Introduction A bladder and bowel retraining program is individually designed for residents who (a) have adequate mental and/or physical function to be retrained, (b) have had a catheter inserted during an acute illness, or (c) have had a stroke or other acute trauma or illness resulting in incontinence. The bladder retraining program helps the resident by strengthening the bladder and sphincter muscles and training the bladder control center in the brain to expect a regular pattern of urination. The process begins with the charge nurse assessing the resident’s physical and mental ability to participate. The nurse assistant’s observations are vital to this assessment process. An evaluation of the resident’s voiding pattern over a 7–14- day period provides information on the resident’s habits. A good bowel retraining program includes the following: (a) evacuation at the same time each day, (b) proper diet, (c) daily physical exercise, (d) resident education, and (e) initiation of defecation on demand with digital stimulation and abdominal massage (not to be done by the nurse assistant).

Terms and Definitions • Acute – rapid onset, short term • Chronic – long, drawn out, long term • Nocturia – to urinate during the night

Nurse Assistant’s Responsibilities for Bladder Retraining • Providing adequate fluid is a must! It is needed to keep the urinary system functioning properly. The elderly often have a decreased thirst sensation and should be offered fluids every 2 hours for a total of 2,000-3,000 cc per 24-hour period. The charge nurse should set up a schedule of fluid intake that the resident and staff can follow. Follow the care plan. You may have to remind or help the resident to drink. Keep an accurate I&O record and document accurate information on the B&B flow sheet. Most fluids should be taken between 7 a.m. and 7 p.m. to prevent nocturia. Follow the care plan.

Nurse Assistant’s Responsibilities for Bladder Retraining • A voiding schedule should be established and adhered to. You must observe and record the resident’s voiding history for 48-72 hours to determine a schedule. This should include times and amounts. Adequate fluid intake should be provided during this time. Follow the care plan. Start an intake record. After bladder retraining is started, the resident should be taken to the bathroom or given a bedpan/urinal just before the expected time of voiding. The resident should be assisted to the bathroom at least every 2 hours during the day and every 4 hours during the night or upon resident’s request. If the resident cannot stay dry for at least 2 hours, then he/she must be taken to the bathroom ever 2 hours.

Nurse Assistant’s Responsibilities for Bladder Retraining If the resident is dry for 3 to 4 hours, then taking him/her to the bathroom upon awakening in the a.m. before and after meals and at bedtime may be sufficient. Follow the care plan. • If the resident is independent and able to tell you, answer the call signal without delay or offer your assistance at the usual times he/she voids. • Measure and record urinary output. • The resident will need to be awakened during the night and assisted to the toilet if he/she usually voids during that time. Resident can void easier in an upright position – standing for men and sitting for women.

Nurse Assistant’s Responsibilities for Bladder Retraining If the resident is incontinent at times, keep him/her clean and dry; never scold the resident if unsuccessful. Involve the resident. Explain the bladder retraining program to him/her. If a resident can accomplish this, it helps him/her feel more confident, independent, and it increases the resident’s self-esteem. • Bladder retraining must be a team effort by all nursing staff.

Habit Training Program for Chronic Bladder Incontinence • Residents who suffer from chronic bladder incontinence should be placed on a scheduled toileting or prompted voiding program to keep him/her dry. Resident who have severed weakness of bladder and sphincter muscles Diseases/injuries causing brain damage of area that controls bladder function Enlarged prostate gland in males

Habit Training Program for Chronic Bladder Incontinence • Nurse assistant’s responsibilities Observe and record the resident’s usual times for voiding for a few days to determine his/her pattern. Set up a toileting schedule from observations to check resident for incontinence. Generally, a toileting schedule is every 2 hours. If this does not work, try every 90 minutes. If this does not work, try every 60 minutes. Encourage p.o. liquids and record intake. Remove incontinent briefs/pads and give good peri care. Apply fresh incontinent pads or briefs (according to manufacturer’s or facility’s directions). Observe the skin for any signs of breakdown – redness, irritation, sores, etc. Treat the resident with respect; be understanding.

Bowel Retraining Program • A program set up to assist the resident to eliminate at his/her usual time of day and to prevent incontinence of stool • Nurse assistant’s responsibilities Observe and record resident’s usual pattern of bowel movements; include time of day (a.m./p.m.) and how often for 7-14 days. Assist resident to bathroom toilet/bedside commode/bedpan at time of day that he/she usually defecates. Provide as much privacy as possible, allow plenty of time for resident to finish, and ensure a sitting position as much as possible. Encourage adequate fluid intake and proper diet containing fiber. Encourage regular exercises.

Bowel Retraining Program The physician may order suppositories as part of the training program to promote a regular elimination pattern. • The CMT or charge nurse inserts the suppository. • The CMT or charge nurse tells the nurse assistant how many minutes to wait before assisting the resident to use the bathroom or bedpan. Note time of elimination and character of stool. Report any changes in schedule to the charge nurse. Be patient and understanding. If the resident can accomplish this, it helps him/her to feel more confident, independent, and increases his/her self-esteem.

Conclusion The retraining of the bladder and bowels can be accomplished. It requires your time and patience. It can be frustrating if the resident is not making progress, but we must keep a positive attitude for the resident’s sake throughout the scheduled program. It also can be very satisfying and rewarding to know that you have helped someone feel good about himself/herself by gaining confidence and control in this area.