Best practices for caregivers to regain bladder control after a stroke

About half of stroke patients lose bladder control. One-fourth leave the hospital with the problem. Still, 15 per cent deal with it at the year’s end.

What are the best practices to regain bladder control after a stroke?

Standard guidelines recommend two best practices.

Bladder re-training with timed toileting.
Pelvic floor muscle strengthening.

Bladder re-training with “timed toileting (voiding):

The 2023 UK National Guidelines for Stroke recommend “timed toileting” to improve bladder control after a stroke.

What is timed toileting?

“Timed toileting” helps to “re-train the bladder after a stroke. It is a behavioural technique.

To achieve that, we need a bladder timetable.

The following infographic list steps you can follow to create a bladder time table. It is available at the the UCSF³ (the University of California San Francisco) Health website.

Step 1: Create a three-day bladder diary to understand the nature of the problem
Step 2: Create a urine void timetable
Step 3: Increase the interval by 15-minute increments weekly until you reach the 3-4 hour interval; when you feel the urge before the time suppress it; use relaxation methods
Step 4: Continue the exercise for 6-12 weeks; there will be good days and bad days in between.
Step 5: Complement it with daily pelvic floor muscle exercises

Pelvic floor muscle strengthening

The guidelines also recommend training pelvic floor muscles.

How to train pelvic floor muscles

Step 1: Locate pelvic floor muscles (read the next section)
Step 2: Create a timetable for exercises: At breakfast, lunch, dinner, and before bedtime; make it a habit
Step 3: Squeeze the muscles for a slow count of three; then relax in the same way; do 15 times in one set; increase the count gradually.
Step 4: Maintain a bladder diary (download the template from their website, and modify it to suit your needs)

How to locate pelvic floor muscles (Figure 1 below)

Method 1: Tighten the anus as if not to pass gas
Method 2: insert a finger into the vagina and try to squeeze the finger
In both situations do not tighten the abdominal, buttock, or thigh muscles

An educational graphic tool (Figure 1)

Pelvic floor muscles: A graphical presentation

Do you know how a stroke causes bladder problems?

Read the following posts…

How stroke robs bladder control: strokecarer.com
What bladder problems stroke can cause: strokecarer.com
How measuring urine leak helps in bladder control activities
University of Health Network: How to do pelvic floor muscle exercises: University Health Network: This includes a graphical presentation of pelvic floor muscles and some other methods of locating the muscles.

References

Jo Booth (2019): Bladder rehabilitation in stroke survivors: who don’t nurses do it? The British Medical Journal blog/Evidence-based nursing
Royal College of Physicians (2016): National Clinical Guidelines for Stroke, NICE accredited
University of California San Francisco (UCSF Health): University of California San Francisco; bladder re-training.
University of California San Francisco (UCSF Health): University of California San Francisco; pelvic muscle exercises
Stroke Network, SouthWest Ontario: Module 4: Incontinence.