A large part of good nursing is educating your patients. Our job is to make our patients as independent as possible. So when you have patients with urinary incontinence, instructing them on bladder training that they can perform themselves, is a skill you will need.
Patients who have had an indwelling urinary catheter for any length of time can lose control over their bladder. With the foley constantly draining urine into the down drain bag, the bladder shrinks and like a brand new balloon, is difficult to get it to stretch to hold a reasonable amount of urine.
I have found that timed voiding works well for these patients. It requires the patient to go to the bathroom at specific intervals (every hour, for example) whether or not they feel the urge to go. That way they can prevent accidents by emptying their bladder before it becomes an urgent problem.
After a few days the bladder stretches to accommodate the urine produced in one hour and the patient can then progress to voiding every two hours. Once the patient’s bladder can handle that amount of urine comfortably, the patient can increase it to every 3 hours and eventually progress to the normal of every 4 hours for micturation.
Another reason for incontinence can be a UTI (Urinary Tract Infection). If your patient went from being continent to suddenly having a problem, you should probably contact their physician to ask for an order for a urinalysis. Training will NOT help this. The infection needs to be treated before determining if training is even needed.
While in younger patients, UTIs have symptoms of burning or general discomfort in voiding, older patients have no symptoms other than incontinence or mental changes.
Working in a facility as opposed to home care, allows you as the nurse to visit the patient periodically through the day to remind them and coach them through timed voiding. Never underestimate the lack of energy older patients have to initiate getting up out of the recliner to go to the bathroom on a regular basis.
Related to training is the need to encourage fluids unless contraindicated by other disease processes. There are many older folks who will admit to not drinking fluids, either because they don’t like water or they know it will create more urine and force them to get up from the chair to the commode.
Regular fluids will create sufficient urine to regularly fill and therefore stretch the bladder.
The overactive bladder is a general symptom that can have many causes. It means there are frequent muscle spasms that cause the urge to void frequently.
Gently re-educating those muscles and nerves are possible, as shown in the video above..
This system of strengthening the pelvic floor muscles to reduce or eliminate urinary incontinence is also part of bladder training. If you have the opportunity to follow up with your patient to remind, instruct and watch them perform the exercises throughout the day, that will increase the chances for success. More specific information on this portion of bladder training can be found on this page.