GI/GU: Bladder and bowel training

Most clients are able to hold their urine and feces until they make it to the bathroom or until a receptacle like a bedpan or a urinal is provided. However, some clients have urinary or fecal incontinence, meaning they have involuntary loss of urine or feces. This is particularly uncomfortable for the client because their clothes and bedsheets get soiled and smell foul. It’s important that you know how to assist them.

Let’s start with urinary incontinence. There are several types of urinary incontinence. Urge incontinence is when someone has a sudden urge to urinate followed immediately by involuntary urination. This usually results in frequent urination, especially at night. Urge incontinence can occur after a bladder infection, which can cause the muscle of the bladder to spasm leading to unintentional urination.

Stress incontinence is when urine leaks out when pressure inside the abdomen increases. Often, the problem is a weakened sphincter muscle. When the intra abdominal pressure increases, like when you sneeze, cough, laugh, or bear down, the pressure inside the bladder also increases and urine leaks out through the weakened sphincter.

Overflow incontinence is when the bladder can’t empty normally, so the urine builds up until it overflows or leaks out. This can be due to a blockage of the urethra caused by a tumor or an enlarged prostate. Weakened muscles in the bladder wall can also cause this type of incontinence since they can’t push all the urine out when voiding. This type of incontinence results in a weak or intermittent urinary stream or hesitancy, where it takes awhile for the urine to begin to flow.

Reflex incontinence happens when damage to the nervous system disrupts normal bladder functions. Various conditions, like spinal cord injuries, Parkinson disease, and multiple sclerosis, as well as procedures, such as prostatectomy or hysterectomy, can damage parts of the nervous system involved with the urination reflex. As a result, the bladder can contract on its own without warning, and the urine leaks out without the client feeling the urge to urinate.

Urinary incontinence can be either temporary or permanent. If the cause can be treated, like a bladder infection, the incontinence will resolve as you treat the cause. However, if the cause is an untreatable disorder, such as dementia, then urinary incontinence is more likely to be permanent.

You’ll need to know the different products that are available when helping a client control urinary incontinence. These include incontinence pads, briefs, bed protectors, as well as catheters. These help keep the client dry and sanitary.

At night, make sure they have a bed protector. Remember, pads, briefs and bed protectors have to be changed regularly. Provide them with a washcloth or pre-moistened wipes if they are able to clean themselves; otherwise, you might be asked to assist in perineal care. Either way, make sure they’re comfortable and dry in order to avoid the development of skin problems, such as rashes.

Now, to control urinary incontinence in biological males, condom catheters can be used. They consist of a soft plastic sheath that’s placed over the penis like a condom. Urine flows from the urethra to a tubing and then into a collection bag that’s attached to the client’s leg. Check to see that the condom fits the penis tight enough to prevent leaks but not so tight that it obstructs blood circulation.

The catheter might have a special material on the inside to secure it to the penis. If it doesn’t, you can use a strip of elastic tape. Make sure to apply the tape in a spiral pattern since a circular pattern is more likely to cut off circulation during an erection. Also, remember that a condom catheter requires daily change and cleaning of the penis and the perineal area.

Now, for some clients, bladder training can also help them control urinary elimination. During the training, they’ll re-learn how to hold their urine. One component is to encourage them to urinate at scheduled times. The training plan depends on the client’s current voiding habits.

For example, if they have the urge to go every 30 minutes, the training will gradually increase the time between voiding by 5-10 minutes over a period of days. Their fluid intake should also be on a schedule, like two glasses with each meal and no fluids 2 hours before sleep.

Kegel exercises are also taught to help prevent leaks. First, the client experiments to identify the muscles they use to stop the urine flow. Once they know which muscles to contract, they’ll train daily to isolate and strengthen them by repeatedly flexing these muscles in sets of 10-15 three times a day.

This technique can also be combined with urge suppression, where they distract themselves with positive thoughts until the urge passes. Doing kegel exercises during this time can help prevent potential leaks.