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Agency for Health Care Policy and Research (US). AHCPR Quick Reference Guides. Rockville (MD): Agency for Health Care Policy and Research (US); 1992-1996.

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

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AHCPR Quick Reference Guides.

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2bHelping People with Incontinence

Caregiver Guide: Clinical Practice

Created: .

What Is Urinary Incontinence?

Many people cannot control when or where they urinate. Many nursing home residents and residents in home care have this problem. When residents wet themselves, it is called urinary incontinence (u-rin-a-ry in-kon-tin-ence). A short way to say this is "UI." UI is not the resident's fault. It is not a normal part of aging. The resident is not bad or lazy. He or she has a health problem. And you can help. This booklet will help you take care of and help residents with UI.

You Are the Key

UI can be cured and improved. But residents need to get the right care. Many of the treatments in this booklet can help. And you are an important part of the team that will make the UI treatment work.

Causes of Urinary Incontinence

UI is most often caused by:

  • Urinary tract infections (UTIs).
  • Constipation or impaction.
  • Reaction to medicine.
  • Confusion.
  • Muscle weakness.
  • Trouble getting to the bathroom.
  • Problems with clothing.
  • Vaginal problems in women.
  • Prostate problems in men.

Finding UI

You might be the first person to notice that a resident has UI. How will you know? See the box below:

Does the resident have UI? If you can answer "yes" to one or more of these questions, the resident may have UI.

  • Do you ever find the resident wet?
  • Do you ever find the bed wet?
  • Does the bed have urine stains?
  • Does the resident smell like urine?
  • Does the resident leak urine on the way to the bathroom?
  • Does the resident use pads, tissue paper, or cloth for protection?
Tell the nurse if you think a resident has UI.

Finding Out More About UI

People with UI should be checked by a doctor or nurse. They may be able to find the cause of the problem. This will help decide the best way to treat or even cure the UI.

Here is how you can help:

  • Watch the resident to see what kind of UI he or she might have.
  • Keep a bladder record.
  • Tell the doctor or nurse what you know about the resident's health and medicines.

1. Watch the resident to see what kind of UI he or she might have

The types of UI are listed below. There are different kinds of UI:

  • Urge incontinence.
  • Stress incontinence.
  • Overflow incontinence.

People with urge incontinence may leak urine:

  • As soon as they feel they have to go to the bathroom.
  • On their way to the bathroom.
  • After they drink just a little bit of liquid.

Sometimes they will feel like they have to urinate if they touch or hear running water. They may need to go to the bathroom many times during the day and night.

People with stress incontinence leak urine when they:

  • Move or exercise in a certain way.
  • Sneeze, cough, or laugh.

They may also lose urine when they:

  • Get up from a chair.
  • Get out of bed.
  • Exercise, walk, or lift something.
Women often have stress incontinence.

People with overflow incontinence:

  • Feel as though they never empty their bladder all the way.
  • Pass a little bit of urine, without feeling the need to go.
  • Pass urine again after they just went.
In men, this may be a sign of prostate problems.

2. Keep a bladder record

A bladder record can help you keep track of a person's daily urinating habits. This record also shows when the person has an accident. The bladder record can also help you and the nurse or doctor to find the best treatment for the UI.

3. Tell the doctor or nurse what you know about the resident's health and medicines

The doctor or nurse will check the resident to try to find the cause of the UI. You know important information about the resident that will help.

Treating UI

There are three treatments for UI. These are:

  • Behavioral treatments that help the resident control his or her urine and use the toilet at the right time.
  • Medicine.
  • Surgery.

Behavioral Treatments

Many residents have problems getting to the bathroom. Some residents are not able to tell you when they have to go. Most of these people will need one of three behavioral (or "toileting") treatments. These are:

  • Scheduled toileting.
  • Prompted voiding.
  • Habit training.

Image f55_cuigf4.jpg

The steps for each of the behavioral treatments are in the following boxes. If you have any questions, be sure to ask the doctor or nurse.

You can help the doctor or nurse choose the right toileting treatment by watching the resident and keeping a bladder record .

You may also be able to answer some questions to help pick the right toileting treatment.

Does the resident need help getting to the bathroom? Residents who cannot get out of bed or cannot get to the bathroom alone can use scheduled toileting.

Scheduled toileting.Take the resident to the bathroom every 2-4 hours.

Does the resident know if his or her bladder is full? Some people know they have a full bladder, but do not ask to go to the bathroom. These people may be able to use prompted voiding.

Prompted voiding

  1. Check the resident often to see if he or she is wet or dry.
  2. Ask the resident "Do you want to use the toilet?"
  3. Help the resident to the toilet if he or she needs to use the toilet.
  4. Praise the resident for being dry and trying to use the toilet.
  5. Tell the resident when you will come back to take him or her to the toilet again.

Does the resident go to the bathroom at the same time every day?If the answer is yes, habit training may be best for them.

Habit training

  1. Watch the resident to find what times he or she urinates.
  2. Take the resident to the bathroom at those times every day.
  3. Praise the resident for being dry and using the toilet.

Most of the time, the toileting treatment will be written out for you in a care plan. The care plan shows when to take the person to the bathroom. It is important to follow the care plan.

Be patient. Toileting treatments take time to work. Treat the resident as an adult with dignity. Residents may feel bad about being wet. They may not like having someone see them undressed. It may help you to remember a few things:

  • Answer call bell as soon as possible.
  • Do not rush the resident.
  • Give the resident enough time to empty his or her bladder.
  • Try to give the resident some privacy. Pull the curtain or close the door, even if you must stay in the bathroom.
  • Never yell at the resident if he or she is wet. Tell the resident that he or she can try again the next time.
You are the key to making behavioral treatments work.

Image f55_cuigf5b.jpg

Image f55_cuigf5t.jpg

Medicine and Surgery

If residents need medicine or surgery to treat their UI, you will probably be asked to help with their care during or after treatment. But your most important job will be to work with the resident on the behavioral toileting treatments.

Exercises

Some people need to do exercises that make muscles around the bladder stronger. These pelvic exercises are called Kegel exercises. Nurses who have special training work with people who need these treatments. Later, you may be asked to help with these exercises.

In the nursing home, your supervisor or nurse in charge will tell you when and how you will help.

In home health care, you may need to ask your supervisor or visiting nurse if Kegel exercises will help.

The muscles that are made stronger by Kegel exercises are the same ones that stop and start the flow of urine. These muscles are called the pelvic muscles.

To do Kegel exercises, the person tightens the pelvic muscles for a few seconds and then releases them.

This is repeated up to 10 times, four times every day.

When the person feels that urine might leak, he or she tightens the muscles and keeps from leaking.

Other Ways To Help Residents with UI

Some people with UI may need extra help. They may leak urine sometimes. Or, their treatments may not work. Here are some things that might happen.

If the person can't get out of bed or can't get to the bathroom, you can help by bringing them:

  • Bedpan.
  • Urinal (male or female).
  • Bedside commode.
These should be kept by the bed, so that they are easy to reach for you and the resident.

If the resident can use a wheelchair, walker, or cane to get to the bathroom, it will help if you:

  • Keep the path to the bathroom clear and well lit.
  • Keep the wheelchair, cane, or walker near the bed.
  • Answer the call light as soon as possible.

If the resident wets the bed at night, the nurse in charge may ask you to:

  • Keep the resident from drinking too much liquid in the evening. Be sure to do this only if you are told to by the nurse in charge.

If none of the treatments work: Some residents may need to use special pads or clothing. These pads and clothing help keep the skin dry. Wet pads and clothes should be changed often, because wetness can cause skin problems.

If the resident has sore or tender skin from being wet, be sure to:

  • Keep the skin clean and dry.
  • Use creams to protect skin after it has been cleaned and dried.
  • Use pads and clothing that are soft to the skin.
  • Keep pads and clothing wrinkle free.
  • Change wet pads and clothing often.
Doing all these things can help prevent pressure sores.

Some residents need to have a urinary catheter. A catheter is a tube that a doctor or nurse places into the bladder. It drains urine into a special bag attached to the body. Some men use a condom catheter that fits over the penis. It is important that all catheters be checked often because some residents can get infections from them. If a condom catheter is too tight, it can harm the penis. Be sure to wash your hands before and after you empty the catheter bag.

For More Information

You can get more information about incontinence from:

  • Bladder Health Council,
  • c/o American Foundation for Urologic Disease
  • 300 West Pratt Street,
  • Suite 401,
  • Baltimore, MD 21201,
  • (800) 242-2383,
  • (410) 727-2908
  • National Association for Continence (formerly Help for Incontinent People),
  • P.O. Box 8310,
  • Spartanburg, SC 29305,
  • (800) BLADDER or (800) 252-3337
  • Simon Foundation for Continence,
  • Box 835,
  • Wilmette, IL 60091,
  • (800) 23-SIMON

You can get more copies of this caregiver guide and booklets on bed sores. Ask for:

  • Helping People With Incontinence (AHCPR Publication No. 96-0683)
  • Preventing Pressure Ulcers: Patient Guide (AHCPR Publication No. 92-0048)
  • Treating Pressure Sores: Consumer Version (AHCPR Publication No. 95-0654)

Call toll free: 800-358-9295 or write to:

  • Agency for Health Care Policy and Research,
  • Publications Clearinghouse,
  • P.O. Box 8547,
  • Silver Spring, MD 20907

Sample bladder record

Sample bladder record

NAME: ____________________________________________
DATE: ____________________________________________
INSTRUCTIONS: Place a check in the appropriate column next to the time you urinated in the toilet or when an incontinence episode occurred. Note the reason for the incontinence and describe your liquid intake (for example, coffee, water) and estimate the amount (for example, one cup).
6-8 a.m. ______________________________________________________ ____________________________________
8-10 a.m. ______________________________________________________ ____________________________________
10-noon ______________________________________________________ ____________________________________
Noon-2 p.m. ______________________________________________________ ____________________________________
2-4 p.m. ______________________________________________________ ____________________________________
4-6 p.m. ______________________________________________________ ____________________________________
6-8 p.m. ______________________________________________________ ____________________________________
8-10 p.m. ______________________________________________________ ____________________________________
10-midnight ______________________________________________________ ____________________________________
Overnight ______________________________________________________ ____________________________________
No. of pads used today: No. of episodes:

Comments:_______________________________________

AHCPR Publication No. 96-0683.

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