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home pelvic health incontinence treatments toileting programs

toileting programs to treat incontinence

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

Persons with UI can improve or be cured 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 it can improve incontinence in 80% of cases. But the person must follow instructions. Behavioral interventions are active interventions which require understanding, cooperation, compliance and participation.

Routine/scheduled Toileting and Habit Training

Routine/scheduled Toileting and 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.

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 UI 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 discriminate their incontinence status and to request toileting from care givers. Prompted voiding has 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 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.

There have been several research studies which have looked at prompted voiding in nursing homes. Average reduction of 1.0 to 2.2 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.

Last Updated: December 2003

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