Incontinence/sexuality Flashcards by Rachel Crothers

Incontinence

loss of voluntary control over urination or defecation

urinary incontinence most common in women over 50
caused by enlarged prostate in men (BPH)

caused by weak muscles of pelvic floor/urethra, multiple pregnancy, decreased estrogen

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4 type of incontinence

stress incontinence
OAB
Overflow incontinence
Functional incontinence

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Stress Incontinence

leaking due to strain on bladder from movement (coughing, sneezing, jumping, laughing) most common, weak pelvic floor/menopause

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Overactive Bladder OAB

sudden/unstoppable urgency even when the bladder is not full, hyperstimulation of detrusor muscles due to nerve damage, infection, medication or abdominal trauma

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Overflow incontinence

inability to fully empty the bladder leading to urine build up that may leak out unexpectedly

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Functional incontinence

urinary leakage due to cognitive issues such as dementia, delirium, intellectual disability and neurological/muscular limitations such as arthritis, inability to recognize need for bathroom

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Fecal incontinence

due to weakening of external anal sphincter or lack of awareness (Dementia), exacerbated during episodes of diarrhea

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Results of incontinence

social isolation, increased risk of infection, skin irritation, anxiety, depression, reduced sexual activity, and reduced QOL

fear of incontinences leads to self-management –>dehydration–>falls

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Assessing incontinence

Occupational profile- gather data impacting daily function and QOL

Evaluate body posture, core strength, breath hold and release pattern

Eval posture on toileting; identify if added pressure or tightening of pelvic floor decrease emptying, breath holding can strain/weaken pelvic floor

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Incontinence Intervention

Lifestyle modfication
Pelvic floor exercises: knack vs. kegel
Core and LB strengthening: bridges, hip abduction/adduction
Postural training when toileting and sit to stand

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Lifestyle modification: incontinence

Scheduled toileting
Keep bowel/bladder diary
Dietary/fluid intake modification
Medication timing
Breathing techniques when voiding

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Knack technique

In standing turn toes out tighten from back/release, repeat with toes turned in

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Adaptive/environmental approach to incontinence

Avoid bulky pads that might trap moisture

Clothing options for easier management

Bedside commode

Pinch/grip strength for clothing management

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Sexuality

Plays role in sense of self, embraces how one feels about themselves, how they relate to others, how they create relationships with others, and overall
How they express themselves

Includes: sex, gender identity, sexual orientation, eroticism pleasure, intimacy, reproduction

Biosocial, psycho, spiritual, ethical, and cultural influences

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Sexual expression

Encompasses ways that sexuality can be expressed through feelings/actions associates with QOL, wellbeing, and health

Includes flirting, kissing, holding hands, masturbating, intercourse

Thoughts, desires, beliefs, attitudes, roles, and relationships

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Sexual activity

aDL, participation in a gamut of possibilities of sexual expression, requires ROM, strength, endurance, mobility, ability to receive and give consent

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Sexual functioning

Ability to participate in sexual activities w/o difficulty that results in satisfaction

Difficulties include pain/discomfort, physiological challenges, dysfunction due to physical/psychological, medication side effects

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Sexual health

Ability to embrace/enjoy sexuality, right to access services and information

Proper education to fulfill sexuality

Healthy sex life = good physical and mental health, better health associated with increased QOL

Changes in aging affecting sexuality

-Hormones: decreased estrogen/testosterone
-Skin: drier less elastic, wrinkles, fat layer thins, loss of cushion
-Muscle: shrink/lose mass, decrease in size/fibers, decreased water contents within tendons = stiffer muscles, deceased hand strength, heart muscle less able to push blood
-Bones/joints: decreased bone mass, decreased mineral contents, cartilage breakdowns, loses water content, restricts flexibility due to stiffer tendon/ligaments
-cognition: decreased attention, processing speed, working memory, executive function

Reduced testosterone

Andropause
Decreased libido, ED
Increased depression
Enlarged prostate

Reduced estrogen

Menopause, shortening/narrowing of vaginal walls, vagina becomes less flexible, then, reduced lubrication, decreased libido, decreased arousal and orgasm

Cardiovascular d/s effect on sex

Increased ED, vaginal dryness, decreased libido, dyspareunia (painful intercourse), decreased genital sensation, decreased orgasms

Diabetes effect on sex

ED, impaired ejaculation, decreased libido, painful intercourse, feelings of inadequacy, nerve damage to tip of penis/clitoris, decreased genital sensation

Urinary tract d/s effect if sex

Chronic prostatitis
Interstitial cystitis= women bladder pressure and pelvic pain
CKD
Men= premature ejaculation, painful ejaculation, decreased libido

Women= frequency/urgency, suprapubic dysfunction, dyspareunia (painful intercourse), decreased libido, hypo active sexual desire, inability to achieve orgasms

Arthritis effect in sex

Pain, fatigue, motor restriction, depression, loss of self-esteem

Lung D/S (Ca/COPD) effects on sex

ED, depression, dyspnea, decreased libido, fatigue

Medications impacting sexual dysfunction

Diuretics Antihistamines Antidepressants Muscle relaxants Statins/fibrates

Physical changes impact on sexual function

Decreased ROM=increased difficulty with positioning and clothing mgmt Decreased bone density and increased stiffness = difficulty transferring and moving Decreased endurance from decreased cardiac function= long tome to recover with sexual partying

Decreased sensation and skin eleasticity

Tears and less pleasurable

Cognitive changes impact on sexual function

Increase processing time/decision making during intercourse Difficulty sequencing steps and responses, giving/receiving consent

Psychosocial changes impact on social Functioning

Decreased self-esteem can lead to challenges with sexuality and intimacy Losing partner leads to decreased sense of belonging/security Motivation= reduced meaningful Occupational

Evaluation of sexual function

Bring up topic, normalize it, make it a routine to address within evaluation, give client permission to discuss concerns Create comfortable and open environment Prepare resources and build rapport

BETTER Model

B bring it up E explain T tell T timing (based on pt preference) E educate R record info

Occupational Performance Inventory of addressing Sexuality and intimacy (OPISI)

Self report addressing client factors/ body functions concerning sex and intimacy 4 item performance measure

Changes in Sexual Functioning Questionnaire

14 item questionnaire to measure changes in sexual functioning, specific version male vs. female Desire, pleasure, arousal, orgasm

PROMIS sexual function and satisfaction

Assess sexual functioning in males/females in 7 domains Interest in sexual activity Vaginal discomfort Lubrication ED Orgasm Overall sexual satisfaction

Owestry Disability index

Symptoms associated with low back pain Domains: self-care, lifting, functional mobility, sitting, standing, sleeping, sexual activity, social participation, and traveling

Brief Pain Inventory (BPI)

Not specific to sexually related concerns, self report measure on location of pain, intensity, how often it interfere, and pain management strategies

Physical interventions for sexual functioning

Modifications—> lighting, bed height, hand rails, grab bar Pain mgmt/ECT Personal hygiene Increase UE ROM to maintain position during expression Increased strength to support self/partner Increased endurance for longer duration of sexuality activity Increased safety during transfers Sensation impairment =explore other forms of intimacy

PLISSIT model

Permission- give permission to raise sexual issues Limited Info- give limited info on sexual side effects of tx Specific Suggestion- based on eval Intensive Therapy- sex tx, psychological, biomedical Linear in nature

EX PLISSIT

Extended PLISSIT model Permission giving normalizing sexuality at every stage, throughout process we ask open ended questions Allows for reflection, self-awareness of clinician, and allows for discussion

Sexual Rehab Framework (SRF)

Identifies key components of sexual health and outlines roles of team members Sexual drive/interest—>sexual function—>factors associated with condition—>motor/sensory influences—>bladder/bowel influences—>fertility/contraceptions —>sexual self view/esteem—>partnership issues OT= sexual function, factors associated with condition, motor/sensory influences, bladder/bowel issues, self-esteem and sexual self-view

Referrals for sexual function

Make referral, advocate pt’s need to referral source, educate pt on self-advocacy, educate on how to bring up conversation PCP if due to meds, sx, or chronic condition Sex therapy talk tx aimed at helping people past physical or emotional problems Pelvic floor