Incontinence/sexuality Flashcards
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
4 type of incontinence
stress incontinence
OAB
Overflow incontinence
Functional incontinence
Stress Incontinence
leaking due to strain on bladder from movement (coughing, sneezing, jumping, laughing) most common, weak pelvic floor/menopause
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
Overflow incontinence
inability to fully empty the bladder leading to urine build up that may leak out unexpectedly
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
Fecal incontinence
due to weakening of external anal sphincter or lack of awareness (Dementia), exacerbated during episodes of diarrhea
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
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
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
Lifestyle modification: incontinence
Scheduled toileting
Keep bowel/bladder diary
Dietary/fluid intake modification
Medication timing
Breathing techniques when voiding
Knack technique
In standing turn toes out tighten from back/release, repeat with toes turned in
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
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
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
Sexual activity
aDL, participation in a gamut of possibilities of sexual expression, requires ROM, strength, endurance, mobility, ability to receive and give consent
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
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
