Ms. Spencer’s goal was to increase her confidence
when traveling by learning to hold her urine
for three to four hours at a time. The nurse supported
Ms. Spencer’s goal by recommending that
she follow an evidence-based, 12-week, pelvic floor
muscle training (PFMT) program. The nurse then
taught Ms. Spencer how to identify her pelvic floor
muscles by imagining that she is stopping the escape
of gas from her rectum and moving the contraction
forward. A pelvic floor muscle examination
enabled Ms. Spencer to experience the sensations
associated with contracting her pelvic floor, while allowing
the nurse to determine the maximum duration
of Ms. Spencer's muscle contractions, so as to
appropriately tailor the first month’s PFMT exercises
(the number of slow and fast pelvic floor muscle
contractions), which would be incrementally increased
in the second month. Ms. Spencer determined
that she could perform the PFMT exercises
four times a day (before getting out of bed, at lunchtime,
after dinner, and at bedtime) in two positions
(lying down and sitting). When the nurse mentioned
that coffee was both a diuretic (because of its caffeine
content) and a bladder irritant (even when
decaffeinated), Ms. Spencer agreed to gradually
reduce her coffee intake, with the goal of eliminating
it from her diet over a two-week period, replacing
it with drinks that contain no caffeine, such as
hot fruit infusions.