By Paula Rizzo, MS, OTR/L
Occupational Therapist, New Jersey Shore North 3

Urinary incontinence is a condition that many older adults face, but often do not discuss with their primary care physician because they assume that it is a normal part of aging. In addition, fears of embarrassment surrounding this topic of conversation prevent people from bringing up these issues to their physicians. As a result, many of these urinary issues go unaddressed. 

Although there are many medications available to help assist with incontinence, these medications do not always alleviate a patient’s problem. When medications do not resolve a patient’s issues with incontinence, physicians should make a referral to an OT and let their patients know that OTs are well-equipped to assist older adults with incontinence.

Here are just some of the ways occupational therapists can assist older adult patients with incontinence. 

1. Bladder Retraining

Toileting is one of the many activities of daily living (ADLs) that OTs address. Within their evaluation, OTs gain a clinical picture of a patient’s toileting habits and urinary frequency. In doing so, they identify any particular issues with incontinence on the very first treatment so they can incorporate this into their treatment plan. 

OTs can assist patients with incontinence by helping them to increase the amount of time between their trips to the bathroom through the process of bladder retraining. By setting up a toileting schedule, OTs can help patients come up with specific times for the patient to utilize the bathroom so they can gradually increase the amount of time they can hold their urine. 

The total process may take a few weeks. Initially, an individual might start by holding their urine for twenty minutes and then gradually try to hold their bladder for increased durations of time during the day. In addition, OTs can educate their patients on how to keep a bladder journal so they can learn to track the frequency that they are urinating, the time between voiding, and whether they were wet before they made it to the toilet. 

With consistent bladder retraining and by regularly recording their urine output, patients have a way to track their progress as they gradually build up to their desired length of time. OTs work with the patient to find times and strategies within the patient’s daily schedule so that they can be successful with this treatment plan.

2. Addressing the Pelvic Floor Musculature

Weak or overactive pelvic floor muscles can often exacerbate a patient’s incontinence. OTs can educate patients on how to perform pelvic floor exercises or stretches in various positions, such as lying down, seated, and standing. With the incorporation of a home exercise plan, patients can maximize both the strength and isolation of their pelvic floor muscles, improve their urinary symptoms, and reduce episodes of leakage. 

Patients’ positioning when toileting can also be addressed so that patients are making sure that they are engaging their pelvic floor when voiding. Diaphragmatic breathing when urinating can also be incorporated into an individual’s treatment to avoid straining or compensating by utilizing abdominal muscles and instead training an individual to naturally contract their bladder muscles. These strategies can help to improve a patient’s technique going forward and minimize symptoms.

3. Diet Modifications

Through an open dialogue with patients surrounding their bladder habits, OTs often identify that patients may be drinking or eating trigger foods and drinks that contribute to their incontinence. 

Patients are sometimes unaware that what they are eating and drinking can actually make their urinary symptoms worse. OTs can provide education on diet and how it relates to bladder functioning. In doing so, patients can learn to cut back on acidic foods such as citrus fruits and tomato products, or switch to decaffeinated coffee or tea. By making these simple diet changes, patients may be delighted to see immediate improvements in their bladder control and a reduction in the number of accidents they experience.  

4. Environmental Modifications

OTs are well qualified to assist patients with modifying their environment to help reduce episodes of incontinence. OTs can assist patients with setting up their bathroom environment with proper hygiene products, pads, diapers, etc. so that everything a patient needs is readily available to them in their bathroom in the event of an accident. 

OTs will teach patients to pack all necessary toileting products in their walker or purse so that they have what they need with them during the day and they can continue to participate in their desired activities regardless of their incontinence. By keeping these products handy during the day for quick bathroom trips to change their pad or diaper, patients can avoid the need to change all of their clothing after an accident. 

Many patients who struggle with incontinence tend to stay close to a bathroom, or in some cases in their own home at all times due to fearfulness of wetting themself in public. By incorporating these strategies into their routine, they can decrease their risk of social isolation. In addition, OTs can recommend clothing that is less restrictive with simple fasteners or elastic to allow for improved clothing management and decreased pressure on the lower abdomen which can sometimes exacerbate symptoms.

Refer Your Patients to FOX Rehabilitation

A referral to occupational therapy can help educate patients who deal with incontinence on strategies to not only improve their urinary symptoms but also minimize the negative effects of urinary incontinence such as social isolation or embarrassment. 

OTs are experts in the area of toileting and activity analysis and they can provide patients with compensatory strategies and/or exercises and stretches that can help allow patients to regain control over their pelvic floor muscles to improve their symptoms. OTs can provide patient education and lifestyle modification recommendations for diet, clothing, or scheduled bathroom trips so that urinary incontinence can be greatly reduced or corrected.

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