dare to age well workshop package · 2016-11-08 · once you have done the warm up, you can start...

DARE TO AGE WELLWORKSHOP PACKAGE

FOR COMMUNITY CONTINENCE CHAMPIONS

Introduction for Community Continence Champions

Many women face problems controlling their bladder. In fact 1 in 4 women are likely to expe-rience some leakage of urine and this becomes even more common as we get older.

Unfortunately most women do not seek help. They think nothing can be done or feel alone or embarrassed. Most older women wrongly believe that incontinence is a normal part of ageing and so they suffer in silence. The chances are they use pads purchased from the chemist or super-market, and put up with the problem.

But, there is still plenty we can do to reduce symptoms, or even eliminate them, regardless of our age.

This Workshop package is designed to help you help the women in your community. This makes you a Community Continence Champion and by doing this Workshop with other women, you will be performing a very valuable service.

The Workshop should last approximately 40 minutes. The times at the bottom of each slide picture is given as a guide only.

The Workshop has been developed as a result of extensive research carried out by universi-ties in the UK, Canada and France. It has shown that a workshop combined with information leaflets are effective in helping women become aware of their bladder, what they can do to help themselves achieve and maintain good bladder health, and to understand whether or not they should seek professional help for any problems.

It is intended primarily for women aged 50+, but the messages are applicable to women of all ages.

It has been proven that delivery of this Workshop package can reduce incontinence symptoms, potentially improve quality of life and possibly reduce the chances of a fall.

The Dare to Age Well™ Continence Package has been designed to be used by people with-out clinical training. You don’t need any specific qualifications to deliver the Workshop, just en-thusiasm and a desire to communicate improving health.

It can be delivered to any group of women whether they are part of a Lunch Club, Women’s Institute, or Care Home, or any other group.

You will need:• a quiet room• audio visual equipment • internet access (desirable but not essential)• a flip chart (optional)• some refreshments (optional)N.B. check any health & safety regulations with the host organisation.

Introduction for Community Continence Champions

Setting

Continence problems are embarrassing, and many women do not like to admit that they have any. This can make attending a workshop on continence difficult for some individuals.

The following conditions seem to work best:

• Group sizes of 10-15 women allows for a de-gree of intimacy without pressure on any one individual.

• Groups should ideally comprise peers, i.e. similar age group, only women present.

• Ensure the room feels safe, secure and com-fortable.

• Make sure the group can see and hear the speaker.

• Sitting in a circle or semi-circle helps inclu-sion and openness. Sitting around tables can also work well.

• Tell the group that the shared information is confidential and must be kept within the room.

• Have some refreshments to help to relax people – sitting around tables can be useful for this.

• Invite women to a Dare to Age Well™ Work-shop, rather than one specifically on inconti-nence.

• Make it clear that the messages of the Work-shop are applicable to ALL women whether or not they have incontinence symptoms.

Suggestions are included to encourage partic-ipation. Your group may not know the answers, but asking the question may make them think about the topic. If there is no response, you can give them the answers and move on.

The Warm Up

Start the session with:

• A welcome • Introductions• House-keeping information• A short Warm Up (3-5 minutes)

The Warm Up is essential to make the women in your group feel at ease. It helps to encourage participation. It should be fun, relaxing and not challenging.

Suggestions for the Warm Up:• A simple health quiz with a small prize for the

winner.• Stretching & breathing exercises

Once you have done the Warm Up, you can start the Workshop proper.

You can use the PowerPoint slides in your Dare to Age Well™ Continence Workshop Package.

This booklet has some narrative that you can use along with the slides. Feel free to use your own words and add your own anecdotes. The import-ant messages are shown in bold type. Do not change these key messages and make sure you say them during the Workshop.

Some links in the slides require you to have in-ternet access to the Dare to Age Well™ website. Alternatives have been provided in case you do not have internet access or prefer not to use it.

5 mins

Dare to Age Well™

What does this mean to you?

Slide 1

We start this Workshop by exploring what it means to Age Well.

When I think of Ageing Well, I think of [insert your own thoughts on Ageing Well, e.g. being able to look after my grandchildren for as long as I can, learning something new, etc].

(Optional). This is a short video on getting old-er. Start video: https://vimeo.com/137249858 (4.41 mins).

What does getting older mean to you?

Suggestions:• Write suggestions on the Flip Chart• Use poetry about growing old to stimulate

thoughts

We are living longer, but are we living healthier? What can we do to have a good quality of life?

As we get older many of us worry about our health. For example, I worry about [insert your own concern, e.g. osteoporosis because my mother had it and so I have a chance of having it too].

Do you have any particular concerns that you can share with us today?

Suggestions• Write down concerns raised on a white board or

flipchart• Allow for discussion

Many women say that they are concerned about memory loss, medication [mention some of the concerns they have brought up], but no-one mentions urinary incontinence. [If someone in your group does bring up incontinence say “it is very rare indeed for anyone to mention inconti-nence, so this is clearly an exceptional group!”)

Dare to Age Well™

10 mins

Why can’t we talk about incontinence?

• Toileting is a private business

• I feel embarassed

• I am getting older so I just wear pads

• My doctor thinks I’m manag-ingfine

• I’m scared of having surgery

Slide 2

Why cant we talk about incontinence?

We are so used to toileting being a private activ-ity (unless there are small children around!), that we don’t discuss it.

You never hear the characters on Eastenders talking about going to the toilet, do you? It is hard to admit to having incontinence, and it can be embarrassing and isolating.

Many people with incontinence worry that they smell or worry that they will have an ‘accident’ while they are out.

So we try to hide it.

We buy pads from the supermarket.

We think it is just a part of growing old and therefore do not seek help.

Sometimes we think surgery is the only answer.

Suggestion:• Beopentogroupdiscussionandfocusonthe

issuestheyraise.

13 mins

How the bladder works

Slide 3

How the Bladder Works

The kidneys (point to these on the presentation) are bean-shaped organs about the size of your fists. The kidneys filter all your blood to remove waste and liquid from your body and form urine which collects in the bladder.

The bladder gradually fills with urine, and mus-cles in the pelvic floor hold the urine inside the bladder until you are ready to urinate.

Nerves in the bladder tell your brain when it is getting full of urine. The nerves will send a mes-sage to your brain that it is time to urinate and you should have 20 minutes or so to find a toilet.

When it is time and appropriate to urinate, the brain tells the bladder muscles to tighten, which squeezes urine out of the bladder. At the same time, the brain signals the sphincter muscles to relax. As these muscles relax, urine exits the bladder through the urethra. When all the sig-nals occur in the correct order, normal urination occurs.

But if part of this complicated muscle and nerve system goes wrong, incontinence can be the result.

15 mins

Urinary incontinence is a symptom...

Slide 4

...that something is wrong

• with the bladder• withthepelvicfloormuscles

that hold in the urine• with brain-bladder communi

cation• somewhere else in the body

(arms and legs even!)

Urinary incontinence is…

….. any involuntary leakage of urine.

What is urinary incontinence?

Urinary incontinence is any passing of urine that you have not intended.

It is a symptom, not a disease, and is an indica-tion that something is wrong with the bladder, the muscles around the bladder or with the nerves that connect the bladder to the brain.

There are a number of different causes.

16 mins

Incontinence could be a problem for you if…

…you leak – even a little bit - when you cough or sneeze

…you cannot get to the toilet with-out leaking urine – even if it hap-pens occasionally

…you wear a pad or other protec-tion – even if it is ‘just in case’

…you wake up more than twice per night and do not reach the toilet on time.

Slide 5

Incontinence could be a problem for you if…

You do not have to leak urine a lot or often to have incontinence. If any of the above (point to or read the slide) apply to you, you have inconti-nence.

If you are worried about where the toilets are when you go out, you have a problem with conti-nence.

Bladder problems are extremely common as women get older so it is important that we take steps to look after our bladder health.

Our eyesight gets worse as we get older, so we get glasses. If we have heart problems, we go to the doctor for medication. However, if we have incontinence, we tend to think nothing can be done or are too embarrassed to seek help.

The message for today is that, incontinence is not inevitable as we age. We don’t need to suffer in silence or buy pads forever, there are steps we can take to reduce or eliminate symp-toms.

Incontinence is not necessarily something you have to put up with, even as you get older.

17 mins

It is very common but less than 50% of sufferers seek help.

Bladder problems are embarrassing and can affect self-esteem and daily activities.

The majority of women can be curedorsignificantlyimprovedWITHOUT medications or surgery...even at age 98!

Why spend money on pads when you don’t need to?

Reasons we SHOULD talk about incontinence

Slide 6

But we should talk about it.

First of all we know that many women worry about incontinence - it can be embarrassing if leaks occur when we are in public.

We know it is very common - 55% of women over 60 have some degree of urine leakage. And if we don’t talk about it we cant bust the myths that surround it.

There are plenty of myths about incontinence but here are two Major Myths for you to remember.

Major Myth 1It is just something that happens when you get older.NOT true! More older people have inconti-nence but it is not an inevitable part of age-ing.

Major Myth 2There is nothing I can do about it and I don’t want surgery.NOT true! For most women there is something they can do about it which doesn’t involve sur-gery.

We will talk more about this later.

Reasons we SHOULD talk about incontinence

18 mins

Leakage of urine can happen when pressure or ‘stress’isputontothepelvicfloormusclesandtheyare not strong enough to resist.

Stress incontinence

Slide 7

Stress incontinence

Most often, incontinence in women is due to weakness in the pelvic floor muscles - re-member those from the earlier slide? These are the muscles that support the bladder.

With Stress incontinence, the pelvic floor muscles and sphincter are not strong enough to hold in the urine. Leakage can happen when you cough or sneeze or even laugh.Doing sport or gymnastics can often be the first time women realise they might have a problem. Try trampolining after having had several children!

Stress incontinence can often be reduced or completely stopped by improving the strength of the pelvic floor muscles and the external sphinc-ter.

Exercises to do this are called Pelvic Floor Mus-cle Training or Kegel Exercises. Doing these exercises will help with all types of incontinence and are necessary even if you don’t have inconti-nence symptoms.

19 mins

Urge incontinence

‘When you’ve got to go, you’ve GOT to go’

Slide 8

Urge incontinence

Another type of incontinence is Urge inconti-nence. This when you feel an urgent desire to urinate which you can’t control or you can’t get to the toilet in time.

Urge incontinence is associated with an overac-tive bladder, which is when the bladder contracts when we don’t want it to. This can be due to:

• what we have eaten or drunk• certain medications • ‘association’, which is what happens when

you know you can finally go to the toilet, but the feeling becomes overwhelming and you lose the ability to wait just a few more min-utes.

Urge incontinence can often be alleviated by :• changes to diet • changes to medications • retraining the bladder

Urge incontinence can also be associated with wanting to go to the toilet more often. This is termed ‘frequency’.

20 mins

Other types of incontinence

Mixed incontinenceA mix of stress and urge incontinence

Functional incontinence

Nocturnal incontinence

Slide 9

Other types of incontinence

Mixed incontinence is a sort of double whammy; your bladder is sending urgent “I need to go NOW” signals and the pelvic floor muscles are weak, so they are not closing the door very firmly.

Another very common type of incontinence is called functional incontinence, which simply means you have a problem actually getting to the toilet. This could be because of mobility problems or obstacles to getting to the toilet.

Have a look at the picture, it is of the Great Wall of China and the toilet seems to be miles away, maybe in that building in the distance? I think we might all be functionally incontinent if we had to get there in a hurry! .

And finally, nocturnal incontinence which is when you leak in the bed or before you can get to the toilet at night. And this is often associated with having swollen legs.

21 mins

Major Myths

Major Myth 1It is just something that happens when you get older.

Major Myth 2There is nothing I can do about it and I don’t want surgery.

50-75% of women aged 60+ with urinary inconti-nence can be cured or improved without medicine or

surgery

Slide 10

Major Myths

Remember our Major Myths?

Did you know that over half of older women with urinary incontinence can get symptom relief without medications or surgery.

We will now talk about how you can do this.

Suggestion:Ask the group what three things they can do to help alleviate Urge incontinence.

These are:• changes to diet • changes to medications • retraining the bladder

These changes can help to reduce symptoms if they are relevant to us and if you are determined to address them.

22 mins

Changes to diet – the irritants

• Caffeinated drinks

• Spicy food

• Acidic drinks

• Alcohol

Slide 11

Changes to diet – the irritants

Let’s start with changes to diet.

Can you think what foods or drinks might irritate the bladder and cause urge incontinence?

Suggestion:Ask the group to identify bladder irritants and write themontheflipchart.

These are:• Coffee and tea – these have caffeine in them• Fizzy drinks – some also have caffeine in them• Acidic drinks• Alcoholic drinks• Spicy foods

So, to reduce or eliminate symptomsDON’T consume the food and drink that irritate the bladder.

At the very least, consume in small quantities. Cut them out altogether for at least 2 weeks and see if your symptoms improve. You can try to gradually reintroduce them one by one and see if that makes your symptoms worse again.

23 mins

Changes to diet – the protectors

• Drinks such as water or herbal teas

• Fresh fruit & veg

Slide 12

Changes to diet – the protectors

Suggestion:Ask the group what positive things they can do to reduce incontinence symptoms.

The things you CAN do are:

• Eat plenty of fresh fruit and vegetables. These help you to maintain a healthy weight and reduce constipation.

• Being overweight puts stress on the pelvic floor resulting in pressure on the pelvic floor.

• Having constipation can also cause incon-tinence if the full bowel presses onto the bladder.

Drink enough fluid (e.g. water, herbal tea) – about 1½ litres. Food like soup counts towards our fluid intake.

If you drink within a few hours of going to bed, you are very likely to need to get up in the night to go to the toilet. To avoid this, make your last drink earlier in the evening.

24 mins

Check your medications

Slide 13

Check your medications

Some medicines can also result in symptoms. Examples of these are:

• Diuretics/water tablets • Some types of antidepressants • Some pain killers• Some anti-inflammatories• Some blood pressure pills• Some diabetes pills• Hormone Replacement Therapy (HRT)

If you have fluid retention…

Ask your doctor if wearing support stockings to prevent leg swelling is suitable for you. Sitting with your legs up can help.

25 mins

If you are taking any medications:

• Discuss these with your doctor. It may be possible to change to ones that do not affect your bladder.

• Do NOT stop or change your medication without checking with your doctor first.

1

1

Pelvic floor exercises

Slide 14

2

Pelvic Floor Exercises

All of us are affected by weakening muscles as we get older. So, in addition to the changes to diet and medications, you will almost certainly need to address the strength of your pelvic floor.

A weak pelvic floor results in leakage (point to diagram1)A strong pelvic floor keeps you dry (point to dia-gram 2)

Earlier I mentioned Kegel exercises to help stop Stress incontinence. These are exercises for our pelvic floor muscles and are recommended to women of all ages, and to men too.

They help you regain control of your bladder and sphincter, and it’s never too late to start!

It is important to do the exercises:correctly

and regularly

and tokeep on doing them...forever

We need to learn how to do them and then build them into our daily lives.

And there is no time like the present. Let’s do them now. Yes, now!

26 mins

Pelvic Floor Exercises: Lets do them!

• co-ordination• strength• endurance

Slide 15

Pelvic Floor Exercises: Lets do them!

OK, so let’s Get Ready…

• Sit forwards on your chair.• Straighten your back and lift the top of your

head towards the ceiling.• Maintain the normal inward curve in your low-

er back by relaxing your shoulders. • Be aware of the area in and around your 3

pelvic openings - anus, vagina and urethra.• Squeeze and lift inside in and around these

3 pelvic openings. It’s like trying not to break wind.

• Try not to tighten your buttocks or tummy – just the pelvic area.

• There are short and long exercises. The short ones help to develop strength and the longer ones endurance.

Get Steady…

Now we will do the exercises with the video. Don’t worry if you cant do it all at once. This is to show you how to do it and your Dare to Age Well™ Continence leaflet will remind you and show you where to look for more reminders.

Go! start the video https://daretoagewell.wordpress.com/the-exer-cise-programme/ (8.37 mins)

Go to slide 19 when the video has finished.

As an alternative to using the online video, you can go through the exercises with your group yourself. These are covered in the next 3 slides. 16, 17 & 18.

34 mins

Relax

Pelvic floor exercises: Strength

6 seconds 6 seconds6 seconds 6 seconds6 seconds

Repeat 10 times

Maximum contraction

Maximum contraction

Relax Relax

Slide 16

Pelvic Floor Exercises: Strength

The first exercise is to build up the muscle strength.

It involves alternating contractions and relax-ations for 6-8 seconds each.

Relax the muscles completely before the next contraction.

Repeat this series of 2 contractions and re-laxations 10 times.

29 mins

Stand up behind a chair

COUGH

C o n t r a c t

Relax Relax

Pelvic Floor Exercises: Co-ordination

The ‘knack’

Slide 17

The second exercise is to practice co-ordination. As you stand up behind a chair, contract your pel-vic floor muscle and at the same moment cough. Then relax completely. Repeat 10 times.

This is a really useful exercise for when you feel yourself about to sneeze or cough. It is some-times called the ‘’knack’ as in ‘having the knack’.Consciously tighten the pelvic floor muscles and hold them tight until the sneeze or cough has passed.

Hey presto, no leakage!But it does require practice.

Pelvic Floor Exercises: Co-ordination

31 mins

Pelvic Floor Exercises: Endurance

6 seconds 6 seconds 6 seconds

Light contraction

Light contraction

Maximum contraction

The ‘elevator’

Slide 18

6 seconds

Relax

The third exercise, for endurance, is called the ‘elevator’. We sit down again for this exercise.

For this one, we move from a slight contraction to a maximum contraction and back to a slight contraction before relaxing completely. Each step should last 6-8 seconds. Repeat 8 to 10 times.

Pelvic Floor Exercises: Endurance

34 mins

Pelvic Floor Exercises: Practise and Persistence

(After doing the exercises)

Is anyone thinking “Oh I’m too old for this”? Truth is, it is never too late to start. Cara the doctor who developed these workshops has had a women of 98 years old completely cured of in-continence simply by doing these exercises. You are also never too young, everyone can benefit from doing these exercises regularly.

As with all exercises, it take practice and repeti-tion before any improvements can be noticed.

Pelvic Floor Exercises: Practise and PersistenceYou need to:

• Do the exercises every day. It can take 12 weeks before you notice any improvement.

• Start by doing them lying down.

• Choose a time in the day when you will have 10-15 minutes of uninterrupted time.

• Do not engage in any other activity while do-ing the exercises (such as watching television or reading) until you are confident you can do them correctly.

• Step up the difficulty every 4 weeks up to 12 weeks. This is explained in the accompanying booklet.

• Quality is more important than quantity.

35 mins

Strategies to cope with the ‘urge’

1. Stop

2. Sit down

3. Contract your pelvic floor muscles

4. Use distraction techniques

Slide 20

Strategies to cope with the ‘urge’

If you have the ‘urge’, the first thing to do is to STOP wherever you are.

If you can, SIT DOWN on a hard surface.

CONTRACT and hold your pelvic floor muscles strongly 8-10 times - as in the Strength exercis-es – this will send a strong message to your brain that the door is SHUT and that it’s not the right time to go yet.

The other thing to do is to DISTRACT yourself from thinking ‘I need to go, I need to go’ by ac-tively thinking about something else.

For example:1. You could count backwards from 100 to 0.

While you are thinking about that your blad-der will have time to relax again.

2. Or try thinking of girls or boys names for every letter of the alphabet, Alice, Betty, Carmen, Debbie, Eleanor, Florence, and so on.

Once the urge has passed, get up and walk slowly to the toilet or wait until you feel the need again.

.

36 mins

Strategies to cope with ‘frequency’

Slide 21

Wait at least 2 hours between visits to the toilet

Date:

Ihavetakenthefollowingaction:

Ihavedonethepelvicfloorexercisestoday.Yes/No

Time Typeandquantityoffluidtaken

Emptiedbladderintoilet

Accidentallyleakedurine

6-8a.m.

8-10a.m.

10a.m.-12noon

12noon-2p.m.

2-4p.m.

4-6p.m.

6-8p.m.

Strategies to cope with ‘frequency’

We have just talked about strategies to cope with the ‘urge’. If you also want to go to the toilet more often than you used to, you probably have ‘frequency’. This can occur because of other incontinence symptoms and an anxiety about leakage.

Essentially do the same techniques as for urge, by not dashing to the toilet every time you feel you need to go, but instead of going to the toilet once the urge has passed, extend the time be-fore you next go to the toilet. Try at least 2 hours between going initially, and gradually extend this to every 4 hours. This will help you to gain more control.

Because we are not always aware of our habits and behaviours, it is recommended that you complete a bladder diary for a few days so that you can see how frequently you empty your blad-der and how this relates to the amount you drink and when you drink, and if and when you have incontinence episodes.

Bladder retraining is a commonly used and suc-cessful technique for curing Urge incontinence.

More information on bladder training can be found in your Dare to Age Well™ Continence leaflet.

37 mins

Empowerment is when YOU take charge of YOUR health

Slide 22

YOU identify if there is a PROBLEM

What can I do?

How will I do it?

Will I do it?

How well did it work?

Are the target symptoms better?

Did it work?

Empowerment is when YOU take charge of YOUR health

Well done everyone. We have covered a lot of information and you have worked hard.

The main purpose of this Workshop is to give you the information and tools to help yourself, wheth-er this is making the changes we have talked about, or seeking professional help.

Review your symptoms, if you have any, and then ask yourself which of the actions we have talked about are most appropriate for you. Try them and look for improvement. If there is no improve-ment, try something else and/or continue doing it for longer. Results will not be immediate, so patience and persistence are required.

Even if you have no urinary incontinence symp-toms it is a good idea to start doing regular pelvic floor exercises to keep your muscles strong and prevent incontinence in the future.

This approach is about taking control. Having the information and the tools to do something yourself is empowerment. Being empowered gives you more control over your life and your decisions. Taking control of your continence is just one way of being empowered.

Be empowered. Be in control. Be symptom free.

We are nearly finished. I will just talk briefly about symptoms that do need professional help and revisit the key messages.

38 mins

Red flag symptoms

• Blood in urine• Pain when passing urine or

around lower abdomen• Fever• Cloudy urine• Smelly urine• General discomfort when pass-

ing urine• Severe incontinence – complete

bladder emptying

If you have any of these symp-toms

or incontinence symptoms persist

SEEK PROFESSIONAL HELP

Slide 23

Red flag symptoms

We have talked a lot about self-help, but you may need professional help.

If you have severe symptoms or are experiencing pain or blood on your urine, it is recommended that you seek professional help from your GP as soon as possible.

Sudden or temporary Urge incontinence can be caused by a urinary tract infection. If you have dark or cloudy urine you may have an infection. If you are free of other symptoms such as fever or pain, the best thing to do is immediately increase your fluid intake. If symptoms get worse or per-sist then you need to go to your GP.

There will always be some women for whom surgery is necessary or desirable to relieve symp-toms. It is important that if you do need medical attention, you seek it.

If you do all the things we have talked about in this Workshop and symptoms persist after several months or get worse, you should also seek pro-fessional help.

39 mins

Key messages to remember

Slide 24

Key messages to remember

We can only reduce symptoms if they are rele-vant to us and if you are determined to address them.

Do not suffer in silence!Be empowered! Be in control!

Youwillfindmoreinformationanddetailsonwhere to get help in your Dare to Age Well™ Continence booklet.

You may find it beneficial to share your booklet with a friend or family member. They may also have incontinence symptoms or can help you with making the changes necessary to reduce or prevent symptoms.

Thank you for listening and participating in this Workshop.

• Urinary incontinence is any passing of urine that you have not intended.

• It is very common.• Incontinence does not have to be accepted

as a sign of getting older.• 50-75% of women aged 60+ with urinary

incontinence can be cured or improved with-out medicine or surgery.

• Strengtheningthepelvicfloormusclesisim-portant for all women. It is important to do thepelvicfloorexercisescorrectly,regularlyand to keep on doing them.

Urge incontinence can often be alleviated by:• changes to diet • changes to medications • retraining the bladder

40 mins

Dare to Age Well!https://daretoagewell.wordpress.com/

Copyright Brunel University 2016

dare to age well workshop package · 2016-11-08 · once you have done the warm up, you can start...

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