You donâ€™t have to suffer:
End the Silent Suffering of Bladder Leakage
Contents: What is Urinary Incontinence? ......................................................................... 1 Why Do You Need to be Aware? ................................................................... 2 What Can You Do?............................................................................................... 3 Healthy Bladder Habits ...................................................................................... 5 Why Choose Brooks Rehabilitation? ........................................................... .9
What is Urinary Incontinence?
Urinary Incontinence is the unwanted leakage of urine. Any involuntary urine leakage is abnormal. Urine leakage is NOT a normal part of aging. People with urinary incontinence typically also have weak pelvic floor muscles. Physical therapy is proven to improve pelvic floor muscle strength and reduce symptoms of urine leakage. Who is affected? Fifty percent of women over the age of 65, 30% of women younger than 65, and 22% of men of all ages.
Types of Urinary Incontinence • • • • • •
Urge Incontinence: a person has a strong urge to urinate, caused by an over active bladder, and leakage occurs before reaching the toilet Nocturia: waking at night to urinate because of urge to urinate Stress Incontinence: a person loses small amounts of urine during physical movements such as coughing, sneezing, exercising, or changing positions Mixed Incontinence: a person has combined symptoms of both stress and urge incontinence Enuresis: a person leaks urine but did not know it when it happened Overflow Incontinence: a person loses a small amount of urine when the bladder is full but does not experience an urge to urinate
Why Do You Need to be Aware? •
What are the effects of incontinence? Urinary incontinence leads to: - increased risk of falls - skin breakdown and wounds - low back pain - depression and social isolation - increased risk of admission to nursing home
Pelvic floor muscle disorders, such as urinary incontinence, are widespread and costly. In the U.S. the annual costs for overactive bladder in 2005 were more than nine billion dollars (Hu 2005). Thirty seven percent of women 24-85 years old have one or more disorder of the pelvic floor (Lawrence 2008). About 20% of men are affected by urinary incontinence related to enlarged prostate, treatments for the prostate, diabetes, and Parkinson’s and other diseases. Fifty two percent of homebound elderly suffer from urinary incontinence (Landi 2003 ). Women with existing urinary incontinence have more than double the risk of admission into nursing homes, independent of age or the presence of any co-morbid condition (Thom 1997). Older women with mixed incontinence are more than 3 times more likely to fall than those without urinary incontinence (Takazawa 2005). Women who have incontinence are 2.5 times more likely to have back pain compared to women without incontinence (Smith 2006).
spine pelvis pelvic floor muscles hip pubic bone ÂŠ Primal Pictures 2009
What Can You Do?
Practice Pelvic Floor Muscle Exercises: Pelvic floor muscles form the floor of your torso. They attach from the pubic bone in the front, to the side walls of the pelvic bones, and to the tailbone in the back. The pelvic floor supports the bladder and rectum, and the uterus in women. The muscles surround the urethra, where urine comes out, and the anus, where gas and bowel movements are expelled. Identify Your Pelvic Floor Muscles: Probably the easiest way to identify your pelvic floor muscles is to squeeze or contract the muscles you use to stop the flow of urine. Donâ€™t try this when your bladder is very full (for instance, first thing in the morning). Stopping urine flow too frequently may lead to other problems, such as difficulty emptying the bladder properly. Another way to identify the correct muscle contraction is to squeeze around your anus as if you are trying to avoid passing gas. Women can insert a finger into the vagina and attempt to squeeze it to feel the right muscle action.
Exercises to Strengthen Your Pelvic Floor Muscles: Once you know how to identify the pelvic floor muscles, you should practice contracting and relaxing the muscles in order to strengthen them. You should tighten in the front and the back (around the anus) all together to make the entire muscle group contract; Try NOT to contract the abdominal and buttock muscles too much when contracting the pelvic floor muscles. When contracting the pelvic floor muscles, you should feel them move UPWARDS AND IN. When you stop contracting, or when you relax the muscles, you should feel them move DOWNWARDS AND OUT. You should be able to contract and relax the muscles in different positions, such as sitting, standing, and lying down. Specific Exercises: Do a set of long holds and a set of quick flicks at different times each day and in different positions. Long holds: You should be able to contract the pelvic floor muscles and hold the contraction for several seconds. Start by holding for 5 seconds, repeat 10 - 15 times; try not to hold your breath. Once you can easily hold for 5 seconds, try holding for 7 seconds, 10 - 15 times, then try holding each contraction for 10 seconds, 10 - 15 times. If it is hard to hold for 10 seconds, try “pumping” the contraction as you are holding it; squeeze a few extra times during the 10 seconds without letting go. GOAL: 2 - 3 sets of 10 - 15 repetitions of 10 second holds, 1 - 3 times per day. Perform at least 30 repetitions of strong 10 second contractions each day. Quick flicks: Squeeze and lift the pelvic floor muscles quickly and strongly (try to minimize abdominal and buttock contraction). Hold this squeeze for 2 seconds. Then let go. Be sure to fully let go and relax the muscle each time. Repeat 10 15 times each set. GOAL: 2 - 3 sets of 10 – 15 repetitions of 2 second holds, 1 - 3 times per day. In addition to these specific exercises, talk to your physical therapist about additional pelvic floor and core strengthening exercises that may be right for you.
To make an appointment or for a location near you call us at 1-888-323-8005 or visit our website at BrooksRehab.org/UI
Practice Healthy Bladder Habits What are Good Bladder Habits? • •
Try to allow your bladder to store urine for 2-4 hours at a time during the day. Take your time when emptying your bladder. Don’t strain or push to empty your bladder. Make sure you empty your bladder completely each time you pass urine. Do not rush the process. Consistently ignoring the urge to go (waiting more than 4 hours between toileting) or urinating too infrequently may be convenient but not healthy for your bladder. Avoid going to the toilet “just in case” or more often than every 2 hours. It is usually not necessary to go when you feel the first urge. Try to go only when your bladder is full. Urgency and frequency of urination can be improved by retraining the bladder and spacing your fluid intake throughout the day. Practice good toilet habits. Don’t let your bladder control your life!
What is Considered Normal? • •
The average bladder can hold about 2 cups of urine before it needs to be emptied. The normal range of voiding urine is 6 to 8 times during a 24 hour period. As we get older, our bladder capacity can get smaller and we may need to pass urine more frequently but usually not more than every 2 hours. Urine should flow easily without discomfort in a good, steady stream until the bladder is empty. No pushing or straining is necessary to empty the bladder. An urge is a signal that you feel as the bladder stretches to fill with urine. Urges can be felt even if the bladder is not full. Urges are not commands to go to the toilet, merely a signal and can be controlled.
Tips to Maintain Good Bladder Habits •
Maintain a good fluid intake. Depending on your body size and environment, drink 4-8 cups (8 oz each) of fluid per day unless otherwise advised by your doctor. If you are not drinking enough fluid, it creates a foul odor and dark color of the urine. Limit the amount of caffeine (coffee, cola, chocolate, or tea) and citrus fruits that you consume; these foods can be associated with increased sensation of urinary urgency and frequency. Limit the amount of alcohol you drink. Alcohol increases urine production and also makes it difficult for the brain to coordinate bladder control. Avoid constipation by maintaining a balanced consumption of dietary fiber.
Meet With a Brooks Physical Therapist, Especially if You Are Having Urine Leakage. •
Pelvic Floor Rehabilitation is the conservative and comprehensive treatment for common pelvic floor disorders including urinary incontinence (UI), anal incontinence, and pelvic pain. Pelvic Floor Rehabilitation is very strongly supported in the literature as the first line of intervention for stress, urge, and mixed urinary incontinence by researchers. (Goode 2010) Pelvic Floor Rehabilitation is provided by physical therapists (PT) and occupational therapists (OT) who have completed postgraduate training in this specialized area of patient care.
Components of Pelvic Floor Rehabilitation: •
Private Examination: The evaluation for urinary incontinence includes a comprehensive history and physical examination. Examination of the pelvic girdle and pelvic floor muscles MAY include a direct vaginal and/or rectal examination of the pelvic floor muscles in a private setting. Plan of Care: The PT or OT develops a plan of care and treatment goals including a timeline for achievement of goals. The patient is a partner in establishing goals and timelines. The plan of care is sent to the referring physician for review and signature. Pelvic Floor Muscle Training: The patient is trained to perform specific progressive exercises of pelvic floor muscles focusing on correct contraction, motor control, timing, coordination, isolation, endurance, and strength. Behavioral Interventions: The therapist provides analysis and advice regarding the patient’s fluid and food intake related to voiding patterns and habits.
Biofeedback provided by a physical therapist.
Biofeedback: Surface EMG biofeedback to the pelvic floor muscles and abdominal muscles allows the patient to improve awareness and control of the muscles in order to perform exercises correctly and effectively. Electrical Stimulation: Options include internal or external neuromuscular electrical stimulation (NMES) which calms the bladder and helps weak muscles learn to contract. Functional Training: Incorporation of active pelvic floor muscle contraction into daily activities to improve success of long term pelvic floor muscle training. 8
Why Choose Brooks Rehabilitation? Brooks is Committed to Your Health •
Brooks Rehabilitation offers the most current, innovative, and effective approaches to rehabilitation health care specifically for your needs.
Highly Trained Specialists •
Brooks physical and occupational therapists have completed specialized postgraduate training. They work with your physician to develop an individualized plan of care. Brooks therapists use the latest research and state of the art technology to make sure that you receive the best treatments available.
We Offer a Continuum of Rehabilitation Care • •
Brooks Rehabilitation offers incontinence treatment in more than 25 outpatient clinic locations through out central and north Florida to meet your needs. Brooks Home Care Advantage provides home health services including incontinence treatment for those that are homebound and find it too taxing an effort to travel to an outside appointment. Brooks Rehabilitation Hospital offers urinary incontinence treatment. All patients are screened for urinary incontinence and offered individualized treatment when possible.
Our Program • • • • • 9
Provides private individualized treatment with emphasis on respect and dignity Offers patient consultations by clinical experts Uses state of the art technology and therapy techniques Accepts most insurance plans Focuses on YOU and your goals
About Brooks Rehabilitation Brooks Rehabilitation has been serving Northeast and Central Florida for over 35 years. As a non-profit organization, Brooks Rehabilitation, based in Jacksonville, FL, operates one of the nationâ€™s largest inpatient rehabilitation hospitals in the US with 157 beds, one of the regionâ€™s largest home healthcare agencies, 25 outpatient rehabilitation clinics, a skilled nursing unit dedicated to orthopaedic rehabilitation, a rehabilitation medicine physician practice and an award winning skilled nursing facility. In addition, Brooks Rehabilitation operates the Brooks Rehabilitation Clinical Research Center which specializes in research for stroke, brain injury, spinal cord injury and more to advance the science of rehabilitation. Brooks Rehabilitation also provides many low or no cost community programs and services such as the Brooks Clubhouse and our Adaptive Sports and Recreation Program to improve the quality of life for people living with physical disabilities. 10
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