Question
Why should OT address incontinence?
Answer
Incontinence negatively impacts occupations. When urinary and bowel leakage are in the mix, it can definitely reduce people's goal achievement, and their quality of life. 45% of clients receiving home health care reported having difficulty with bladder and bowel control. We are seeing this a lot in home care, skilled nursing facilities, and hospitals. OT evaluations address multiple areas of occupational performance directly related to incontinence including:
- Context
- Cognition
- Safety
- Transfers
- Musculoskeletal deficits
- BADL and IADL routines
- Activity tolerance
- Mood
- Positioning
- Pain
- Fine motor control
- Hygiene
- Balance
- Equipment needs
We want to address whether they can safely get to and from their toilet. We want to also look at cognition to see if they can sequence through a toileting routine safely and well. We look at transfers, ADL routines, activity tolerance, mood, positioning, and pain. These are all the things that we should be addressing in a standard OT evaluation. With pain, you can take it one step further and ask if they ever have pain during a bowel movement or when they cannot go to the bathroom. Do they have pain with urination? If somebody has Parkinson's or an issue with their hands, can they get their buttons and zippers undone, pull their pants up and down, and can they open the package that the incontinence products come in? We also want to look at hygiene. How are they bathing and are they doing a good job in the shower? Can they get cleaned up well when they are on the toilet? If you add incontinence on top of that, things can become even more challenging.
Furthermore, occupational therapy practitioners have different roles in different settings. The type of setting you are in may dictate that you address incontinence issues slightly differently.
Hospital
It depends on what type of hospital setting, but you may not feel like you have the time to address incontinence in this setting. However, if you are in a rehab type hospital setting, you might be able to talk about incontinence. It might be as easy as grabbing your client's hand and letting them know, that with the onset of an illness or with surgery, that they can have an increase in bowel and bladder dysfunction. You can go over this with them, and it may reduce their anxiety. You can begin to educate them on their options as they go through rehab, even if you are only going to be seeing them for a short period of time. We may be the only one disseminating this type of information. Occupational therapists are already addressing ADL's so it is a natural transition into addressing bowel and bladder health in a practical, non-threatening way.
Skilled Nursing Facility
There are lots of opportunities for OTs to address incontinence in a skilled nursing facility. We spend a lot of time talking with clients and building relationships. We end up getting a lot of personal information from them that they may not be sharing with other medical professionals or their families. We can integrate incontinence issues into our goals. We can take some leadership opportunities here to start talking about incontinence with nursing, dietary, and the activities department. Of course, there has to be a team approach where people are open-minded to discuss incontinence with you. I have had several presentations with these disciplines that have been very helpful and has enhanced the programming at different skilled nursing facilities.
Home Care
I work primarily in a mobile outpatient, but I do also work in home care as we contract with different home care agencies to supplement their staffing. Home care agencies will bring me in sometimes to talk about incontinence with clients. They want their clients to have an increased quality of life and have increased independence when they have completed home care. If they do not address the incontinence issues, they may not get better. When you are working with people in their homes, it is so much easier to establish trust. It gives us a unique stance. For example, when we are observing their environment, we may notice pads on the back of the toilet or soiled clothes in the corner of their bedroom. It gives us an opportunity to see what is really going on behind the scenes.
Outpatient
In outpatient, it can be a little bit different. Typically, you address more specific things, and the client may be more advanced in their training. However, this does not mean that you cannot start integrating an incontinence program in an outpatient setting as this is where those, with incontinence that is more advanced, are referred. Pelvic pain and prolapse are treated by a specialist, but an OT would look at things more holistically by tying clients' abilities to engage in their ADLs. We can really enhance our treatment plans around incontinence using that framework.
