BLADDER & PELVIC HEALTH
Columbus Community Hospital
100 Miles in 100 Days
Introduction

W.O.C. Health Center
 Dr.
Ronald Ernst, Medical Director
 Suite 210, Visiting Physicians Clinic

Wound, Ostomy, Continence Certified Nurses
 Jennifer
Fjell BSN, RN, CWOCN
 Danelle Kratochvil BSN, RN, CWOCN
How Your Bladder Works- Anatomy

The Bladder
A hollow muscular organ shaped like a small balloon that
sits in your lower abdomen (pelvis)
 Held in place by ligaments attached to other organs and the
pelvic bone


The Kidney
Bean shaped organ near the middle back, below ribs
 Remove urine from the blood stream


Ureters

Two tiny tubes that carry urine from the kidney to the
bladder
How Your Bladder Works
How Your Bladder Works


Urine travels from the kidneys down the ureters
to the bladder
Bladder will hold the urine until going to the
bathroom
A
healthy bladder can hold up to 2 cups of urine
for 2-5 hours
 Nerves in the bladder tell your brain when it is
time to urinate

Urethra is a single thin tube that passes urine
from your bladder to the toilet.
When Things Go Wrong
Overactive Bladder (OAB)
Stress Incontinence
Mixed Incontinence
Bladder Outlet Obstruction
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Causes of Incontinence
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Aging
UTI
Declined Estrogen levels
Childbirth/Pregnancy
Medications
Diseases of Nervous System
Benign Prostatic Hyperplasia
Cancer
Surgery
Radiation
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Obesity
Certain Occupations
Dietary irritants
Dehydration
Depression
Excess Urine Production
Restricted mobility
Stool impaction
Vaginitis or Urethritis
Overactive Bladder
Urgency and Frequency Common
 Bladder “working overtime”


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Void 8+ times per day
Up more than 2+ at night
Causes
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Abnormal sensitivity to bladder filling

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Uncontrollable contractions of the bladder (detrusor) muscles due to
stimuli

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Feels uncomfortable or painful
Cold, running water, low urine volumes
Urge to void cause a bladder contraction without the person wanting to
Difficult to stop/control urine
Stress/Mixed Incontinence
Stress Incontinence
 Urine leakage during physical activity or sudden exertion
 Involuntary loss of urine during increased abdominal
pressure


Laugh, cough, sneeze, lifting, exercising
Causes


Weak muscles and lack of support for bladder
Bladder sphincter is too weak to hold urine
Mixed Incontinence
 Combination of OAB and Stress Incontience
Bladder Outlet Obstruction

Blockage at the base of the bladder
 BPH-Benign Prostatic Hyperplasia
 “Anti-Incontinence” Surgery
 Prolapse
 Strictures
of the Urethra
 Foreign Object
 Stool Impaction
Pelvic Organ Prolapse


According to the Mayo Clinic, POP happens when the
muscles and ligaments supporting a woman's pelvic
organs weaken and the pelvic organs can slip out of
place and create a bulge in the vagina (prolapse).
Pelvic Organs
Bladder
 Intestines
 Vagina
 Cervix
 Uterus
 Urethra
 Rectum

Pelvic Organ Prolapse
Pelvic Organ Prolapse Risk Factors
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Genetics
Race
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Lifestyle
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Smoking
Pelvic Floor Injury
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Caucasian women are more likely than African American women to develop pelvic organ prolapse.
Vaginal delivery
Surgery,
Pelvic radiation
Fractures to the back and pelvis caused by falls or motor vehicle accidents.
Hysterectomy or surgery of pelvic floor muscles
Other Health Condiditons
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Chronic constipation
Chronic coughing
Obesity
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obese women have a 40 to 75% increased risk of pelvic organ prolapse.
Menopause
Nerve and muscle diseases that decrease pelvic floor strength
Heavy lifting
Taking Control-Who Can Help
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Primary Care Physician
PA/NP
Urologist
OB/GYN
Urogynecologist
How Diagnosed?
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Health History
 Past
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Medical, Surgical, Family, Psycho-Social
Review Dietary/Fluid History
Exam
Urinalysis
Blood Test
Ultrasound
Urodynamic Testing
Before my appointment…..
What Can I do??
Retrain Your Bladder
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Life Style and Behavior Changes
May take 6 weeks or more.
Bladder Diary
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Urination Schedule
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Monitor fluids
Gradually increase to holding urine for 3 to 4 hours
Suppress the Urge
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Relax
Concentrate
Quick Contractions
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Pelvic Floor Exercises
Distraction
Pelvic Floor Exercises
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Appropriate for Stress, Urge, and Mixed Incontinence
Locate the pelvic floor muscles
Squeeze this muscle for 3 seconds
 Do
not tighten Abdominal Muscles at the same time
 Upper legs should not move
 Body should not rise up or down
 Do not hold your breathe
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Repeat these exercises several times daily
Additional Options for Strengthening Pelvic Floor
Muscles & Bladder Management
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Biofeedback
Vaginal weight cones
Knack
Electrical stimulation
Medication
Surgery
Physical Therapy for pelvic muscles
Vaginal Devices (Pessary)
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Non-Surgical Treatment
Fit by clinician
Absorbent products
Portable toilets
External catheters- Males
Bladder Health Tips
Lifestyle Modifications
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Maintain proper body weight
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Obesity leads to bladder problems
Stay Hydrated!
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6-8 cups of fluid a day
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Avoid alcohol and beverages with caffeine
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Fruits, Vegetables, high-fiber carbohydrates, low-fat, low-salt and lean meat meals
Avoid foods with artificial sweeteners
Do not Strain to empty bladder or bladder
Avoid Constipation

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Cause increased bladder activity
Eat a healthy diet
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Increase with exercise or hot weather
Full rectum can disturb the bladder and cause need to go more frequently
Exercise at least 5 times per week for 30 minutes

Pelvic floor muscle exercises should be done daily
Bladder Health Tips Continued…

Smoking is the main cause of Bladder Cancer.
 Chemicals
in tobacco smoke are absorbed into the
blood, filtered through the kidneys and stored in the
bladder
 Smokers are 2-3 times as likely to develop Bladder
Cancer
 Men are 3 times more likely to be affected than women
 CCH has Smoking Cessation Groups available!!
Signs Medical Attention May Be
Needed!
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Blood in your urine
Need to urinate frequent/urgent
Sensation of pain or burning with urination
Cloudy or foul smelling urine (infection)
Unusual cramping or tenderness in the area of your bladder
Feeling unable to empty your bladder
Nocturia- Get up more than once at night to urinate
Incontinence- Leaking of urine
Sudden inability to empty bladder
Trauma
Resources
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Bladder Health. (n.d.) Retreived December 4, 2015, from
https://www.suna.org/download/members/bladder_health.p
df
Crowe, K. (2008). Bladder Matters: A Guide to Managing
OVeractive Bladder. Deerfield, IL: Astellas US LLC.
Doughty, D. (2006). Urinary & fecal incontinence: Current
management concepts (3rd ed.). St. Louis, Mo.: Mosby Elsevier.
Pelvic organ prolapse. (n.d.). Retrieved December 14, 2015,
from http://www.mayoclinic.org/diseases-conditions/pelvicorgan-prolapse/basics/definition/con-20036092
Take the Floor : Pelvic Organ Prolapse. (2008). Retrieved
December 14, 2015, from
http://www.voicesforpfd.org/p/cm/ld/fid=6