Cath Lab Digest

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Randomized, controlled trials⁴⁰ involving anorectal instrumentation to encourage patient awareness and subsequent modification of voluntary functions have been conducted in medical and surgical patients. Results from these trials ranged from no significant difference between the biofeedback groups and control groups to significant difference between the two. In a randomized, controlled, prospective trial, Aksac et al⁴¹ studied pelvic floor muscle exercises or biofeedback in 50 patients who had urinary stress incontinence. Patients were randomized to three groups. Persons in group one were taught pelvic floor muscle exercises by way of digital palpation and then taught to perform this palpation at home. Group two was taught pelvic floor muscle exercises through biofeedback three times weekly for two months. Group three did not have any exercises. The first two groups significantly improved their urinary stress incontinence versus control (P <0.001). Biofeedback may be applicable to some patients with chronic wounds and is certainly worth a try.

  Urinary incontinence (eg, urge incontinence, stress incontinence, and overflow incontinence) in the elderly may be minimized in frequency or prevented using biofeedback and pelvic floor exercises.⁴¹ As with fecal incontinence, urinary incontinence may lead to skin breakdown and poor wound healing in patients with chronic pelvic wounds wearing containment briefs for prolonged periods of time, which needs to be minimized. In an uncontrolled pilot study, Vaughn et al⁴² studied the effect of biofeedback and pelvic floor muscle exercises in 20 patients with Parkinson disease who had at least four episodes of urinary incontinence per week. The authors concluded that, in this study population, biofeedback- assisted pelvic floor muscle exercises reduced the frequency of urinary incontinence, and improved the patients’ quality of life.

  Other controlled and uncontrolled clinical trials^43,44 in the elderly and in urogynecological patient populations comparing pelvic floor exercises with and without biofeedback, acupuncture, hypnosis, and herbal therapies have been published. Of the interventions cited, authors concluded biofeedback has the most promise for success in reducing urinary incontinence frequency.

  Peristomal skin complications. Peristomal skin complications (eg, regarding ostomy and stoma) can have an impact on the chronic wound patient’s quality of life and risk of wound infection. The Paula Erwin Toth (PET) model⁴⁵ for ostomy care involves assessing the patient’s intrinsic environment, extrinsic environment, and topical wound care to develop a comprehensive nursing care plan for the patient and helps in the development of the ostomy nursing care plan.

  Nutrition/dietary supplements. Chronic wound patients are at risk for nutritional deficiencies. The best integrative nutritional plan for general health, including wound healing, starts with the Mediterranean Diet because it details a diet rich in protein, antioxidants, and anti-inflammatory foods that assist the body’s natural immune system in healing.⁴⁶ Colorful antioxidant foods recommended in this diet include, but are not limited to, blueberries, cherries, tomatoes, green tea, red grapes, and red wine.⁴⁷ Resveratrol is an antioxidant found in the skin and seeds of red grapes.⁴⁸ Anti-inflammatory foods are canola oil, extra virgin cold pressed olive oil (MUFA), walnuts, oily fish, and avocados. In addition to featuring antioxidants and anti-inflammatory foods, the Mediterranean Diet encourages the intake of protein through such foods as kidney beans, pinto beans, fish, low fat dairy, Quinoa, and nuts; oily fish containing omega-3 fatty acids and protein include sardines, herring, wild pacific salmon, and light canned tuna.