Leaky water works - Incontinence
 
There are many myths about incontinence, which are not necessarily true.  For instance many people believe incontinence is an inevitable consequence of ageing or if you drink less it will improve the problem.  Neither of these beliefs is helpful.
 
Some facts about our Water Works:

• The bladder is an expandable muscular bag that gradually fills and once full it automatically contracts to force urine out.
• The bladder can hold 300-400 mls during the day and up to 800 mls overnight.
• We normally empty our bladder 5-7 times a day. 
• Your pelvic floor and urethra sphincter muscles are important in stopping leakage and we have control over these muscles.
• We need to drink 6-8 standard glasses of fluid a day.
• Caffeine, artificial sweeteners, alcohol, some fizzy drinks and medications, including diuretics, are known to irritate the bladder.
• Infection and inflammation of the bladder and urethra will cause pain, discomfort and urgency.
• We can train our bladders to empty before it’s full.

 
There are two types of incontinence – Stress and Urgency.
 
Stress incontinence
 
With stress incontinence there may be leaking when coughing, sneezing, jumping, lifting, pushing, laughing and pulling.  This is caused by weak pelvic floor and urethra sphincter muscles.  The trick is to strengthen your pelvic floor and urethral sphincter muscles and tighten your pelvic floor muscles before stressful activity occurs.
 
Urgency incontinence 
 
Urgency incontinence is the sudden need to go, for example, when opening the front door you generally get the urge. It’s caused by an overactive bladder, which has been trained to empty before it’s full. Typically small amounts of urine are passed more frequently -10 plus times a day.

Preventing or fixing incontinence
 
For both types of incontinence strengthening your pelvic floor and urethra sphincter are important.  To do this:

• sit comfortably with feet and knees apart
• lean forward at the hips with your back straight
• breathe normally throughout
• find your pelvic floor by imagining stopping yourself from passing urine or wind
• tighten your pelvic floor muscles on the out breath 
• close the openings by squeezing and LIFTING inside 
• aim to hold for 3 -10 seconds, rest 5-10 seconds, repeat 5-10 times.  Do this three times a day.

Once you’ve mastered the pelvic floor exercises, practice regularly eg every time you stop at red lights.
 
Tips for managing and training urgency incontinence
 
When you experience the sudden urgency to pass urine, it is often associated with a feeling of panic.  The following may help:

• keep calm – don’t panic
• stand still or sit down
• remember the bladder is a large bag and you do not actually need to go
• let the tummy muscles relax
• KEEP BREATHING
• pull up the pelvic floor muscles hard ie PULL THE BRAKES ON!
• think of something else.
• wait until the urgency passes, usually about 10-30 seconds, and then carry on with activity or slowly make your way to the toilet.

 
If desperate:

• cross the legs, or
• press on the pelvic floor muscles by sitting on the arm of a chair or pressing with the hand.

 
If you are still struggling there is help:

• Consult your Doctor to rule out inflammation, infection or drug irritation
• Contact the Nurse Maude Continence Service
• Contact our friendly Physiotherapist who will be able to help you improve your pelvic floor and urethra strength.

 
You don’t have to suffer alone - contact us we can help
 
 
Ph:                   03 3775280
Email:              admin@tpl.nz
Web:                www.therapyprofessional.co.nz
 
 
 
Reference:     Women’s Waterworks – Curing Incontinence by Pauline E Chiarelli

Teaching Shaving Skills
 
Shaving is a major part of growing up and for a boy, it signals the transition from childhood into manhood.  Shaving is a complex task, which requires consideration of safety and sensory challenges.
 
How can you make this easier?
 
Get him used to the idea he will be shaving his face one day by:

• telling him routinely he will be shaving when he starts getting whiskers on his face 
• getting him to watch someone experienced shave regularly
• getting him used to handling an electric razor in front of the mirror and turning it on and off under supervision
• using mime to pretend he is shaving
• using pictures with simple words for each step of the shaving process 
• talking about when shaving will happen in their daily routine eg before or after their shower

 
We would recommend using an electric razor to start with, as they can be easier and safer to use.  However, for some, the noise or vibration may be too much and a razor blade may more successful.
 
Like all skills, there are a large number of smaller skills or activities used when shaving eg with an electric razor.

1. Go to the bathroom
2. Get razor from drawer
3. Take off safety cap
4. Plug electric cord into razor 
5. Plug cord into the wall socket 
6. Turn razor on
7. Shave right cheek then the left cheek  
8. Shave upper lip 
9. Shave chin 
10. Shave neck  
11. Check in the mirror you haven’t missed any hairs
12. Turn the razor off
13. Unplug razor from the wall socket
14. Unplug razor from the electric cord
15. Brush the hair out of the razor into the sink
16. Turn on the cold tap and wash the hair away down the sink
17. Place safety cap on razor
18. Return razor to drawer.

To assist teaching, take photos of each of these steps:

• in the environment the shaving will take place 
• with the equipment he will be using
• with the individual doing the activity himself, where possible. 

 
If it is not possible, try and locate pictures from the internet showing the shaving steps.
 
Put the photos or simple pictures in the correct sequence with simple words describing the activity.  Use this schedule as a prompt while teaching. Initially you may have to use verbal and physical prompts along with the schedule.
 
If you are experiencing any problems with the development of these skills our Occupational Therapist may be able to help.  
 
 
Just contact us at Therapy Professionals 
 
Phone:                03 3775280
Email:                  admin@tpl.nz 
Web:                    therapyprofessionals.co.nz

​https://www.carautismroadmap.org/shaving-for-young-men/

About Dietitians

Dietitians help you to improve your health, wellbeing and prevent illness through good nutrition. They can translate scientific information about nutrition into practical dietary advice and tailor an eating plan based on your individual factors (age, medical history etc). 
 
Dietitians can help with a range of health problems and chronic diseases such as: 

• unplanned weight loss or gain 
• a restricted diet eg gluten free, vegetarian, dairy free
• high cholesterol 
• heart burn (reflux)
• allergies/intolerances 
• diabetes (high or low blood sugars)
• stomach cramps, bloating, nausea and vomiting
• vitamin and mineral deficiencies
• constipation
• wounds that won't heal 
• easily broken bones 
• dry mouth 
• fatigue, low energy and dietary deficiencies

 They will recommend practical solutions for: 
 

• maintaining optimal health and energy levels
• balanced nutrition 
• personalised meal planning and preparation 
• grocery shopping 
• reading nutritional labels 
• keeping food safe to eat
• portion control
• fluid intake
• healthy eating on a budget
• reducing the risk of chronic disease eg cancer, diabetes and heart disease
• sports

 
Dietitians are able to prescribe:
 

• nutritional supplements
• tube feed formulas
• vitamin and mineral supplements

 
What's the difference between a Dietitian and Nutritionist? 
 
Dietitians are health professionals registered under theHealth Practitioners Competence Assurance act 2003 and meet standards required by the NZ Dietitians Board. 
 
Dietitianshave a science degree in human nutrition as well as a postgraduate Diploma or Masters in Dietetics. By law, a Dietitian must hold a NZ current practicing certificate, participate in a continuing competency programme and adhere to a code of ethics. 
 
Nutritionists: The term nutritionist is not protected and can therefore be used by anyone regardless of qualifications. Nutritionists who meet set criteria are able to become registered Nutritionists with the Nutrition Society of New Zealand. 
 
Therapy Professionals has a Dietetic service, so if you need help you just call us we come to you. 
 
            Therapy Professionals Ltd
            Phone No:       (03) 377 5280
            Email:              admin@tpl.nz
            Website:         www.therapyprofessionals.co.nz
 

Skin injuries caused by pressure
 
For those of us caring for people who barely move or rely on others to move them, it is important to know how to best look after their skin. Pressure injuries, otherwise known as pressure areas, ulcers or bedsores, are among the negative effects of immobility.
 
What is a pressure injury?
 
A pressure injury is damage to an area of skin, usually around a bony part of the body, which has been under pressure for some time. The pressure stops the blood flow feeding the skin in the area and if the pressure is not removed the skin will break down and eventually become an ulcer.  Friction from chaffing, or rubbing over these bony areas can also cause sores and ulcers.
 
What areas are prone to pressure injuries?
 
The diagrams below indicate where most pressure injuries generally occur, however people with unusual posture may develop them elsewhere.

Who is likely to develop pressure? 
 
Anyone who is immobile or can’t feel any sensations are at serious risk, especially those who:

• are bedridden after surgery or during a long illness
• have a health condition such as diabetes, stroke, chronic obstructive airways disease and malnutrition
• have had pressure injuries before
• sit or lie in one position for hours because they can’t move themselves 

 
 
How will I know someone is developing a pressure injury?
 
The skin area around a bony part of the body may:

• be discoloured - dark or red 
• feel hard
• be warm
• not go white when pressed with your finger
• have a blister, blood blister, crack or open wound

 
How can I prevent pressure injuries?
 
A pressure injury is serious, can take a long time to heal, and many are preventable.
 
We can help prevent pressure injuries by relieving direct pressure on the bony areas, taking good care of the skin and having a healthy diet and adequate fluids.  Here are a few tips:
 
Avoid direct pressure

• change position regularly, at least two hourly
• use special pressure-relieving mattresses and cushions
• don't drag heels or elbows when moving, bathing or dressing 
• make sure the bed sheets and clothesare smooth, not wrinkled 
• use cotton or silk like fabric sheets and clothing

 
Skincare 

• keep skin clean and dry
• avoid scented soaps as they can be more drying
• moisturise skin thoroughly after washing and keep well moisturised
• avoid using talcum powder as this dries the skin’s natural oils

 
Diet

• provide a well balanced diet
• give at least 2 litres of fluid a day 

 
What should I do if you think a pressure injury is developing?
 
Immediately reposition the person to completely take all pressure off the affected area and follow all the prevention tips above.  Seek help from:  

• their GP, who may refer to the community therapy or nursing team if required
• Therapy Professionals Physio, Occupational Therapists and Dietitians.

 
How can Therapy Professional’s Therapists can help?
 
Our therapists can help with:

• education on pressure injury prevention 
• manage current or recurring injuries

 
Dietitians:  advise on:

• nutritional requirements to aid wound healing. 

 
Occupational Therapists: advise on: 

• pressure relieving products e.g. cushions, mattresses, heel protectors
• positioning for pressure relief

 
Physiotherapists:  advise on:

• moving and turning people in bed safely to avoid friction on the skin
• changing position and movements to prevent staying in one position for too long.

 
If you require education on prevention and management of pressure injuries, our friendly Physio and Occupational Therapists and Dietitians can help, just contact us at Therapy Professionals. 
 
Ph:                  03 377 5280
Email:             admin@tpl.nz
Website:        therapyprofessionals.co.nz

Getting yourself up from the floor

Currently, one in seven New Zealanders are 65 years and over. Around 30% to 60% of people in this age group have a fall each year. And 10% to 20% will end up in hospital with a fracture.
 
Those over the age of 85 are 15 times more likely to fracture their hip in a fall than a 65-year-old. Hip fractures can have a huge impact, with 30% of those over 85 who suffer one, requiring placement in aged residential care.
 
It’s important for those of us who are ageing and those around you, to know how to get up off the floor if you are not badly injured. The majority of calls to London ambulances from over 65 year olds are for help after a fall.  Of these, 40% do not need hospitalisation – they simply cannot get up from the floor. 

Many carers hurt themselves, and the person they are trying to get up off the floor, because of lack of knowledge. 
 
To avoid further injury, here are some tips on how to get yourself or help someone up from the floor:

• Stay calm and take things slowly, take some deep breaths.
• Check for injuries like bruises, bleeding, possible sprains and broken bones.
• Check any pain, where is it and how severe it is.
• If there is severe pain or obvious major injury (eg a broken bone), then don’t move.  Call 111. Keep comfortable, warm and as still as possible until help arrives.
• If not badly hurt get up slowly when you’re ready. Stop at any point if you become stuck, experience pain or become too tired to get all the way up.
• Find a sturdy chair or get the person to crawl to a sturdy surface nearby eg some stairs

​Follow the instructions in the Chart below:

Our friendly Physiotherapists recommend all older people, their families and carers practise getting up from the floor regularly, before you need to do so, after a fall. 
 
If you want advice on falls prevention our friendly Physiotherapists can help, just contact us here at .Therapy Professionals

        Ph:                  03 377 5280
        Email:            admin@tpl.nz
        Website:       www.therapyprofessionals.co.nz