toileting programs as treatments for urinary incontinence

by Diane K. Newman, RNC, MSN, CRNP, FAAN

People with urinary incontinence can improve their symptoms or cure by entering a behavioral training program.

Behavioral training includes toileting programs, bladder retraining, and pelvic muscle (Kegel) exercises with or without biofeedback. There is a lot of research that shows that behavioral training can improve urinary incontinence in 80% of cases. But the person must follow instructions. All types of behavioral training are active interventions that require understanding, cooperation, compliance and participation.

Routine/scheduled Toileting and Habit Training

Routine/scheduled toileting and toilet habit training establish a routine voiding schedule, usually every 2 to 4 hours, whether or not a sensation-to-void is present. The goal of habit training is not to change bladder function but for you to stay dry.

Toilet Habit Training

Habit training is when the toileting schedule is matched to a person's voiding habits. The habits are based on bladder records or by electronic device monitoring. In nursing homes, the nursing staff will attempt to toilet residents on a consistent basis, especially people who cannot toilet themselves. Pre-established toileting times, e.g. every 2 or 4 hours or related to events, are used and persons are encouraged to toilet independently. This type of toileting program is helpful in persons for whom a natural voiding pattern can be determined and in homebound persons living with a care giver, usually a family member.

A study looked at voiding patterns of 51 nursing home residents using an electronic monitoring device. Nursing home staff were taught to toilet these residents during the periods of highest probability of urinary incontinence based on individual voiding patterns. Results showed that the frequency of urinary incontinence was significantly decreased during the three month intervention among 86% of the subjects, with one-third of this group showing 25% or greater improvement. This research shows that scheduled toileting works.

Prompted voiding

Prompted voiding is another toileting program and is a supplement to habit training. Prompted voiding attempts to teach persons to assess their urinary incontinence status and to request toileting from care givers. Prompted voiding has been successful with persons who have functional and mental impairments. Prompted voiding has three steps:

• Person is asked by care givers on a regular basis (usually every 2 hours) if urinary incontinence has occurred.
• The care giver prompts or asks the person to use the toilet.
• Praise is given if the person is continent (dry) and for attempting to toilet.

Several research studies have looked at prompted voiding in nursing homes. Average reduction of 1.0 to 2.2 urinary incontinence episodes per client per day has been reported. Residents with lower voiding frequencies (less than 4 in a 12-hour period) and residents who appropriately toilet over 75% of the time during a brief 2 to 6 day prompted voiding trial are most likely to show long-term benefits with prompted voiding.

Behavioral training as a treatment for urinary incontinence is often successful in reducing or eliminating symptoms of urinary incontinence.

References

Newman, DK. Managing and Treating Urinary Incontinence. Health Professions Pr. 2002.

Posted December 2003
Last updated July 2209

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