catheterization
  • Pelvic floor exercises
  • Biofeedback
  • Review diet and food intake
  • Skin care and cleanliness
  • Surgery
bladder training
Bladder Training

A behavioural approach to the treatment of the overactive bladder, which is often used in combination with drug therapy.

bladder training1
Bladder Training
  • Aims:
  • Increase the time intervals between bladder emptying.
  • Increase bladder capacity by teaching patients to resist and suppress the urge to pass urine.
slide21

Incontinence Pads and Protective Equipment

All-in-one briefs

Reusable

underpants

designed to

carry disposable

absorbent pads

Absorbent pads

Dribble pouch

Chair and bed pads

incontinence pads and protective equipment
Incontinence Pads and Protective Equipment

Thesedo not treatthe cause of the problem.

• At best, they are a passive form of management for only one of the symptoms (i.e. urge incontinence).

incontinence pads and protective equipment1
Incontinence Pads and Protective Equipment

Ideally, incontinence pads should be used only as atemporary or supplementarymeasure while the results of drug therapy or bladder training come into effect.

bladder catheterization
Bladder Catheterization
  • For some patients, drug therapy and bladder trainingwill not be adequateto manage their symptoms.
    • For example, patients with a spinal cord injury may be unable to empty their bladder completely.
pelvic floor exercises
Pelvic Floor Exercises

Also known asKegel exercises.

pelvic floor exercises1
Pelvic Floor Exercises

Aim:

To strengthen the pelvic floor muscle and increase overall muscle tone.

pelvic floor exercises2
Pelvic Floor Exercises

Locate pelvic floor muscles

Repeat, as

recommended

by physician/

continence

advisor

Squeeze pelvic

floor muscles

as tightly as

possible for a

few seconds

(maximum of

10 seconds)

Relax completely for at

least 10 seconds

biofeedback
Biofeedback

Aim:

Helps patient identify the correct muscle for performing Kegel exercises

biofeedback1
Biofeedback

Source: Biofeedback Instrument Corporation

review diet and fluid intake
Review Diet and Fluid Intake

Some patients will try to reduce the risk of leakage by restricting their fluid intake.

review diet and fluid intake1
Review Diet and Fluid Intake

However, drinking too little results in concentrated urine, which itself canirritate the bladder.

review diet and fluid intake2
Review Diet and Fluid Intake

Therefore, it is important that patients are encouraged to drink appropriate amount of fluids.

review diet and fluid intake3
Review Diet and Fluid Intake
  • Reduceconsumption of:
  • Caffeine (i.e. tea and coffee)
  • Carbonated soft drinks
  • Alcoholic drinks
skin care and cleanliness
Skin Care and Cleanliness
  • Tips:
  • The skin around the perineum and groin needs to be cleaned whenever the area becomes soiled with urine and faeces.
skin care and cleanliness1
Skin Care and Cleanliness
  • Tips:
  • Do not over powder as this will cause caking.
skin care and cleanliness2
Skin Care and Cleanliness
  • Tips:
  • Do not use alcohol based products which will cause over-drying of the skin.
good bladder habits
Good Bladder Habits

Step 1:Maintain appropriate fluid intake

Step 2:Practice good toilet habits

Step 3:Maintain good bowel habits

Step 4:Exercise of pelvic floor muscles

step 1
Step 1
  • Maintain appropriate fluid intake
  • 6 - 8 glasses of water per day, unless contrary to doctor’s advice.
  • Limit intake of caffeine, i.e. coffee, soft drinks or tea
  • Limit intake of alcohol as it increases urine production
step 2
Step 2
  • Practice good toilet habits
  • Allow plenty of time to empty the bladder
  • Ensure bladder is completely empty each time urine is passed
  • Avoid going to the toilet “just in case” as this results in the bladder developing a smaller capacity
step 3
Step 3
  • Maintain good bowel habits
  • Maintain regular bowel movements and avoid constipation
step 4
Step 4
  • Exercise pelvic floor muscles
  • • Exercise pelvic floor muscles regularly
  • Keep weight down
  • • Obesity puts an additional stress on the pelvic floor muscles
slide45

Control

Confidence

Freedom

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