Bladder & Pelvic Health Columbus Community Hospital 100 Miles in 100 Days

Introduction W.O.C. Health Center Dr. Ronald Ernst, Medical Director Suite 210, Visiting Physicians Clinic Wound, Ostomy, Continence Certified Nurses Jennifer Fjell BSN, RN, CWOCN Danelle Kratochvil BSN, RN, CWOCN

How Your Bladder Works- Anatomy The Bladder A hollow muscular organ shaped like a small balloon that sits in your lower abdomen (pelvis) Held in place by ligaments attached to other organs and the pelvic bone The Kidney Bean shaped organ near the middle back, below ribs Remove urine from the blood stream Ureters Two tiny tubes that carry urine from the kidney to the bladder

How Your Bladder Works

How Your Bladder Works Urine travels from the kidneys down the ureters to the bladder Bladder will hold the urine until going to the bathroom A healthy bladder can hold up to 2 cups of urine for 2-5 hours Nerves in the bladder tell your brain when it is time to urinate Urethra is a single thin tube that passes urine from your bladder to the toilet.

Overactive Bladder (OAB) Stress Incontinence Mixed Incontinence When Things Go Wrong Overactive Bladder (OAB) Stress Incontinence Mixed Incontinence Bladder Outlet Obstruction

Causes of Incontinence Aging UTI Declined Estrogen levels Childbirth/Pregnancy Medications Diseases of Nervous System Benign Prostatic Hyperplasia Cancer Surgery Radiation Obesity Certain Occupations Dietary irritants Dehydration Depression Excess Urine Production Restricted mobility Stool impaction Vaginitis or Urethritis

Overactive Bladder Urgency and Frequency Common Bladder “working overtime” Void 8+ times per day Up more than 2+ at night Causes Abnormal sensitivity to bladder filling Feels uncomfortable or painful Uncontrollable contractions of the bladder (detrusor) muscles due to stimuli Cold, running water, low urine volumes Urge to void cause a bladder contraction without the person wanting to Difficult to stop/control urine

Stress/Mixed Incontinence Stress Incontinence Urine leakage during physical activity or sudden exertion Involuntary loss of urine during increased abdominal pressure Laugh, cough, sneeze, lifting, exercising Causes Weak muscles and lack of support for bladder Bladder sphincter is too weak to hold urine Mixed Incontinence Combination of OAB and Stress Incontience

Bladder Outlet Obstruction Blockage at the base of the bladder BPH-Benign Prostatic Hyperplasia “Anti-Incontinence” Surgery Prolapse Strictures of the Urethra Foreign Object Stool Impaction

Pelvic Organ Prolapse According to the Mayo Clinic, POP happens when the muscles and ligaments supporting a woman's pelvic organs weaken and the pelvic organs can slip out of place and create a bulge in the vagina (prolapse). Pelvic Organs Bladder Intestines Vagina Cervix Uterus Urethra Rectum

Pelvic Organ Prolapse

Pelvic Organ Prolapse Risk Factors Genetics Race Caucasian women are more likely than African American women to develop pelvic organ prolapse.  Lifestyle Smoking Pelvic Floor Injury Vaginal delivery Surgery, Pelvic radiation Fractures to the back and pelvis caused by falls or motor vehicle accidents.  Hysterectomy or surgery of pelvic floor muscles Other Health Condiditons Chronic constipation Chronic coughing Obesity obese women have a 40 to 75% increased risk of pelvic organ prolapse. Menopause Nerve and muscle diseases that decrease pelvic floor strength Heavy lifting

Taking Control-Who Can Help Primary Care Physician PA/NP Urologist OB/GYN Urogynecologist

How Diagnosed? Health History Review Dietary/Fluid History Exam Past Medical, Surgical, Family, Psycho-Social Review Dietary/Fluid History Exam Urinalysis Blood Test Ultrasound Urodynamic Testing

Before my appointment….. What Can I do??

Retrain Your Bladder Life Style and Behavior Changes May take 6 weeks or more. Bladder Diary Monitor fluids Urination Schedule Gradually increase to holding urine for 3 to 4 hours Suppress the Urge Relax Concentrate Quick Contractions Pelvic Floor Exercises Distraction

Pelvic Floor Exercises Appropriate for Stress, Urge, and Mixed Incontinence Locate the pelvic floor muscles Squeeze this muscle for 3 seconds Do not tighten Abdominal Muscles at the same time Upper legs should not move Body should not rise up or down Do not hold your breathe Repeat these exercises several times daily

Additional Options for Strengthening Pelvic Floor Muscles & Bladder Management Biofeedback Vaginal weight cones Knack Electrical stimulation Medication Surgery Physical Therapy for pelvic muscles Vaginal Devices (Pessary) Non-Surgical Treatment Fit by clinician Absorbent products Portable toilets External catheters- Males

Bladder Health Tips Lifestyle Modifications Maintain proper body weight Obesity leads to bladder problems Stay Hydrated! 6-8 cups of fluid a day Increase with exercise or hot weather Avoid alcohol and beverages with caffeine Cause increased bladder activity Eat a healthy diet Fruits, Vegetables, high-fiber carbohydrates, low-fat, low-salt and lean meat meals Avoid foods with artificial sweeteners Do not Strain to empty bladder or bladder Avoid Constipation Full rectum can disturb the bladder and cause need to go more frequently Exercise at least 5 times per week for 30 minutes Pelvic floor muscle exercises should be done daily

Bladder Health Tips Continued… Smoking is the main cause of Bladder Cancer. Chemicals in tobacco smoke are absorbed into the blood, filtered through the kidneys and stored in the bladder Smokers are 2-3 times as likely to develop Bladder Cancer Men are 3 times more likely to be affected than women CCH has Smoking Cessation Groups available!!

Signs Medical Attention May Be Needed! Blood in your urine Need to urinate frequent/urgent Sensation of pain or burning with urination Cloudy or foul smelling urine (infection) Unusual cramping or tenderness in the area of your bladder Feeling unable to empty your bladder Nocturia- Get up more than once at night to urinate Incontinence- Leaking of urine Sudden inability to empty bladder Trauma

Resources Bladder Health. (n.d.) Retreived December 4, 2015, from https://www.suna.org/download/members/bladder_health.p df Crowe, K. (2008). Bladder Matters: A Guide to Managing OVeractive Bladder. Deerfield, IL: Astellas US LLC. Doughty, D. (2006). Urinary & fecal incontinence: Current management concepts (3rd ed.). St. Louis, Mo.: Mosby Elsevier. Pelvic organ prolapse. (n.d.). Retrieved December 14, 2015, from http://www.mayoclinic.org/diseases-conditions/pelvic- organ-prolapse/basics/definition/con-20036092 Take the Floor : Pelvic Organ Prolapse. (2008). Retrieved December 14, 2015, from http://www.voicesforpfd.org/p/cm/ld/fid=6