I’m glad you’re joining me for the third and final article in a series on bladder control problems. Today we’ll focus on long-term care residents who experience incontinence.
While bladder incontinence is very common in the long-term care setting, it’s often preventable and treatable. Just like anyone else, our residents deserve a thorough evaluation and treatment of their bladder control concerns. This needs to be a multi-disciplinary approach with input from the resident and/or their decision-maker. Together you’ll develop an individualized plan of care. Residents also deserve the opportunity to see a urologist, geriatrician, specially trained physical therapist, or gynecologist to evaluate and treat the underlying cause of incontinence.
Now let’s look at the 4 major types of bladder incontinence affecting long-term care residents and what we can do to help. I hope you’ll refer back to my previous articles for more information about the definitions and possible causes & treatments of these conditions.
Lifestyle changes often help decrease stress incontinence. This might include developing a plan to control constipation, referral to a dietician for help with reaching a healthy weight, or resources to help a resident stop smoking.
Many long-term care residents are able to do Kegels. These exercises help strengthen the pelvic floor muscles, thereby preventing or decreasing incontinence. Lots of resources are available to help residents learn how to do Kegels. For example, the company that provides incontinence products for our nursing home also produces several educational DVD’s as well as an app to promote pelvic floor exercises.
When a resident experiences urge incontinence they have a sudden, urgent need to urinate. It’s not that they’re being impatient or they waited too long to use their call light. Your resident must get to the toilet quickly or they’re going to get wet.
A common cause of urge incontinence is a urinary tract infection. Care must be taken to accurately diagnose and treat a UTI. Excessive use of antibiotics often results in bacteria becoming resistant to these medications. Therefore, the best approach is a focus on preventive measures. This includes good handwashing, teaching residents to wipe from front to back after toileting, and encouraging adequate fluid intake. You can find much more information at this site from the Minnesota Department of Health.
While medications are helpful for many people with urge incontinence, they must be used with great caution in elderly people. Side effects may include dizziness, constipation, cardiac changes, and nausea.
A bladder diary is an important tool to treat urge incontinence. This involves recording fluid intake, times and amounts of urine output, and episodes of incontinence. Then a toileting routine is developed to prompt the resident to use the toilet before urgency strikes.
Have you ever had this experience? You just assisted a resident to the toilet and got them settled back into their wheelchair. Five minutes later they want to go again. While this is sometimes related to a cognitive issue, if they have overflow incontinence then they really do need to go again. This is because they weren’t able to completely empty their bladder the first time. A bladder scanner is often used to evaluate this condition. The scanner is a noninvasive tool that measures how much urine is left in the bladder after urinating.
If a resident is incontinent due to a physical problem that makes it difficult for them to use the toilet, there are lots of environmental changes and adaptive equipment options you can try. This includes such things as a raised toilet seat, easy-to-remove clothing, or a night light. The occupational therapy and physical therapy staff at your facility are great resources.
When incontinence is due to a cognitive impairment, there are still many approaches available to help residents remain continent. This might include signage on the bathroom door, a colored toilet lid, or scheduled toileting.
Sadly, there does come a point in some illnesses when incontinence is unavoidable. For example, loss of bladder control is expected in late-stage Alzheimer’s disease. Now the focus turns to the proper use of incontinence products. Here’s where it’s so important to use the correct type and size of products to promote comfort, prevent skin irritation, and maintain the dignity of your residents.
What other approaches do you use to help your residents manage bladder control issues? Please share in the comment section so we can learn from each other!