HOW TO HAVE A ‘GLADDER BLADDER’: IMPROVING BLADDER CONTINENCE Krista Cochrane, PT Pelvic Support Physiotherapy www.pelvicsupport.com 302 - 2039 Robertson Road, Ottawa PREVALENCE OF URINARY INCONTINENCE Urinary Incontinence (U.I.) = ‘The involuntary loss of urine’ Affects 3.3 million Canadians 1 in 4 Women 1 in 9 Men 80% of people with M.S. have bladder problems URINARY PROBLEMS IN M.S.  Problems related to urine storage:  Urgency  Frequency  Nocturia  Incontinence  Problems related to bladder emptying:  Hesitency  Retention  Incomplete emptying SOCIAL CONSEQUENCES  ↓ Self-esteem  Depression & isolation  ↓ Social & physical activities; fear of new places  Worries about intimacy  Fatigue & sleep deprivation  Leading cause of institutionalization in elderly  Skin irritation / breakdown, falls, fractures WHAT YOU CAN DO ABOUT IT …  Likely due to pelvic floor weakness  Strengthening exercises for the pelvic floor muscles (Kegel exercises) beneficial  Do not practice these exercises while voiding  Brace the muscles before coughing, sneezing, lifting TYPES OF URINARY INCONTINENCE Urgency / Urge Incontinence (over-active bladder)  Aggravated by stress & anxiety  May have specific triggers:  Key in door  Running water  Approaching toilet WHAT HAPPENS WHEN THINGS GO WRONG? URGENCY / URGE INCONTINENCE WHAT YOU CAN DO ABOUT IT … URGENCY / URGE INCONTINENCE  Do NOT run to washroom during urge  Sit down  Stay calm  Breathe deeply into the abdomen  Distract … song … poem … count …  Wait 1 minute for urge to subside, then calmly walk to washroom  Gradually start to defer voids TYPES OF URINARY INCONTINENCE Functional Incontinence  Inability to reach & use the toilet:  Poor or painful mobility  Loss of dexterity  Benefit from OT assessment:  Adaptations to clothing (velcro, elastic)  Grab bars in washroom  Commode beside bed TYPES OF URINARY INCONTINENCE Overflow Incontinence (retention)  Bladder is unable to empty well. A large post-void residual urine volume, causes continuous dribbling  Recurrent Urinary Tract Infections common  Symptoms ↑ with constipation  Often managed with Intermittent Self-Catheterization WHAT HAPPENS WHEN THINGS GO WRONG? DETRUSOR –SPHINCTER DYSSYNERGIA PELVIC FLOOR MUSCLES (PFM) Voluntary muscles:  Bladder function  Bowel function  Sexual function PFM may be:  Too Weak  In spasm → too tight SIGNS YOUR PF MUSCLES MAY BE IN SPASM  If you have difficulty emptying your bladder  If you have to really focus on relaxing to be able to void  If it is difficult / painful to insert a urinary catheter  Women who experience painful intercourse or pain with tampon insertion  Constipation, anal fissures, hemorrhoids  Lower abdominal discomfort HOW TO ENCOURAGE YOUR PF MUSCLES TO RELAX  Relax the abdominal muscles  Practice diaphragmatic (abdominal) breathing  Visualize the PF muscles relaxing when voiding  Tighten the pelvic floor muscles, then focus on relaxing them fully  Try not to ‘hold on’ to your bladder  Do not do pelvic floor strengthening ‘Kegel’ exercises  See a pelvic health Physiotherapist CORRECT EVACUATION POSITION www.squattypotty.com LIFESTYLE INTERVENTIONS  You can defer voiding, but do not ‘hold on’ to your bladder  Do NOT restrict fluids, but ↓ caffeine, alcohol & carbonated drinks  Diet & fluid interventions to ↓ constipation  Weight loss  Stop smoking  Toilet position TAKE HOME MESSAGES  Urinary problems are common – you are not alone  Just because you have a neurological condition, there may still be strategies you can use to improve your bladder control  There are no negative side effects or risks to improving your bladder control by improving muscular coordination THANK YOU! Krista Cochrane, P.T. www.pelvicsupport.com Email: [email protected] Questions?