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Module 11│Incontinence & Constipation

Module #11 outlines certain elements in managing a patient with either incontinence and/or constipation. Incontinence can happen for many reasons, including urinary tract infections, vaginal infection or irritation, or constipation. Some medications can cause bladder control problems that last a short time. When incontinence lasts longer, it may be due to weak bladder or pelvic floor muscles.

Read carefully because at the end of this module is a quiz. There are 10 questions in total and 5 minutes to complete.  7 questions (70%) must be answered correctly. You have 8 chances to pass this module. 

In-Service Exams provided by Essential In-Services for Home Health, 2021

Urinary Incontinence (UI)

People who cannot control when or where they urinate suffer from urinary incontinence (UI). There are things that can be done to improve this condition, but it is important to know what the cause is so the right care and treatment can be provided. 

This condition is not the person’s fault, and it is not a necessary or normal part of growing older. It is not caused by laziness or meanness. UI is a health problem with a number of possible causes. Some of the most common causes include:

  • Urinary tract infections (UTI)
  • Confusion and forgetfulness
  • Muscle weakness
  • Vaginal problems (in women)
  • Prostate problems (in men)
  • Medication reactions
  • Problems with clothing
  • Trouble getting to the bathroom
  • Constipation

Any patient who ever wets the bed, leaks urine on the way to the bathroom, or has to use protective pads or padded briefs is suffering from UI. If you notice a patient, a bed, or a room that has urine stains or a urine odor, then you know the patient needs help with this condition.

However, you probably don’t know what kind of UI the patient has. You can often determine this by watching the patient closely and keeping track of his or her urinating habits on a bladder record. There is an example included with this learning guide. It shows regular daily habits as well as accidents.

Keeping a bladder record is an excellent way to get information about a patient’s UI so ways can be found to treat it.

There are 3 different types of UI:
Urge incontinence.
With this type, people may leak urine on their way to the bathroom, after drinking just a little bit of liquid, or as soon as they feel the urge to go.

Stress incontinence may cause urine to leak when people sneeze, cough or laugh or when they exercise or move a certain way (getting out of bed, up from a chair, walking, lifting). This is common in women.

Overflow incontinence causes people to feel they need to urinate again right after going, to feel as though they never totally empty the bladder, or to pass small amounts of urine without feeling any need to go. It may be a sign of prostate problems in men.

What Can Be Done to Help a Patient With Urinary Incontinence?

Your first responsibility is to report UI to your supervisor, the agency nurse or the patient’s doctor. A doctor or nurse should check a patient with UI, and your observations about the patient, such as a bladder record, will help them determine the cause and type of UI. The three treatments for UI are:

Surgery

Medication

Behavior Treatment

These help people control their urine and use the toilet at the right time. They work well for patients who have problems getting to the bathroom or are not able to tell you when they need to urinate. We will discuss three behavioral treatments for UI that you can assist with:

  • Scheduled toileting
  • Prompted voiding
  • Habit training

Retraining Your Bladder: Information for Patients/Caregivers

It is possible to retrain your bladder if you have trouble controlling your urine flow. First, keep a record of your normal drinking and urinating patterns. Next, schedule your urination at regular intervals and begin to gradually increase the amount of time between urinating. Eventually, you want to train yourself to urinate no more than once every three to four hours.

Follow these steps:

1. Keep a record. Write everything down on the bladder record.

2. Schedule urination.

  • Begin by going to the bathroom every hour or two, whether or not you feel the need.
  • If you feel the need to urinate more often than that, practice tightening your pelvic muscles to hold the urine. Relax, concentrate and breathe slowly and deeply until the urge decreases or goes away.
  • After the urge goes away, wait a few minutes, then go to the bathroom and urinate. Do this even if the urge has passed. Don’t wait for the next urge, because it may be difficult to control.
  • After a week of this kind of training, if you are able to wait for two or three minutes easily, increase the waiting time (between feeling the urge and using the bathroom) to five minutes and then to 10 minutes.
  • Work toward intervals of three or four hours between urination. If you have an accident, don’t let it discourage you. Just keep trying.

Helpful Hints

  • Be sure you can reach your bathroom or commode easily.
  • Walk to the bathroom slowly.
  • Urinate just before going to bed.
  • Set an alarm clock to remind you when to use the toilet. Do this in the daytime and also once or twice at night.
  • Drink 8-10 glasses of fluid daily to prevent urinary tract infections and constipation.
  • Avoid caffeine drinks and alcoholic beverages.
  • Do Kegel exercises to increase bladder tone (ask the nurse to teach you how).

Scheduled Toileting
Use scheduled toileting for patients who can’t get out of bed or can’t get to the bathroom alone. To do this treatment, assist the patient to the bathroom every 2-4 hours on a regular schedule.

Prompted Voiding
Use prompted voiding for patients who know when they have a full bladder but do not ask to go to the bathroom. To do this treatment:

  • Check the patient often for wetness.
  • Ask, “Do you want to use the toilet?”
  • Help the patient to the toilet.
  • Praise the patient for being dry.
  • Tell the patient when you will come back to take him or her to the bathroom again.

Habit Training
Use habit training for patients that tend to urinate at about the same time every day. To do this:

  • Watch the patient to find what times he or she urinates. A bladder record can help you do this.
  • Take the patient to the bathroom at those times every day.
  • Praise the patient for being dry and using the toilet.

For all behavioral treatments, remember the following things:

  • Be patient. These treatments take time.
  • Treat the patient as an adult.
  • Do not rush the patient.
  • Give the patient plenty of time to completely empty his or her bladder.
  • Give privacy by closing the door, even if you must stay in the bathroom.
  • Never yell or be angry with the patient if he or she is wet. Say, “You can try again next time.”
  • Respect dignity and confidentiality.

Dietary Management For Urinary Incontinence. 

While there is no dietary treatment for urinary incontinence, some foods and drinks can irritate the bladder, such as sugar, chocolate, citrus fruits (oranges, grapefruits, lemons, limes), alcohol, grape juice and caffeinated drinks like coffee, tea and cola. Patients with UI could try eliminating these foods and beverages from their diet and determine whether the condition improves.

Dietary Management For Bowel Incontinence & Constipation.

The average American diet contains 10-15 grams of fiber per day. The amount of fiber recommended for good bowel function is 25-30 grams of fiber per day, plus 60-80 ounces of fluid. In the table below get an idea of the fiber we get from different foods.

Most people can successfully treat their bowel irregularities, both incontinence and constipation, by adding high-fiber foods to their diet, along with increasing fluid intake to desired levels. Increase dietary fiber slowly to give the bowel time to adjust.

High-Fiber Diet Alternatives

Food Type

Low Fiber Foods

Fiber Grams

High Fiber Alternatives

Fiber Grams

Breads

Cereals

Rice

Vegetables

Fruits

Beans

White, 1 slice

Corn flakes, 1 oz

White rice, 1/2 cup

Lettuce, 1/2 cup raw

Green beans, 1/2 cup

Banana 1 medium

0.50

0.45

1.42

0.24

1.89

2.19

Whole wheat, 1 slice

Oat ban, 1 oz

Brown rice 1/2 cup

Green peas, 1/2 cup

Pinto beans, 1/2 cup

Blackberries, 1 cup

2.11

4.06

5.27

3.36

5.93

7.20

*People with diverticulosis or diverticulitis should not consume a high-fiber diet.

Bowel Retraining for Bowel Incontinence & Constipation

Food Sensitivities
Some people are sensitive to, or even allergic to, certain foods that cause them constipation or diarrhea.

Dairy products such as milk and cheese, wheat products such as bread, and foods containing chocolate are some of the more common problem foods. A physician should evaluate a patient who seems to have particular food sensitivities.

Habit Training
Habit training means designating a specific time each day to have a bowel movement. Keep a record of the patient’s bowel habits just as you do with a bladder record.

If a pattern develops, that pattern can be used to set up a habit regimen that will reinforce a scheduled time each day to have a bowel movement.

If no pattern can be seen in the patient’s bowel activities, then a regimen can be established by selecting a convenient time each day, or even three times per day in the case of someone with bowel incontinence, for the patient to try to have a bowel movement.

Be sure to help the patient stick with this schedule, even when he or she does not feel the need to go. Over time, the body will develop a habit that conforms to the scheduled routine.

Exercises
The Kegel exercises that are used to prevent urinary incontinence can be slightly modified to strengthen the anal muscles that control the outflow of stool.

To do them, the person tightens the muscles around the rectum. The muscles should be squeezed tightly for a few seconds and then released, up to 10 times at one sitting, four times every day.