1. Successfully improving bladder function begins with the recognition that hope for improving is often realistic.
“Bladder function can be improved, especially with those who are recently incontinent or those who had a catheter removed recently,” says Pam Brooks, OTR/L, a clinical occupational therapy specialist for Centrex Rehab.
Recalling the most common reversible causes of urinary incontinence can be as easy as the mnemonic DIAPERS (Delirium, Infection, Atrophy, Pharmaceuticals, Excess urine output, Restricted mobility, Stool impaction), says Michelle Christiansen, vice president of clinical sales for Medline’s Personal Care Division.
To help residents help themselves return to a continent bladder, a series of important exercises is employed based on their level of cognition, Brooks explains. These may include pelvic floor muscle strengthening exercises, relaxation strategies like deep breathing, visualization and body/mind quieting. If those aren’t fruitful, an electrical stimulation protocol may be used.
Cognitively impaired residents may also require environmental adaptations and cues, and a therapist may recommend prompted voiding schedules or timed toileting schedules.
Bladder training, most suitable for cognitively healthy residents, is a common powerful tool that also can vastly improve bladder function, Christiansen adds.
Residents also should be educated about any and all possible irritants that can impair bladder function, and encouraged to keep a bladder diary, Brooks adds. Helping keep residents physically fit can involve improved mobility and transfers, muscle strengthening, adaptive equipment training, and posture and balance.
2. A vital first step in improving bladder function involves a thorough assessment, identifying any urinary tract and nervous system pathology, and evaluating the resident’s mental and physical status, comorbidity, medications, environment, quality of life, and availability of resources, says Christiansen.
If bladder incontinence is an issue, it’s important to determine when it began and its type (stress, urge, mixed or functional), Brooks adds.
“It is important to distinguish between residents who have incontinence that may be caused by a potentially reversible cause or condition and residents whose incontinence is chronic and not responsive to treatment,” Christiansen notes.
Karen Welsh, director of clinical outcomes for Functional Pathways, stresses identifying vital clues such as the resident’s sensation of bladder fullness, increased urinary frequency or urgency, any loss of urine when coughing, sneezing and standing or during physical activity, feeling of pressure or bulging in the bladder/lower abdomen, difficulty in initiating urine stream and inability to empty the bladder completely.
3. Improving bladder function is a multidisciplinary exercise involving everyone from administration and nursing to rehab and bath aides to physical therapist assistants and certified occupational therapy assistants. Activities staff, housekeeping, dietitians and foodservice also may be involved. Certified nursing assistants are a critical cog.
“Throughout the years, we have learned how important it is for CNAs to understand and feel some commitment to the desired outcomes, and to clearly understand the role they will play in achieving the outcome,” observes Christiansen. “They want to be part of the decision-making team. They want their knowledge, skills, observations and insights to be considered in the resident’s care.”
Communication between these staff members is critical.
“Excellent communication and documentation are needed between each department on a regular basis regarding a patient’s symptoms, voiding patterns, routines and risk factors. It is necessary to determine the most appropriate and effective treatment program,” Welsh says.
4. Outcomes measurement of a bladder program is based on each resident’s unique condition.
“Even a reduction in incontinence episodes will provide an improvement in quality of life for most residents,” says Tony Forsberg, RN, BSBA, WCC, CSPHA, national clinical director for Essity. “Success for some may be one fewer episode per day, while others may achieve full continence.”
Indeed, the objective of any bladder function therapy is improving a resident’s daily quality of life.
“Incontinence is a primary reason for admission to nursing homes,” says Emily Rampmaier, vice president of clinical services for Reliant Rehabilitation. “Continence is a skill developed privately in childhood and seldom discussed in adulthood due to embarrassment. Maintaining continence is at the heart of dignity and quality of life.”
A successful program can range from reducing nighttime incontinence from three episodes to one time per night to complete continence, as well as expectations of needing fewer special undergarments, medications or surgery, she adds.