Supporting Neurogenic Bowel & Bladder: The OT’s Role in Self-Catheterization

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More about my guest:

Carly Rosenthal, MS, OTR/L an occupational therapist located in Philadelphia, PA who graduated from Thomas Jefferson’s Occupational Therapy program in 2019. Currently Carly works both in a pediatric inpatient rehabilitation program as well as owning her own pelvic floor therapy practice, Enliven Occupational Therapy. While she loves helping children with their pelvic floor dysfunction, she is particularly passionate about assisting both children and adults who face challenges with neurogenic bowel and bladder. She has extensive experience in helping individuals with spinal dysfunction attain functional continence. Each person's journey is unique, and she loves collaborating to find tailored solutions that enhance their daily lives. The combination of creativity, problem-solving, and compassion involved in this work truly inspires her.

How to contact: 

email: carlyrosenthalot@gmail.com

instagram: @enliven.ot

website: www.enlivenot.com

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Transcript

Lindsey Vestal (00:00):

My guest today is Carly Rosenthal, who's an occupational therapist in Philadelphia, Pennsylvania, who graduated from Thomas Jefferson's OT program in 2019. She works both in the pediatric inpatient rehab program as well as owning her own pelvic floor therapy practice and live in occupational therapy. While she loves helping children with their pelvic floor dysfunction, Carly is particularly passionate about assisting both children and adults who face challenges with neurogenic bowel and bladder. She has extensive experience in helping individuals with spinal dysfunction attain functional continence. Each person's journey is unique and she loves collaborating to find tailored solution that enhance their daily lives. The combination of creativity, problem solving, and compassion involved in this work truly inspires her. All right, let's get into today's conversation. New and seasoned OTs are finding their calling in pelvic health. After all, what's more a DL than sex peeing and poop? But here's the question. What does it take to become a successful, fulfilled, and thriving OT in pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions, and this podcast will give you the answers. We are inspired OTs. We are out of the box OTs. We are pelvic health OTs. I'm your host, Lindsay Vestal, and welcome to the OTs and Pelvic Health Podcast.

(01:41):

Carly, it is so awesome to have you as a guest on the OTs for Pelvic Health Podcast. Thank you for being here.

Carly Rosenthal (01:48):

Yeah, thanks for inviting

Lindsey Vestal (01:49):

Me. This is going to be so much fun. I want to hit the ground running and just ask you a question if you could share just a little bit with us about your journey as a pelvic floor therapist and specifically how self catheterization became an area of focus in your practice.

Carly Rosenthal (02:07):

Sure. So when I was in OT school, I had a teaching assistant who helped us learn how to get people in and out of their wheelchairs. He was someone with a spinal cord injury, and at the end of our class, he was like, oh, I do this thing called quad rugby and you should come out and join us. And so I was like, that sounds interesting. So I went out to the Philadelphia wheelchair rugby teams practice when I was in my first year of grad school at that point, and I just sort of was like, oh, I really love this. And then I got hooked in with an individual on the team who needed a home health aide. And when I was in grad school, I became one of her primary home health aide. So she was an individual with a high spinal cord injury.

(03:12):

She was a quadriplegic. And I really became intimately aware of what successful bowel and bladder routines look like for someone who's five years, 10 years, 20 years post-injury, both through working with a wheelchair rugby team and through working with a woman who I'm her home health aide. And fast forward I graduate OT school. I sort of jump around to a couple different jobs, and I eventually found myself in an inpatient pediatric rehabilitation hospital, and I got my first spinal cord injury patient and I was like, whoa, the hospital is so much different than what people do in real life. And that inspired me to really sort of reinvent the wheel at my specific hospital. And so I worked really closely with the physicians and the nurses and the therapy team to sort of recreate our hospital protocols around spinal cord injury, bound bladder management in pediatrics, which I came to learn that there's not a lot of standards of care when it comes to pediatrics.

(04:45):

There's tons of information out there when it comes to adults, but in pediatrics there's very little information. So I reached out to my network and I found some really awesome people all across the country and sort of helped gather their information and then recreate my hospital's protocols. And so I ultimately became the pooping and peeing lady at my hospital. And after that I was like, okay, I think I want to get to know this topic a little bit more. And I started taking coursework in pelvic floor therapy, took their level one, I took their level two, I took Dawn's pediatric class, and I've sort of combined all of that information to both. So right now I still work at the pediatric inpatient rehab center, but I've also opened up my own practice where I'm seeing both pediatric pelvic floor therapy patients as well as individuals with neurogenic bound bladder. So I found this really specific niche area where I help individuals really become more independent with their bowel bladder routines.

Lindsey Vestal (06:04):

That is incredible. What a story. I really appreciate that it went back to OT school and just sort of that really organic opportunity to go, what was the sport called again?

Carly Rosenthal (06:18):

It's quad rugby right now. It's called the U-S-W-R-A, so the United States Wheelchair Rugby Association. Oh my

Lindsey Vestal (06:29):

Gosh. And I know that feeling when you're a student and it's just like an opportunity just feels like gold. You're just like, I'm soaking this all in. And I just love that you can reflect on that now and be like, that was a pivotal moment for me that set up a chain of events, and I wish our listeners could see you, but you just have this huge smile on your face right now. You clearly have found your passion and your life's work, and I don't know. I appreciate that story so much. This is awesome.

Carly Rosenthal (06:57):

Yeah, I'm so thankful. I have my team still the ones who I text when I'm like, okay, I have this patient. What do you guys think about this? And they always have the best ideas.

Lindsey Vestal (07:10):

I'm so curious why you think there's not a lot of information out there about the pediatric clients.

Carly Rosenthal (07:17):

I wish I could tell you. So right now there's huge amounts of information on the adult patient. What is the name of them? The there's the Paralyzed Veterans of America. The PVA has this huge book of information about what the standard of care is for bowel bladder management. There's stuff out there, multiple different organizations have published stuff, but it's just the same amount of information just doesn't exist in the pediatric world.

Lindsey Vestal (07:55):

Maybe that's your second act creating that. That's so cool. For listeners who may not be familiar, would you mind just taking a step back and explaining why self cathing, what self selfing is and why someone might need to do it?

Carly Rosenthal (08:12):

Yeah, sure. So typically self cathing is done for individuals who are having a difficult time emptying their bladder voluntarily. So this could be due to a lot of different reasons. One of the main ones is though, is a neurogenic bladder. And that could be from a spinal cord injury, spina bifida, multiple sclerosis, cauda aquina, tethered cord. But you can also need to self cath for diagnosis like prostate tumor enlarged prostate, or even during pregnancy, people could have to catheterize. So neurogenic bladder occurs due to nerve damage and it can be from the spinal cord or it can also be from the brain itself.

(09:05):

And neurological issues in the bladder can be in the bladder itself, in the bladder neck or in the sphincter. So in the hospital setting, the way that someone would catheterize would be you get sort of a standard non lubricated catheter. You open up the package, you dip the catheter into the lubricating jelly, and you insert the catheter into your urethra and you wait for the urine to flow, and then you remove the catheter out, you dispose of the urine. But it sort of gets tricky when there are certain client factors or things that make the catheterization process more challenging. So that could be things like low dexterity, it could be things like executive dysfunction, but it can also be really tricky when you have female anatomy that you are working with. So finding a urethra for someone with male anatomy is pretty easy. Finding your urethra when you're a female can be pretty hard.

(10:21):

So there's a lot of different catheters and adaptive tools on the market that can help address each of these different roadblocks that you might encounter. Just an example of some of them. So there are catheters that are pre lubricated, and that might help for someone who needs less steps to the process or wants to carry around less supplies with them. There are catheters that are more flexible and less flexible. Someone with female anatomy may prefer a catheter that's less flexible because the flexibility of the catheter can make it hard to insert. Someone with sensation may prefer a more flexible catheter because it's less painful. There's closed system catheters, there's open system catheters. What an open system catheter? Sorry, what? A closed system catheter is one that has a bag attached to it and potentially is completely encased in some sort of sheath. And that can help with preventing infections. It can help with someone who also has low dexterity and may not be able to manage a urinal or a toilet or something like that. Or for someone who just can't get out of their wheelchair to cath and might require the extra packaging for the urine to catch into to allow them to be more independent with the routine.

Lindsey Vestal (12:05):

That was so helpful. I really appreciate the way you broke that down. I definitely understand it a lot more now. I think probably I would imagine a really important part of the work that you do is helping clients learn self cathing in a way that really feels empowering rather than intimidating. Would you mind sharing how you approach that?

Carly Rosenthal (12:28):

Sure. So I always start my teaching for self catheterization training with learning about how the bladder and the body works. I think it's really important to go back to how a typical bladder might work, and then talking about how someone's specific diagnosis may affect their ability to void. And then I think that helps provide some context to the situation and helps with a little bit of motivation as to why they might have to start this routine. And then another thing I'm huge on is the anatomy lesson. So most of my experience is actually teaching in the pediatric population. So adults may have more information about anatomy, but not always. And so I bring out my trusty pelvic model, and a lot of times for my females, I point out we have three holes. There's a urethra, there's a vagina, and there's an anus. And then we talk about what happens for each of those holes. And so I think that's super important, especially with my kids. I stay in a super anatomically correct sort of language for them. I think that helps empower them and makes it not like an awkward thing. And I really encourage parents and families to also use anatomically correct language.

(14:09):

I also really love using medical play with my kids. So what that might look like is before we start working on independent self cathing, I might pull out all the supplies that's required in self cathing, and we go into one of our playrooms and we pull out the catheters and we have dolls that have penises and vaginas, and we work on talking about it and naming them and naming the supplies that are required. And I have food coloring and we dye some water yellow. And it's just really fun. And I try to make it as fun and unstressful as possible for the older kids and adults I work with. I really tend to talk about it in the context of how self ing can open up their world. And so it's not only from the perspective of you might not need someone to help you with this anymore once you learn this routine, but think about all the things you can do once you learn this. For my kids, it's sleepovers. For the adults, it's like, oh, I can go out on a date, or I can hang out with my friends without needing someone there to help me. But also talking about it in the context of how self cathing can help with medical things. So if you are the one who self casts, there's actually research out there that shows that it reduces UTIs, which is really interesting to me. If a caregiver casts you, you're actually at increased risk of UTIs. If you cast yourself, you're at decreased risk for UTIs.

(15:50):

And then finally, for the older kids and adults who are experiencing some difficulty, I really love pairing them with someone who's at a similar functioning level to them. So working through peer mentors, working through finding individuals who are similar to them and talking through how they manage it. So I think that's so important because a lot of times people look at me and they're like, well, it's easy for you to say that I can do this by myself. But when you see someone who also might have to use tenodesis to grasp and they're like, oh, okay, I see that I can make this work.

Lindsey Vestal (16:35):

Oh, that is so incredible. There's so much about what you said that was so, so novel, and I can see just how much you approach your work from that OT perspective. I really love the peer mentoring that you're doing. I think that's got to be so empowering on so many levels. Super quick question. Do you know why those statistics vary so much with UTIs versus doing it yourself versus someone else doing it to you?

Carly Rosenthal (17:01):

Yeah, I think it's about the introduction of new bacteria. So we're all colonized on our bodies and on our skin and stuff like that. And so when you're introducing a new person's microbiome into the situation, that's when things tend to pop up.

Lindsey Vestal (17:22):

That makes sense. Cool.

Carly Rosenthal (17:24):

And I also wanted to add, I feel like adaptive sports actually is a huge help with learning to be independent in your bowel and bladder routines. Not only is it a supported environment to help with talking with individuals who are similar to you, but you also have supported traveling opportunities supported the first time you go to a hotel and you can't get into the bathroom, what do you do? So I feel like I always, always recommend being a part of adaptive sports. I think it's just such an important and unique opportunity to be around people who are similar to you.

Lindsey Vestal (18:04):

Yeah, I think you're right. I think that is pretty essential. What role, in your opinion, does pelvic floor therapy play in supporting clients who need to self cath? And I'm thinking possibly beyond just the mechanics of the process.

Carly Rosenthal (18:24):

So this task requires a lot more than just the task itself. So when individuals are needing to self cath, it's a whole team effort. There's a medical provider that determines if cathing is required, which is sometimes based on diagnosis. Other times it's determined based on testing for something like a urodynamics test, the medical provider then assists in writing the prescription, which includes how many catheters someone needs in a day, how often they need to do it, what type of catheter. But in the background, there's also a lot of other people working on self cathing. So in a traditional sense, a nurse would be teaching self cathing in an inpatient rehab setting or in a urology office. But I think there's a huge role for OTs and pelvic floor therapists to assist with some of the teaching for more complicated situations. So I think there's a lot of room for therapists to be involved with people with impaired executive functioning skills that help determine if they need reminders on their phone to help figure out if the person has low dexterity, what to do positioning wise, if someone has tone in their adductors, how they're going to manage spreading their legs wide enough to be able to cath, I think.

(20:06):

And there's also room for the emotional support of it. So when a medical provider is teaching someone in a medical office, you're given an hour to learn how to do this, versus when you're working with an OT or a pelvic floor therapist, there's so much more room to be like, well, I'm really nervous about my partner finding out that I need to self cath. I'm really worried about my friends at school figuring out that I need to do this. And having the space and environment to be able to talk through some of those things, I think is just invaluable.

Lindsey Vestal (20:51):

Oh, absolutely. Those were really powerful examples. I am imagining there are quite a few listeners and join today's podcast and would love to hear some advice from you regarding what they can do next. What can they do to really move forward and learn more about this? Specifically the self Catholic aspect of everything you're talking about?

Carly Rosenthal (21:23):

Yeah. So my number one thing is don't be afraid to help with this task. And this is not just for a pelvic floor therapist or someone in an inpatient rehab. I'm talking about your school-based therapist, your outpatient therapist, your acute care therapist. I think as, I think OTs really just have the skills needed to help with self cathing. I feel like this always gets brought up in your podcast, but activity analysis is the bread and butter of needing to be able to help someone teach this task. So you think about it, the basics of self ing. The person has to open up the catheter, blah, blah, blah. But when you're able to figure out what the breakdown is in that routine, then you can help them. So you don't even need to help someone with inserting the catheter. If you are the school therapist and you know that you have a kid who needs to self catheter is an independent, how do you figure out what the environmental context is that can support them?

(22:37):

How do you figure out, I said this before, but the reminders that get set up on your phone so someone doesn't have to come into the classroom in order to remind someone to go to the nurse's office. So the acute care therapist, providing permission for that person to explore and be okay with this routine. And talking about with someone who might be newly spinal cord injured, talking about how they might be able to help with this task or routine and how that might provide them a little bit more control in the situation. I think that's so important. And when we're bringing it back to the activity analysis, when you're really able to break down the client factors, the performance skills, performance patterns, the context, you really can help so much with this routine. It's a scary one, I think, for people, but I think there's so much that people can help with other than just the insertion of the catheter, which I think people really get nervous around.

(23:40):

There's so much bigger than just that task or just that piece of the task that I think really everyone should be involved with helping someone become independent with this. And then on top of that, I think a pelvic floor therapist really understands the, we have knowledge around bowel and bladder functioning, and the habits surrounded around cathing can be so important. So we know about bladder irritants, we know about how constipation affects your bladder capacity. We know about the importance of the time of day that you void and the activities around it and how to choose about those routines and when to do them. So I think it's so important to support someone just purely in the independence with the routine, but there's so much around that routine that is also important to discuss and talk about that. I think really OTs are uniquely positioned to help someone with this. But also pelvic floor therapists are also uniquely positioned to help someone be independent incontinent with their self cathing.

Lindsey Vestal (25:01):

Yes, yes. I could not agree more. Carly, I have one last question for you, which are there any resources, anything that you can share with our listeners who want to learn more, including if they happen to be going to the A OTA? I heard you may be speaking there.

Carly Rosenthal (25:18):

Yeah, so I'm really excited. But me and a couple other therapists that I've found along my journey, I like to call them my spirit animals. They're like the other people in the world who helping other people learn how to self cath. I'm doing a presentation at A OTA, it's Friday afternoon from 4 45 to 5 45, and it's called Streamlining Success, OTs role in Self catheterization.

Lindsey Vestal (25:53):

Wait, that's literally my favorite title. A OT presentation.

Carly Rosenthal (25:58):

We had to do something, pun it was like me and one of the other therapists that's in it. One of the things that we really bond over is the puns, so we had to include that in our title. But I think if you're looking for other resources, I am a believer that YouTube is a really important place when you're learning to self cath. So there's a huge amount of individuals with spinal cord injuries who have just found that the internet, just Google searching things is not adequate. And so they've taken it upon themselves to actually upload videos of how they personally self cath.

Lindsey Vestal (26:38):

That's incredible.

Carly Rosenthal (26:39):

There's individuals who have female anatomy, male low dexterity, have require tenodesis, require adaptive tools, and you can sort of see how they do it. And I love actually pulling up these videos with my patients and I say, your similar spinal cord injury level to them, what do you, what information do you think you could pull from this? So I think that's super helpful. I'm all about the real person and the real situation and the things that are going to work in real life.

Lindsey Vestal (27:14):

Carly has been such a pleasure talking with you today and just getting a small glimpse into your world. How can people find you, connect with you if they want to be a spirit animal with you,

Carly Rosenthal (27:28):

Come be a spirit animal. So the private practice I just opened up is called Enliven Occupational Therapy am on Instagram. I'm on Facebook. I have a website, and I think I can share that information with you, Lindsay, to maybe post in the notes. Yep. Yeah. So feel free to reach out to me. I absolutely love connecting with other people who are just as passionate, helping individuals with neurogenic bound bladder as I am.

Lindsey Vestal (28:00):

Thanks for listening to another episode of OTs and Pelvic Health. If you haven't already, hop onto Facebook and join my group OTs for Pelvic Health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and post it to ig, Facebook, wherever you post your stuff. And be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic Health Podcast.