MASS Clinical Education - Incontinence

By Kate Dawson Registered Occupational Therapist B.App.Sc (OT)

What is incontinence?

Incontinence is the involuntary loss of urine or faeces.

How common is incontinence?

Incontinence is a widespread condition that ranges from ‘just a small leak’ to complete loss of bladder or bowel control. Over 4.8 million Australians experience bladder or bowel control problems for a variety of reasons. More than 70% of people who experience incontinence are women, with many experiencing problems after childbirth or menopause.

Bladder Function

What is normal bladder function?

Bladder function varies from person to person. Generally:

• 1.5 litres of urine is produced over 24 hours depending on the amount of fluid intake and type of drink - caffeine based drinks act as a diuretic and consequently more urine is produced
• typically a person gets an urge to void when approximately 200mls of urine is in the bladder. Elderly people may get this urge with only 150mls in the bladder
• the amount of urine varies on temperature – less is produced in warmer weather
• most people void 4-8 times daily
• Nocturia – it is normal for some people to void once overnight.

Causes of Urinary Incontinence

The causes of incontinence are wide-ranging and include medical, neurological, psychological and environmental issues.

Types of urinary incontinence

Stress Incontinence

This type of incontinence is related to weakened pelvic floor and urethral sphincter muscles.

The pelvic floor muscle is instrumental in maintaining continence when sneezing, coughing etc. Weakened pelvic floor muscles tend to sag and this allows the bladder neck to prolapse through the pelvic floor. In cases of increased pressure the pelvic floor muscles do not contract effectively and the urethral sphincters are unable to close to prevent the urinary leakage.

Women are predominately affected by Stress Incontinence as a result of pregnancy and childbirth or oestrogen deficits post menopause. Men also may experience Stress Incontinence following prostate surgery.

Urge Incontinence

Urge incontinence occurs because the sacral reflex arc is not inhibited, meaning that the bladder contracts before the person is able to void voluntarily resulting in leakage. Causes can include anything that irritates the bladder including urinary tract infection, alcohol and caffeine drinks and medications. Other causes may be related to the disturbance of the nerve pathway, after stroke or spinal cord injury.

Urinary retention with overflow

This type of incontinence occurs as a result of an underactive bladder or an obstruction. In this case the detrusor muscle does not produce a contraction capable of expelling urine. The pressure inside the bladder increases and becomes greater than the urethral pressure resulting in incontinence. Complete emptying of the bladder is only possible with manual pressure or abdominal effort. Usually there is a large residue of urine. This occurs in people with lower spinal cord injuries and diabetic autonomic neuropathy. It may also occur as a result of an obstruction such as an enlarged prostate, urethral stricture, constipation, fibroids or tumours.

Functional incontinence

This occurs in people who are unable to cope with their bladder function, including impaired mobility, poor manual dexterity, urinary tract infection or depression.

Enuresis

This is defined as ‘the involuntary discharge of urine by day and night or both, in a child aged five years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract’ Forsythe and Butler, 1989

Nocturnal enuresis

Nocturnal enuresis is lack of bladder control at night time or bedwetting.

Management Strategies for Urinary Incontinence

Management strategies for urinary incontinence can be provided post assessment and include good bladder habits, provision of a supportive environment, pelvic floor muscle exercises, bladder training, catheterisation and medication.

Bed & Chair Protectors

Aleva offer a range of washable bed pads and chair pads to assist in the day-to- day management of incontinence.

What is a bed pad?

A bed pad is designed to absorb liquids quickly to leave a feel dry surface for the person lying on it. Aleva’s ABSO® bed pads offer

• Higher than average absorbency levels up to 3 litres/m2
• Skin-friendliness because they are certified under the Oeko-Tex® Standard 100, ensuring that no harmful chemicals have been used during manufacturing. They are PVC and phthalate free.
• A range of sizes including 1mx1m, 85cmx100cm or 85x90cms – all of which provide good coverage for the person lying on them
• Design choices including either a bound edge or tuck-in wings
• Design choices including in-built breathable polyurethane waterproof membranes or bed pads that require a separate waterproof sheet (to protect the mattress

How to use bed pads

1. Choose from either:
   a. a bed pad with an inbuilt breathable polyurethane waterproof membrane to protect bedding with either a bound edge or tuck-in wings
   b. one that absorbs liquid but must be used with a separate waterproof sheet to protect bedding with either a bound edge or tuck-in wings
2. We recommend that the product is washed prior to use – absorbency increases with each wash – See the following table for specific washing and drying instructions to ensure optimal use.
3. Place your bed sheet over the mattress
4. Place
   a. the bed pad with an inbuilt waterproof membrane over the sheet positioning so that the person’s body between the shoulders and knees are covered or
   b. the waterproof sheet and then the bed pad (without a waterproof membrane) over the sheet, positioning them both so that the person’s body between the shoulders and knees are covered
5. Tuck in the wings (if this option has been chosen).
6. ABSO® bed pads can be laundered in both domestic and commercial washing machines – see care instructions in the following table. Importantly do not use fabric softeners, do not bleach, do not dry clean, and do not iron. They may be line or tumble dried on low heat.

What is a chair pad?

A chair pad is designed to absorb liquid quickly to leave a feel dry surface for the person sitting on it. All of the chair pads offered by Aleva have a breathable waterproof membrane to protect chairs, lounges, car seat or wheelchair.

How to use chair pads

Aleva’s ABSO® chair pads offer

• absorbency levels up to 3 litres/m2
• skin-friendliness because they are certified under the Oeko-Tex® Standard 100, ensuring that no harmful chemicals have been used during manufacturing. They are PVC and phthalate free.
• A breathable polyurethane membrane provides waterproofing
• One size is available 50cmx60cms
• Choose from the colour range including red, blue and brown
• The bound edge is shrinkage-free and wrinkle-free
• The base is stay-put terry fabric
• Care instructions are as per ABSO® bed pads

MASS Product Guide 2017 – Chair Pads

MASS Product Guide 2017 – Bed Pads