BLADDER TRAINING FOR THE INCONTINENT PATIENT

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Abstract
The articles prior to January 2008 are part of the back file collection and are not available with a current paid subscription. To access the article, you may purchase it or purchase the complete back file collection here Loida A Spiro As a clinical instructor in a long-term facility, I was increasingly disturbed by the widespread acceptance and use of indwelling catheters for extended periods of time. For example, Mrs. L was an 80-year-old resident who had had a Foley catheter for two years. Although she was nonambulatory due to surgical removal of the head of her left femur, she nevertheless participated in almost all self -care; why then could she not be allowed to attempt control over her bladder as well, rather than have it drain passively? Stone1 states that gerontological nursing includes not only prevention of disease and maintenance of health care but also rehabilitation. Whereas, Mrs. L received attention geared to most physical needs, she clearly was not being rehabilitated regarding an important physiological function: the act of voluntary micturition. There are presently 23.4 million persons over the age of 65; by 1985 the U.S. Bureau of the Census projects there will be a steady increase to 27.3 million and by the year 2000, there will be 31.8 million persons in this age group.2 It is evident that our elderly comprise a considerable segment of the population clearly making the rehabilitation of an individual to his greatest usefulness of ever-increasing importance. Urinary incontinence, the involuntary voiding of urine due to lack of voluntary control, is very often a major problem among the older adult population. It has been estimated that incontinence affects 85 percent of hospital populations over the age of 65.3 In one institution, nurses judged that 76 percent of their geriatric patients had some degree of incontinence while 50 percent were always incontinent.4 Incident for incident, urinary incontinence has been calculated to be at least ten times the most common problem.5 It is a problem not only with disagreeable and frustrating implication for the nursing staff entailing expensive and time-consuming linen changes, prolonged and painful treatment of decubitus ulcers, and esthetically unpleasant assignments, but also is one which inheritantly creates a sense of guilt in the elderly patient. To attempt to correct this condition with the use of catheters certainly constitutes insensitive and uninformed management. Achievement of continence by conformance with a bladder retraining program is, therefore, a highly desirable nursing objective for those patients having fair mental awareness and no neurological impairment. Bladder training to achieve return of normal bladder function among incontinent patients unfortunately is too often a neglected aspect of patient care. It is, nevertheless, a responsibility that is clearly within the scope of nursing practice. The initial investment of time in a bladder training program is greatly offset by a more fully rehabilitated patient, a lessened work load for staff and the decreased cost of bedlinens. On one hand it is a challenge requiring patience, perseverance, and caring, but on the other hand, it is an inestimably gratifying experience as a result of knowing one has assisted in the restoration of an essential function. An additional dividend is the patients heightened sense of dignity with achievement of continence. The underlying cause of urinary incontinence must be understood in order to determine a patients suitability for functional rehabilitation of the bladder. There are numerous conditions which predispose to incontinence. For example, habitual dribbling of urine may indicate sphincter damage or urinary retention leading to overflow. It is important to differentiate those conditions from the short-lived dribbling occurring after the removal of a catheter which may also improve with perineal exercises. Impairment of external sphincter control may lead to stress incontinence, a type of urinary incontinence that occurs predominantly in females during activities such as laughing, coughing, walking, or lifting as a result of… 10.3928/0098-9134-19780501-08