International Continence Society

Education Course Jakarta, 25.-26. May 2012

Overactive Bladder Management

Collaborative Practice with Nurses in

Incontinence Care

Dora Mair, RN,

Continence and Stoma Advisor
Innsbruck, Austria
 Topics

• To teach how to perform a bladder diary

• To councel life-style interventions
• To teach behavioural treatment /
training programmes
• Select adequate supply of incontinence aids
• To teach intermittent catheterisation
• To perform non-invasive conservative electro-
therapy: neuromodulation and neurostimulation
Bladder diary
Involvement of the Continence Nurse

Information of the patient and the carer

Why is a bladder diary important?

• Nowadays the bladder diary is standard in the

evaluation of bladder function

• The information gained is more precise than verbal

history and urodynamic studies in some regards

• The bladder diary is crucial for management /

strategy planning and outcome control.
 Bladder diary
Involvement of the Continence Nurse

• For how many days?

• How to fill in the forms?

sometimes a written instuction
is helpful
 Bladder diary
Involvement of the Continence Nurse
Evaluation and interpretation of the bladder diary
• 24 hours urinary output
• micturition frequency - day and night
• micturition volumes (mean, maximum, minimum)
• frequency of incontinence episodes
• severeness of urgency
• micturition habits

The results are presented to the doctor with comments

on the patient's cognitive and functional abilities,
collaboration to be expected?
 Topics

• To teach how to perform a bladder diary

• To councel life-style interventions
• To teach behavioural treatment /
training programmes
• Select adequate supply of incontinence aids
• To teach intermittent catheterisation
• To perform non-invasive conservative
electro-therapy: neuromodulation and
neurostimulation
 Lifestyle-Interventions
Involvement of the Continence Nurse

• Diet and fluid management

too much liquid intake, too much coffee, tea (UUI)
Hannestad YS et.al Bjog 2003; 110:247-254

• Weight reduction ( UUI, SUI)

• Cessation of smoking (SUI)
• Relieving constipation (PVR)
• Voiding pattern (bad habits)
 Topics

• To teach how to perform a bladder diary

• To councel life-style interventions
• To teach behavioural treatment /
training programmes
• Select adequate supply of incontinence aids
• To teach intermittent catheterisation
• To perform non-invasive conservative
electro-therapy: neuromodulation and
neurostimulation
Behavioural therapies
Involvement of the Continence Nurse

To teach

- Bladder Re-Training
- Habit Training,
- Toiletting
- Double- Triple voiding
- Pelvic floor Muscle Training

according to the individual needs and abilities

 Bladder retraining
Involvement of the Continence Nurse
How to behave when urgency comes up

maximum
decreases
get stronger
urgency comes fades off

remain seated
squeeze the pelvic floor muscles
wait till the urge decreases/fades off
only then walk to the toilet

prolong intervals step by step

Behavioural therapies
Involvement of the Continence Nurse
How to reduce post voiding residual (PVR) urine ?

Double Voiding

Triple Voiding

Step by step PVR can thus be decreased

 Topics

• To teach how to perform a bladder diary

• To councel life-style interventions
• To teach behavioural treatment /
training programmes
• Select adequate supply of incontinence aids
• To teach intermittent catheterisation
• To perform non-invasive conservative electro-
therapy: neuromodulation and neurostimulation
 Adequate supply with pads
based on the individual needs
Check
• frequency of incontinence episodes
• severity of leakage
• anatomical circumstances
• individual priorities and personal preferences
• social life
• amount of incontinence weighing the pad on
the balance before and after use
• time necessary for appliance supply /
change the pads
• dependence / help from caregivers
Absorbent products
Involvement of the Continence Nurse
Select
• Type
Diapers Slips
Pull-Ups
Pouch, shield and leaf products for men

• Size
• Absorption capacity
• Handling
• Costs
Condom catheters
Involvement of the Continence Nurse
Select
size according to the anatomic situation
material (latex, silicone)
urinary bag

Educate
how to roll on, how to remove
frequency of changing
risk factors
how to prevent skin lesions and knicking tubes
 Topics

• To teach how to perform a bladder diary

• To councel life-style interventions
• To teach behavioural treatment /
training programmes
• Select adequate supply of incontinence aids
• To teach intermittent catheterisation
• To perform non-invasive conservative electro-
therapy: neuromodulation and neurostimulation
Intermittent Catheterisation
Involvment of the Continence Nurse

To counsel and to teach

• Which material is best for the patient ?
• Patient`s choice is important
• With hand handicap occupational therapist may be
necessary

Website: www.eaun.uroweb.org.
 Topics

• To teach how to perform a bladder diary

• To councel life-style interventions
• To teach behavioural treatment /
training programmes
• Select adequate supply for incontinence aids
• To teach intermittent catheterisation
• To perform non-invasive conservative
electrotherapy: neuromodulation and
neurostimulation
Electrical Neuromodulation
Involvement of the Continence Nurse
To perform

Anogenital

and

Transcutaneous
techniques

N.dorsalis penis N.clitoridis

Vodusek et al., 1986; Madersbacher et al., 1998

Craggs et al., 1998; Shah et al., 1998
Management of feacal and urinary incontinence
by specialised nurses

The continence nurse advisor was developed in

England in the early 1970`s and is now well
established in most European countries.

Postgraduate education/ programmes to became a

Continence and Stoma Advisor (Austria)
Continence Advisor (UK)
Urotherapist (Scandinavia, Germany)
 Topics

• To teach how to perform a bladder diary

• To councel life-style interventions
• To teach behavioural treatment /
training programmes
• Select adequate supply for incontinence aids
• To teach intermittent catheterisation
• To perform non-invasive conservative
electrotherapy: neuromodulation and
neurostimulation
• Conclusions
Continence and Stoma Advisor

Continence Stoma Advisor education program was

introduced in Innsbruck/Austria in 1996.

So far 120 nurses from Austria, Switzerland, Italy and

Germany were enrolled and have completed the
postgraduate course: over one year
comprising 580 hours theory, 240 hours practical training
Continence and Stoma Advisor
They work independently on personal responsibility
and on joint responsibility (according to the law of
nursing)

The promotion of continence in a multidisciplinary

responsibility: the nurse can play an important role in
helping patients and carers to understand, to manage
and to improve the patients' quality of life.

The continence nurse specialists' focus are

management, education and ensuring a team
approach which is essential.
 Continence and Stoma Advisor

Conclusions: Based on these results, we recommend adopting the nurse

specialist intervention in primary care, while conducting more research
through careful monitoring of the effectiveness and costs of the intervention
in routine practice.