1. Presentation By: Gina Kaczmarek, Student Nurse

2.  Urinary incontinence (UI) defined as the involuntary loss of urine  Affects 1/3 of community-dwelling elderly women and 1/5 of men  Increases to 50% for elderly in nursing homes, and is seen twice as often in women  At CCCW, roughly 40-45% of members (elderly & disabled), use incontinence products

3.  UI can lead to many problems that affect quality of life  Physical complications  Increased risk of urinary tract infections  Increased risk of falls Rushing to the bathroom  Skin breakdown Prolonged skin contact with soiled items  Increased psychological distress  Reports of increased depression, anxiety and embarrassment  Fear of having an accident  Loss of independence, decreased self-esteem  Social problems  Social isolation due to embarrassment and fear of having an accident in public

4.  There are many different types of UI  Stress Leakage of small amount of urine when laughing, sneezing, exercise, etc. Weakened external pelvic floor muscles, increased intra-abdominal pressure  Urge Leakage of large amounts of urine due to overactive bladder Weakened internal muscles of urinary tract  Overflow Bladder muscles are overextended and have poor tone  Functional Physical or psychological factors hinder ability to make it to the bathroom in time  Mixed Combination of any of the above  Treatment varies depending on the type of UI so a thorough assessment is necessary  However, there are self-management techniques that can be helpful for all types

5.  Self-management techniques can be helpful for members to feel in control of their health  Loss of independence and self-esteem are major psychological distresses  The interdisciplinary team at CCCW is at a great position to give education, guidance and support

6.  Bladder diaries  Help members to self-monitor, along with give health care providers a look into what is causing incontinence  Bladder Training  Scheduled voiding (ex. 2 hour toileting)  Biofeedback to resist urge to go in-between toileting sessions  Time between voids can slowly be lengthened  Pelvic floor exercises  Contraction and relaxation of pelvic floor muscles, or Kegels Contract for 5-10 seconds then relax for 10-20  Research suggests at least 32 contractions a day Can be split up between 3-5 sessions a day  Consistency is key as muscle tone will be lost once exercises are stopped

7.  Lifestyle Modifications  Weight loss Decrease intra-abdominal pressure and pressure on pelvic floor muscles  Smoking cessation Research shows people who smoke are more likely to report urinary incontinence  Caffeine reduction Can increase bladder contractibility  Alcohol reduction Diuretic effect  Appropriate fluid intake Increased fluid intake can have diuretic effect Can be controversial to decrease fluid intake as it can increase risk for dehydration Restrict fluids before bedtime  Bowel management Avoid constipation and straining

8.  Ensuring a safe and accessible environment  Mobility aids Higher toilet set, railings, etc.  Clothing that allows a timely removal Velcro rather than buttons  Knowing location of bathrooms  Incontinence Products  Pads, briefs Ensuring correct product for needs How much urine product needs to hold, comfort, individual preference Prompt removal to decrease risk for UTIs and skin breakdown

9.  Urinary incontinence is a chronic condition that can lead to many complications  It is important that this condition is addressed, especially since it affects so many.  Community-dwelling elderly are in a position where they can utilize self-management techniques in order to regain some independence and increase quality of life

10.  Community Care of Central Wisconsin. (2011). End-of-year report. Retrieved from http://www.communitycareofcentralwisconsin.org/images/stories/2011% 20CCCW%20End-of-Year%20Report.pdf http://www.communitycareofcentralwisconsin.org/images/stories/2011% 20CCCW%20End-of-Year%20Report.pdf  Grandstaff, M., & Lyons, D. (2012). Impact of a continence training program on patient safety and quality. Rehabilitation Nursing, 37(4), 180- 184. doi:10.1002/rnj.34  Imamura, M. (2010). Lifestyle interventions for the treatment of urinary incontinence in adults. Cochrane Database Of Systematic Reviews, (9)  Pellatt, G. (2012). Promoting male urinary continence. British Journal Of Nursing, S5-s11.  Tabloski, P. (2010). Gerontological Nursing (2 nd ed.). Upper Saddle River, NJ: Pearson Education Inc.  U.S. Census Bureau (2010). Age and Sex Composition: 2010. Retrieved from http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdfhttp://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf  Vries, H.F., Northington, G.M., Bogner, H.R. (2011). Urinary incontinence (UI) and new psychological distress among communit dwelling older adults. Archives of Gerontology and Geriatrics, 55, 49–54  Wallace, S., Roe, B., Williams, K., & Palmer, M. (2004). Bladder training for urinary incontinence in adults. Cochrane Database Of Systematic Reviews, (1)