Incontinence is the inability to control one’s urination or defecation. In most situations, it leads to a high dependence on caregivers to care for patients at home. A proper nursing care plan for urinary incontinence is essential in preventing the occurrence of pressure ulcers and infections, as well as to enhance one’s dignity and quality of life.
At Jaga-Me, we believe in empowering caregivers to care for their loved ones. Hence, we have prepared this special piece to reinforce the basics of incontinence management and share some caregiving tips and advice from our Jaga-Me nurses!
What are the types of incontinence?
- Stress Incontinence occurs when pressure is applied to the bladder, which causes urine to leak. It typically happens on occasions when one is laughing, sneezing, or exercising.
- Urge Incontinence occurs when there is a sudden and intense urge to urinate, and the inability to control it causes urine to leak. This is common among the elderly, especially for those who suffer from urinary tract infection and diabetes.
- Overflow Incontinence occurs as the bladder is not emptied completely, causing urine to dribble.
- Functional Incontinence occurs when a physical or mental impairment causes difficulty in urinating at the appropriate time. This commonly occurs post-stroke.
- Stool Incontinence is when stool leaks from the rectum due to one’s inability to control the urge to defecate.
How often should I change the diapers?
Adult diapers must be changed frequently to prevent skin infections and rashes. The frequency largely depends on one’s lifestyle, health, and budget. For most, diaper changes occur 5 to 8 times a day. This means that an average person with incontinence would need at least 150 diapers a month.
In addition, caregivers of people who are less mobile should conduct frequent checks to ensure that diapers are immediately changed when soiled.
As diapers are bulky in nature, we recommend ordering adult diapers online for it to be delivered straight to your home, as compared to buying it in person.
How can I prevent pressure ulcers?
A pressure ulcer is a localised injury to the skin and underlying tissue. This occurs due to pressure exerted on the particular spot over a long period of time. Patients who are incontinent, have limited mobility, underlying medical conditions, and poor nutrition are prone to pressure ulcers.
Do take note of the following for proper care and the prevention of pressure ulcers:
- Use of barrier cream: A thin layer of barrier cream should be applied after each diaper change. The barrier cream should be wiped off gently and thoroughly during each diaper change.
- Turning: You should turn your loved one every 2 hours. Turning should be done gently, and even while your loved one is asleep. A schedule can be used to make things more consistent. For example: 8am – back; 10am – left; 12pm- right; 2pm – back; 4pm – left; 6pm – right…
- Nutrition: Having a well-balanced diet and adequate hydration is important to prevent pressure ulcers.
- Activity: Frequent movement prevents pressure ulcers from forming. Encourage your loved one to sit upright, or move with a walking stick/walking frame as tolerated. For your loved one who is completely bed-bound, aid them in exercising. Simple exercises like squeezing a stress ball, lifting arms and legs encourage blood flow and help maintain muscle strength.
- Keeping skin clean and dry: Singapore is hot and humid. Keep your loved one cool by ensuring good air ventilation, using a fan or cooling mattress to prevent sweat from forming. Always dry your loved one thoroughly after a shower or diaper change. Areas that are commonly missed are between fingers and toes, skin folds at the groin and below the breasts. Wear clothing that is light and airy.
- Cushioning: Elevate prominent bony parts of the body such as the heels with cotton pads. For your loved one who is bed-bound, using alternating-pressure mattresses could reduce pressure ulcers from forming.
- Moving: When moving your loved one along the bed, do not drag him/her by force as it could cause his/her fragile skin to tear. Instead, use a drawsheet or bedsheet that is tucked underneath. Ask your home care nurse for tips on how to move your loved one in a manner that is safe for the both of you.
What should I do when a pressure ulcer forms?
- If you see redness: Apply more barrier cream, turn your loved one more frequently and avoid the areas that are red. If this redness is on the heel, elevate it by placing pillows under the calves. If the redness is on the ear, cushion it with a piece of Mepilex behind the ear.
- If you see a wound: Call your home nurse or bring your loved one to the wound nurse at the polyclinic to assess the wound. Do not use talc powder to “dry” the wound.
- Cradle Nursing: Remove all diapers and pants, and drape the lower half of your loved one with a sarong for a few hours a day. This will allow ventilation of the skin where the diaper is usually at. For your loved one with incontinence, use of an incontinence pad should prevent leaks onto the bed.
- It is always safer to consult a home nurse and learn the best way to care for your loved one with incontinence.
Expert Tips from a Jaga-Me Nurse: What should I look out for if my loved one uses a urinary catheter?
- Lack of urine: An average adult should produce about 30ml of urine per hour. Should there be no urine output for more than 3 hours, contact your home nurse immediately.
- Red and/or swollen meatus (urinary hole): This can be prevented by having adequate slack along the catheter.
- Hygiene: Cleaning of private parts should be done at least once daily. Using warm water and a soft cloth, clean the private parts from top to bottom using a mild soap.
- Pain: If your loved one complains of pain, it is likely that there is an infection or obstruction. Contact your home nurse immediately for assessment of the situation. It is likely that the tube will have to be replaced.
- Sediments along the tube and in the bag: It is likely that your loved one’s urine is too concentrated. Increasing fluid intake, in the form of water, soups, juices etc. will reduce crystal formation. However, please check with your doctor before increasing fluid intake, as your loved one may have a medical condition that prevents them from taking in more fluids.
- Redness along thigh where catheter is taped to using micropore: Alternate the location where the catheter is taped to the thigh. For example: Monday – left, Tuesday – right, Wednesday – left…
- Blood in the urine: Visit or call your doctor for assessment. Do not delay.
Expert Opinion
- We recommend for families to stock up on at least one set of urine bag, catheter pack and urinary catheter, in the event of an emergency.
- Do change the urine bag every 7 days, or as per manufacturer instruction. This prevents the area from smelling bad, as well as infections.
- Always empty the urine bag when it is ½ to ¾ full, and before your loved one walks. This can prevent infections and makes walking more comfortable for him/her.
- Keep the urine bag below the bladder of your loved one. This eases urine to flow into the bag, and not back into the body. Flow-back of urine could cause urinary tract infection.
- If the bag needs to be lifted above the waist level (i.e.: when changing pants), kink the catheter before lifting it above the waist, and only release the kink when the bag is below the waist
- Clean the drainage port of the urine bag with alcohol swab before and after emptying urine from the bag. Use a new piece of alcohol swab before and after.
- Ensure that the urine bag does not touch the floor.
How can I get more expert support?
You can speak to a Jaga-Me nurse at 6717 3737 for medical assistance. Alternatively, you can seek advice from your JagaPro via a teleconsultation or in person when you engage Jaga-Me’s Home Care Services.
Incontinence management requires the purchasing of consumables that may be demanding and challenging for caregivers.
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