1. How Can Your Nurse Advisor Help You? Presented by (insert name of presenter here)

2. Role of Nurses recogniseHelp to recognise patients who have problems maintaining continence helpadviceOffer help and advice to patients and relatives

3. How to Recognise Patients with an Overactive Bladder Symptom assessment Medical history Physical examination Urinalysis Bladder diary Pad test Referral for medical evaluation and treatment

4. Symptom Assessment In total, how many times do you go to the toilet in a 24-hour period? How often do you go to the toilet during the day? How often do you wake to go to the toilet during the night? How often do you feel a strong and sudden desire to urinate? If you fail to go to the toilet in time, how much urine do you usually leak? Do you leak urine when you laugh, cough, sneeze, jump or run?

5. Medical History Other questions that your doctor/nurse might ask: History of previous surgery or radiotherapy involving the pelvic region Medications currently taking Main symptoms (complaints) Duration of symptoms

6. Physical Examination Abdomen exam Rectal exam Pelvic exam

7. UrinalysisUrinalysis urinary tract infection To rule out urinary tract infection

8. Bladder Diary Helps patients Helps patients record details of: Bladder symptoms Type/amount of drinks taken Time/amount of urine passed

9. Bladder Diary Date: Monday 19 March

10. Pad Test A supplementary test used to confirm urine leakage and quantify the degree of urine loss.

11. Pad Test Method: Drink 500 ml of fluid as quickly as possible

12. Pad Test Method (cont’d): Perform a series of physical tasks in a 1-hour period Walking Climbing stairs Coughing vigorously Running on the spot

13. Pad Test Method (cont’d): The pad is re-weighed. A weight gain of more than 1 g signifies that the patient is incontinent.

14. Pad Test

15. Referral for Further Evaluation and Treatment Patients are considered for referral if: Symptoms do not respond to initial treatment within 2-3 months Blood in urine without infection on urine test

16. Referral for Further Evaluation and Treatment Symptoms suggestive of bladder obstruction Evidence of unexplained neurologic or metabolic disease (e.g. renal failure, diabetes insipidus)

17. Management of Overactive Bladder Drug therapy Bladder training Incontinence pads and protective devices Bladder self-catheterization Pelvic floor exercises Biofeedback Review diet and food intake Skin care and cleanliness Surgery

18. Bladder Training A behavioural approach to the treatment of the overactive bladder, which is often used in combination with drug therapy.

19. Bladder Training Aims: Increase the time intervals between bladder emptying. Increase bladder capacity by teaching patients to resist and suppress the urge to pass urine.

20. Bladder Training: Frequency/Volume Regulation

21. Incontinence Pads and Protective Equipment Absorbent pads Dribble pouch Reusable underpants designed to carry disposable absorbent pads All-in-one briefs Chair and bed pads

22. Incontinence Pads and Protective Equipment do not treat These do not treat the cause of the problem. At best, they are a passive form of management for only one of the symptoms (i.e. urge incontinence).

23. Incontinence Pads and Protective Equipment temporary supplementary Ideally, incontinence pads should be used only as a temporary or supplementary measure while the results of drug therapy or bladder training come into effect.

24. Bladder Catheterization will not be adequateFor some patients, drug therapy and bladder training will not be adequate to manage their symptoms. For example, patients with a spinal cord injury may be unable to empty their bladder completely.

25. Bladder Catheterization

26. Pelvic Floor Exercises Kegel exercises Also known as Kegel exercises.

27. Pelvic Floor Exercises Aim: To strengthen the pelvic floor muscle and increase overall muscle tone.

28. Pelvic Floor (Female) Pelvic floor

29. Pelvic Floor (Male) Pelvic floor

30. Pelvic Floor Exercises Locate pelvic floor muscles Squeeze pelvic floor muscles as tightly as possible for a few seconds (maximum of 10 seconds) Relax completely for at least 10 seconds Repeat, as recommended by physician/ continence advisor

31. BiofeedbackBiofeedback Aim: Helps patient identify the correct muscle for performing Kegel exercises

32. BiofeedbackBiofeedback Source: Biofeedback Instrument Corporation

33. Review Diet and Fluid Intake Some patients will try to reduce the risk of leakage by restricting their fluid intake.

34. Review Diet and Fluid Intake irritate the bladder However, drinking too little results in concentrated urine, which itself can irritate the bladder.

35. Review Diet and Fluid Intake Therefore, it is important that patients are encouraged to drink appropriate amount of fluids.

36. Review Diet and Fluid Intake Reduce Reduce consumption of: Caffeine (i.e. tea and coffee) Carbonated soft drinks Alcoholic drinks

37. Skin Care and Cleanliness Tips: The skin around the perineum and groin needs to be cleaned whenever the area becomes soiled with urine and faeces.

38. Skin Care and Cleanliness Tips: Do not over powder as this will cause caking.

39. Skin Care and Cleanliness Tips: Do not use alcohol based products which will cause over- drying of the skin.

40. Good Bladder Habits Step 1 Step 1: Maintain appropriate fluid intake Step 2 Step 2: Practice good toilet habits Step 3 Step 3: Maintain good bowel habits Step 4 Step 4: Exercise of pelvic floor muscles

41. Step 1 Maintain appropriate fluid intake 6 - 8 glasses of water per day, unless contrary to doctor’s advice. Limit intake of caffeine, i.e. coffee, soft drinks or tea Limit intake of alcohol as it increases urine production

42. Step 2 Practice good toilet habits Allow plenty of time to empty the bladder Ensure bladder is completely empty each time urine is passed Avoid going to the toilet “just in case” as this results in the bladder developing a smaller capacity

43. Step 3 Maintain good bowel habits Maintain regular bowel movements and avoid constipation

44. Step 4 Exercise pelvic floor muscles Exercise pelvic floor muscles regularly Keep weight down Obesity puts an additional stress on the pelvic floor muscles

45. Control Confidence Freedom

46. Thank You!