Are You Addressing Incontinence at Home? An OT’s Guide

More than 13 million people in the United States – male and female, young and old – experience incontinence. Approximately 45% of patients receiving home health services experience incontinence. Occupational therapists may find that incontinence limits their patients from reaching their maximum potential and treatment goals. Bowel and bladder incontinence can negatively impact patients’ abilities to complete their occupations. OT’s can enhance patients’ outcomes by improving their clinical skills and comfort level to address bowel and urinary incontinence and pelvic muscle dysfunction.

Preventing Additional Issues

Incontinence not only negatively affects occupations but may contribute to additional issues that impact participation in ADL’s. OT’s are in an excellent position within the care team to identify these problem areas. Unaddressed incontinence can lead to the following additional problems:

• Depression
• Social Withdrawal
• Anxiety
• Fatigue
• Increased fall risk
• Restricted sexual activity
• Increased expenses for supplies
• Higher risk of infection
• Skin irritation

It’s vital to incorporate incontinence into an evaluation to prevent these issues from interfering with a patient’s ADL’s.

How to Incorporate an Incontinence Evaluation

OT’s may struggle with figuring out how to integrate incontinence into evaluations. However, incontinence can be addressed by simply asking additional questions while evaluating another area. For example, some of these areas are listed below and are coupled with a suggestion on how to integrate it into your evaluations:

• Cognition – Is the patient able to cognitively process through toileting tasks?
• Safety – When assessing the bathroom, is the patient safe in mobility and transfers?
• Musculoskeletal deficits – How do the patient’s ROM and strength impact their incontinence management?
• BADL and IADL routines – How often does the patient use the bathroom? Do they go too often or not enough?
• Mood – Is the patient experiencing anxiety or fear over having an accident?
• Positioning – How is the patient’s positioning on the toilet? Could it be changed to improve voiding?
• Pain – Does the patient experience pain with urination or defecation?
• Fine motor control – Can the patient manage their clothing with zippers and buttons?
• Equipment needs – Is equipment appropriate for toileting safely or do they need additional supplies?

These are just a few examples of the many ways you can begin to address incontinence through examination of other issues.

How to Bring Up Incontinence with Your Patient

The more comfortable a therapist is in addressing pelvic floor issues, the easier it is for the patient to open up and feel confident in sharing about these personal issues. Starting the conversation is key to successful integration into the OT treatment plan. Here are some examples on how to ask patients about their incontinence while also reducing feelings of embarrassment and awkwardness:

• “Do you ever have a hard time making it to the bathroom on time?”
• “When you laugh, cough or stand up do you ever experience leakage?”
• “When you need to use the bathroom do you ever experience a very strong urge that makes you feel like you need to rush?”

If a patient answers yes to any of these questions, it gives the OT insight that incontinence should likely be addressed in the treatment plan. Further assessment can then be added at the evaluation or in the following treatment sessions.

For a more in-depth look at addressing these issues, take the MedBridge course, Addressing Incontinence in Home Health OT – professionals will not only learn how to integrate bowel and bladder issues into evaluations but also learn practical tips for treatment in the home health setting. OT’s can advance their clinical outcomes and truly help clients improve their quality of life through these interventions.