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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
•
•
•
•
•
•
•
Symptom assessment
Medical history
Physical examination
Urinalysis
Bladder diary
Pad test
Referral for medical
evaluation and treatment
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
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
• Abdomen exam
• Rectal exam
• Pelvic exam
Urinalysis
To rule out urinary tract infection
Bladder Diary
Helps patients record details of:
• Bladder symptoms
• Type/amount of drinks taken
• Time/amount of urine passed
Bladder Diary
Time
Drinks
(types and
amount)
Amount
of urine
passed
(ml)
Did you feel a
strong and
sudden desire to
urinate ( if yes)
If leakage occurs,
amount of urine
leaked
Small
8:00 am
150 ml
Coffee, 1 mug
11:15 am
200 ml
12:00 pm
100 ml
1:00 pm
100 ml
2:00 pm
2:30 pm
Large
Tea, 2 cups
8:30 am
10:00 am
Medium


Cola, 1 can

Date: Monday 19 March
Pad Test
A supplementary test used to
confirm urine leakage and
quantify the degree of urine loss.
Pad Test
Method:
• Drink 500 ml of fluid as quickly as
possible
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 Test
Method (cont’d):
• The pad is re-weighed.
• A weight gain of more than 1 g
signifies that the patient is
incontinent.
Pad Test
Referral for Further
Evaluation 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 Treatment
• Symptoms suggestive of
bladder obstruction
• Evidence of unexplained
neurologic or metabolic
disease (e.g. renal failure,
diabetes insipidus)
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
A behavioural approach to the
treatment of the overactive
bladder, which is often used in
combination with drug therapy.
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.
Bladder Training:
Frequency/Volume Regulation
Incontinence Pads and
Protective Equipment
All-in-one briefs
Absorbent pads
Dribble pouch
Chair and bed pads
Reusable
underpants
designed to
carry disposable
absorbent pads
Incontinence Pads and
Protective Equipment
These do not treat the 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 Equipment
Ideally, incontinence pads should
be used only as a temporary or
supplementary measure while the
results of drug therapy or bladder
training come into effect.
Bladder Catheterization
• For some patients, drug therapy
and bladder training will not be
adequate to manage their
symptoms.
• For example, patients with a spinal
cord injury may be unable to empty
their bladder completely.
Bladder Catheterization
Pelvic Floor Exercises
Also known as Kegel exercises.
Pelvic Floor Exercises
Aim:
To strengthen the pelvic floor muscle
and increase overall muscle tone.
Pelvic Floor (Female)
Pelvic floor
Pelvic Floor (Male)
Pelvic floor
Pelvic Floor Exercises
Locate pelvic floor muscles
Squeeze pelvic
floor muscles
as tightly as
possible for a
few seconds
(maximum of
10 seconds)
Repeat, as
recommended
by physician/
continence
advisor
Relax completely for at
least 10 seconds
Biofeedback
Aim:
Helps patient identify the correct
muscle for performing Kegel
exercises
Biofeedback
Source: Biofeedback Instrument Corporation
Review Diet and Fluid Intake
Some patients will try
to reduce the risk of
leakage by restricting
their fluid intake.
Review Diet and Fluid Intake
However, drinking too
little results in
concentrated urine,
which itself can irritate
the bladder.
Review Diet and Fluid Intake
Therefore, it is important
that patients are
encouraged to drink
appropriate amount of
fluids.
Review Diet and Fluid Intake
Reduce consumption of:
• Caffeine (i.e. tea and
coffee)
• Carbonated soft drinks
• Alcoholic drinks
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 Cleanliness
Tips:
• Do not over powder as
this will cause caking.
Skin Care and Cleanliness
Tips:
• Do not use alcohol based
products which will cause overdrying of the skin.
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
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
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
Maintain good bowel habits
• Maintain regular bowel movements
and avoid constipation
Step 4
Exercise pelvic floor muscles
• Exercise pelvic floor muscles
regularly
• Keep weight down
• Obesity puts an additional stress on the
pelvic floor muscles
Control
Confidence
Freedom
Thank You!