Following review of the learning package, the individual should be able to:

1.    Define what is meant by urinary incontinence.
2.    Name the 4 types of urinary incontinence.
3.    Understand the signs and symptoms of each type of urinary incontinence.
4.    Implement interventions based on the various types of urinary incontinence.

The ability to control bladder or bowel functioning.

Urinary Incontinence:
The involuntary loss of urine in sufficient amounts or frequency to constitute a social and/or health problem. (Kane, Ouslander,
& Abrass, 1999)

It is important to remember that urinary incontinence is a symptom and not a disease, and it is NOT a normal part of the
aging process.
                                     4 Types of Urinary Incontinence

 Type            Definition         Patient may complain             Goals                 Staff interventions
Overflow   Leakage of urine          Frequent/constant       To resolve/relieve       Allow patients sufficient
           (usually small             urination                the urinary retention     time to void
           amounts) resulting        Post void dribbling                               Encourage double
           from mechanical forces    Retention               To relieve potential      voiding
           on an over distended      Hesitancy                constipation which       Have patients void Q2-4
           bladder or from other     Urine loss without       will enhance              hours while awake
           effects of urinary         urge                     bladder functioning      Use the bladder scanner
           retention on bladder      Sensation of                                       to determine post-void
           sphincter function.        fullness/pressure in    To restore/maintain       residual and monitor
                                      abdomen                  normal bladder            progress with voiding
                                                               contraction and          Ensure bowel routine
                                                               sphincter resistance     Encourage fluids
                                                                                        I/O catheterizations prn
                                                              Prevent UTIs             Provide urinal/commode
                                                                                        Pharmacy to assist with
                                                                                         medication review to rule
                                                                                         out potential contributing
                                                                                        Urology consult
                                                                                        Monitor renal function
                                                                                        Alert patients/families of
                                                                                         signs/symptoms of UTI
                                                                                        Utilize liners if required
                                                                                         for containment of
Type         Definition          Patient may complain              Goals                Staff Interventions
Urge   Involuntary leakage of    Frequency                To maximize           Leave urinals, bedpans,
       urine (usually larger     Nocturia                  toileting and          commodes, call lights in
       amounts) because of       Enuresis                  accessibility &        close proximity
       the inability to delay    Moderate to large                               Ensure adequate non-glare
                                                            visibility; to restore
       voiding after the          amounts of urine loss     urinary continence     lighting
       sensation of bladder                                                       Ensure mobility aids are
       fullness is perceived.                              To achieve continent   close at hand
                                                            voiding patterns      Provide assistance as
                                                                                  Maintain a safe/barrier free
                                                                                  Bladder training/diary
                                                                                  Kegel ~ pelvic floor
                                                                                  Incontinent products ~ liners,
                                                                                   briefs if needed
                                                                                  Instruct patient to completely
                                                                                   empty the bladder
                                                                                  Answer call bells within
    Type             Definition          Patient may                 Goals                       Staff interventions
                                        complain of…
Functional/   Urinary leakage          Not being able to     To maximize             Familiarize patient with surroundings
Environmental associated with the       get to the toilet      toilet accessibility    Assess mental status of patient – have
              inability to toilet       on time                                         OT assess if indicated
              because of               Not being able to     To maximize             Ensure eyewear is readily accessible
              impairment of             see the urinal,        sensory abilities       Leave urinals, bedpans, commodes,
              cognitive and/or          commode or             during toileting         call lights, bed controls close at hand
              physical functioning,     washroom                                       Provide adequate non-glare lighting
              psychological            Not being able to     To maximize             Scheduled toileting
              unwillingness, or         get up                 mobility and            Ensure toilet is accessible
              environmental             independently          independence            Modify drug regimes & fluid intake
              barriers.                 from sitting/lying                              patterns
                                                              To maximize             Modify the environment as needed ~
                                                               physical and             install grab bars, remove obstacles
                                                               cognitive abilities      (barrier free environment)
                                                                                       AVOID restraint use
                                                                                       Assess for mobility aids – have PT
                                                                                        assess if required
                                                                                       Provide assistance to patient as
Type         Definition            Patient may           Goals                  Staff Interventions
                                   complain of…
Stress       An involuntary         small amounts of  To maximize                Kegel (pelvic floor) exercises
             loss of urine           urine loss            strength of pelvic      Bladder training
             (usually small          associated with       floor muscles           Bladder diary to establish routine
             amounts) with           activity, coughing,                           Incontinent products ~ liners to minimize
             increases in intra-     sneezing             To assist in             embarrassment and contain leakage
             abdominal                                     establishing
             pressure. (ie.                                patient routines
             cough, laugh, or
             exercise) (more                              To minimize
             common in                                     embarrassment

                                                    Other useful interventions

       Techniques to trigger voiding:
        Running water
        Suprapubic tapping

       Techniques to completely empty bladder:
        Bending forward
        Suprapubic pressure
        Double voiding
                                          Appendix 1 – Kegel exercises

                            Kegel Exercises: Technique of Performing Pelvic
                                       Floor Exercises properly

Q: How do I identify where the pelvic floor muscles are?

Sit on the toilet and start to void. Try to stop the flow of urine in midstream by contracting your pelvic floor
muscles. If you are having difficulty locating the correct set of muscles, insert a clean finger into the vagina
and try to squeeze the finger with your vaginal muscles. If you feel the squeeze then you are exercising
the correct muscles.

Q: What is the correct method of performing Kegel exercises?

Contract the pelvic floor muscles (vagina and rectum) for 3 seconds. Relax for 3 seconds and repeat the
same sequence 5 more times. Five of these contractions is equal to one set of exercises. Try NOT to
tighten your abdominal, leg or buttock muscles when doing these exercises. Gradually increase the
number of sets over a one month period working up to 5-10 sets every day.

Q: When is the best time to do Kegel exercises?

Try to do the exercises the same time each day. Your first attempt should be made first thing in the
morning before you get out of bed while you are lying down. The next time you can do the exercises while
sitting up, standing or relaxing. You should begin to see improvements within one month time.
       Voiding Record           Patient Name:                              Date:

TIME     INTAKE (amount/type)               URINE    WET      TIME   INTAKE (amount/type)   URINE    WET
                                            OUTPUT   EVENT                                 OUTPUT   EVENT
0600                                                          1800
0630                                                          1830
0700                                                          1900
0730                                                          1930
0800                                                          2000
0830                                                          2030
0900                                                          2100
0930                                                          2190
1000                                                          2200
1030                                                          2230
1100                                                          2300
1130                                                          2330
1200                                                          0000
1230                                                          0030
1300                                                          0100
1330                                                          0130
1400                                                          0200
1430                                                          0230
1500                                                          0300
1530                                                          0330
1600   0400
1630   0430
1700   0500
1730   0530

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