How to deal with urinary incontinence in stroke patients

About 40 per cent to 60 per cent of those admitted to a hospital due to stroke complain of loss of ability to control urine – incontinence. One-fourth of them still leave the hospital with urinary incontinence. And, 15 per cent of them will complain of the problem even after a year.

What do the experts recommend for caregivers to deal with the problem?

Bladder leakage is managed with pads and catheters without treating the cause.

Jo Booth, Professor of Rehabilitative Nursing at Glasgow Caledonian University.1

What can stroke carers do to help stroke survivors regain bladder control?

Two methods to regain bladder control

  1. Train the bladder after a stroke
  2. Do pelvic floor muscle exercises

1. How to train the bladder after a stroke

The following infographic summarises the instructions posted on 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

2. 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)

2.1. 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
This image has an empty alt attribute; its file name is 1200px-1115_Muscles_of_the_Pelvic_Floor.jpg
Figure 1: The pelvic floor muscles;
Image source: Wikimedia Commons from Version 8.25 from the Textbook OpenStax Anatomy and Physiology under the license of CC BY 4.0

Do you want to know how a stroke causes bladder problems?

Read the following posts…

References

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



Author: Ed Jerard

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