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

2. 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

3. 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

4. How Your Bladder Works

5. 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.

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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Pelvic Organ Prolapse

13. 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

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

15. 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

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

17. 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

18. 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

19. 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

20. 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

21. 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!!

22. 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

23. Resources
Bladder Health. (n.d.) Retreived December 4, 2015, from 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 organ-prolapse/basics/definition/con
Take the Floor : Pelvic Organ Prolapse. (2008). Retrieved December 14, 2015, from