Bladders, Bowels, Sexuality…Geriatric OT Marvels
We had a wonderful R.N. named Ruth come in and talk to us about bladder, bowel, and sexuality in the aging. She gave me permission to put up whatever I wanted from her handout, because she said it was all common sense things you could find on the Internet. But still listen to your doctor or OT or other licensed healthcare professional instead of me, the lowly student.
- Loss of bladder capacity to almost half of previous capacity
- Reflex telling us to urinate comes later so older people have to rush to a bathroom
- There are multiple types of incontinence, including transient (like temporarily) or stress (muscle weakness)
- Neurogenic bladder is when the brain and bladder muscles don’t communicate properly anymore. This is frequently seen in MS, Parkinson’s….
- Overflow incontinence: Seen in men with prostate problems – the prostate gland enlarges and blocks passageway so man dribbles urine all day.
Treatments for bladder issues:
Seeing a urologist, stress tests, urinalysis, Kegel Exercises, Biofeedback, Dietary changes, Medication examinations, and more!
- Intermittent catheterization: having to insert a tube inside of yourself at regular intervals to make sure your bladder is emptied.
- Guys are lucky to have condom catheters, while girls aren’t quite so lucky!
- Some condom catheters are held with a band, others with GLUE!!! ::cringe:: apparently it isn’t that strong.
- OTs working in a rehab hospital will frequently encounter Foley catheters…the patient may have a bed bag at night, and then when the OT goes into the patient room in the morning to help with ADLs (activities of daily life), the OT can help the patient switch their bag to a portable leg bag
- Some people spend close to a thousand dollars a month on incontinence pads. In those cases a more permanent catheter may be a better solution.
- Constipation is a big problem for the elderly, with many reasons, including slower digestive system, poor fluid intake, lack of exercise, certain medications, certain diseases…lots of reasons!
- Elderly people often are concerned with having the right amount of bowel movements a day, when in reality there is no “normal” – it can vary substantially
- Laxative abuse is rampant. Laxatives should not be used more than 4x a month or so, roughly.
Treatment can include dietary changes, drinking more, exercising (We saw part of a Richard Simmons wheelchair video!!), stool softeners, suppositories…by the way, she mentioned “Power Pudding” – you can google the recipe – to help with constipation.
- Complications of constipation can include hemorrhoids, anal fissures, and other not fun stuff. If you are helping a patient with ADLs and notice something very wrong with their stool, pass on the information!
OCCUPATIONAL THERAPY WAYS TO HELP PEOPLE WITH BLADDER/BOWEL PROBLEMS:
- Assess hand function and range of motion to make sure they can follow good hygiene
- Make sure the person is educated on possible assistive devices to help in the bathroom.
- Help them learn to wear easy-to-doff clothing so they don’t have to fumble with their clothes when desperate
- Consider a bidet, popular in Europe
- Suggest clearing path to toilet, getting nightlights, grab bars
- Suggest Bedside commode, raised toilet seat, etc…
- Try to help the person get back as much dignity as possible
Wow. Did I mention wow? Wow.
- Women have fewer sexual hormones and lubrication
- Men have slower, quicker erections, less sperm, longer refractory period
- Surgeries, attitudes, alcohol, drugs, disease, depression, and more, can affect sexuality in elders
- Females might try education, counseling, hormone therapy, artifical vaginal lubricants, Kegel exercises
- Males can try education, counseling, penile blood flow studies, suction devices, penile injections, surgical implants, medications..
Side note: We were discussing vaginal lubrication and the nurse got off on a tangent and ended up saying “Wow. How did I get on that topic from vaginal lubrication?” And one of the girls in the class said “That’s ok, I do it all the time!” AHAHAHAHA
- Sexual activity is still possible at older ages, but may require more effort, time, and positive attitudes. (“A woman is like a crock-pot…she needs to simmer…”)
- Sexual activity can be good for the health
- Sex doesn’t have to be just intercourse. Be creative.
- Follow the PLISSIT model: Permission, Limited Information, Specific Suggestions, and Intensive Therapy. Maybe PLISSIT stems from a play on the word Explicit? I don’t know. Basically, don’t shy away from the subject as an OT. Sex is on the forefront for many elderly people and it might be helpful if you bring it up.
- Sex is possible even with catheters and hip surgeries and more.
- If you are uncomfortable with this topic, or feel you have reached your knowledge limit, you can certainly refer the person to a psychologist or psychiatrist or the doctor or whoever needs to know.
Now for the extra amazing part, in my humble opinion.
They were from a medical clinic, but still! We have a 7-foot screen. I don’t care who you are, a seven-foot penis is scary.
The videos were about various ways males can achieve erection, including injections, suction, and implants. They had graphic descriptions of each one, clearly focusing solely on the penis as it became erect, filling up a 7-foot screen. We have Baptists and virgins and your average uncomfortable people in the class, shielding their eyes. I watched it like a train wreck, trying not to laugh. I know it’s a serious topic, but it was a very cheesy movie and I don’t think many people are used to watching these things on gigantic screens. They had cheesy couples who would say things like “I take it. It works.” – “I even help with the injection. It’s part of our lovemaking.” My favorite part was when the cheesy announcer guy talked about how Viagra was invented in the 1980s as a heart drug, but…”It didn’t do much for men’s hearts, but talk about a happy accident.” AHOSEEOHAHAHAHAHAHAH!!!!!!!! I love it!!!! It does kind of kill me though, that Medicare will not pay for shower benches but it will pay for Viagra.
So anyway…there are lots of ways to make sex possible and comfortable for elders (or those with disabilities in general and according to “Cookie Gimp” there is a better medical clinic video I need to see, showing couples with disabilities having intercourse.) It’s important as an OT to be aware of the sexual needs of elderly people and not be afraid to discuss it. It’s an activity of daily life and there are a lot of options.
Finally, I want to know if senior erotica exists. If it doesn’t, I’m totally getting a part-time job, writing it!! Seniors are our fastest growing population and they need some good reading!
Update: There is an unmet need for senior erotica, based on my google searching…