Tuesday, October 4, 2022

Management Of Urinary Incontinence In Stroke Patients

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Getting Individual Assessment And Treatment

Managing Incontinence Post Stroke

It is vital you seek treatment, because most bladder and bowel problems can be improved. If you are caring for a stroke survivor with bowel and bladder problems, you should be given advice on how to help them.

Your medical and nursing team will assess and treat your bladder and bowel problems. They should help you to understand the causes of your problems, and support you to make lifestyle changes and perform exercises and training to manage your bladder and bowel.

The assessment may include:

  • A history of any bladder and bowel problems you had before the stroke and your current medication.

  • A diary recording what you drink and how much urine you pass over two to three days.

  • A urine test to rule out infections.

  • A diary of your bowel movements.

  • Other tests may include a physical examination, a bladder ultrasound scan, abdominal X-ray or specialist investigations to find out how the bladder and bowel are working.

Help with continence problems

If you have good bladder and bowel function but you cant tell anyone when you need the toilet because of a communication difficulty, staff may offer you the toilet or commode every two hours or so. You could be offered a bottle or sheath urinal or a bedpan .

Until you can start to regain control of your bladder or bowel, you may be offered absorbent pads. These should be changed immediately if they become soiled. Good hygiene and skin care are important to protect your skin from damage.

Which professionals can help me?

How To Deal With Incontinence After Stroke

Friday, November 30th, 2018

More than 15 million people suffer a stroke worldwide each year. Approximately half of all stroke survivors admitted to a medical facility will be affected by temporary bladder incontinence and one in three will struggle with bowel incontinence. Losing control of ones bladder or bowel movements can be frustrating and embarrassing for survivors. Fortunately, there are many strategies to help survivors regain bladder and bowel control after suffering a stroke. Its important to remember that every stroke is different and every recovery and rehabilitation model will be unique for each stroke survivor. In this case, it all starts with a greater understanding of the causes of incontinence.

New Frontiers And The Place For Plasticity In The Rehabilitation Continuum

Rehabilitation after stroke is often focused on compensatory strategies to restore function rather than improve impairment. An example is learning to dress with one arm rather than focus on retraining use of a patients hemiparetic upper extremity. Such emphasis on compensatory strategies has increased with cost reduction measures that have resulted in shorter acute rehabilitation lengths of stay. These decreased days in inpatient rehabilitation settings have been shown to result in worse discharge outcomes. In addition, focus on compensatory techniques to complete functional tasks at the expense of therapy directed toward remediating impairment could facilitate learned nonuse of a paretic extremity.

Neural plasticity has been defined as any change in neuron structure or functions that is observed either directly from measures of individual neurons or inferred from measures taken across populations of neurons. A rapidly expanding body of evidence using both animal and human models has shown specific motor stimulation or movement can induce changes in the motor cortex both on a cellular level, as well as in the representative cortex devoted to limb or finger movement. The profound implication of these basic research findings has inspired application towards recovery efforts for patients with various neurologic pathology, including stroke.

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Pelvic Floor Muscle Exercises

The pelvic floor is layers of muscles that stretch from the pubic bone to the coccyx and then from side to side. These muscles help to support the bladder and bowel plus the womb in women. These muscles can become weak through trauma such as childbirth or surgery, changing hormones, persistent coughing, chronic constipation or even damage caused to the brain such as from a stroke. When these muscles become slack it can weaken the sphincter muscle to the rectum or bladder allowing the involuntary passing of stool or urine. Click to read more about pelvic floor muscle exercises.

Exercises In Bladder And Bowel Control

PPT

These are common techniques and exercises for bladder and bowel retraining:

  • Timed voiding. Also known as prompted voiding, it involves scheduling bathroom breaks at specific times to avoid the sudden and uncontrollable need to go. The goal is to increase the length of time between scheduled bathroom breaks.
  • Urgency control. A combination of deep breathing and complex mental tasks help ignore the need to go. One example of a complex mental task is counting down from 100.
  • Pelvic floor muscle training. Also known as Kegel exercises, builds strength in the pelvic floor muscles leading to better muscle and bladder control.
  • Medication. Stool softeners or laxatives can help with bowel incontinence and other medications can help with urinary incontinence.

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Appendix 1 Search Methods And Terms Used For The Extra Specific Searching For This Review

Due to the comprehensive nature of the searches already performed by the Stroke Collaborative Review Group, no additional searches were performed other than on CINAHL, combining stroke terms with terms for urinary incontinence without a research methods filter. This was done because of the potentially poor indexing of nursing research. The following strategy was used to search CINAHL on Dialog Datastar:

Key: # = explode, .de = index word, $ = wild card.

The above search was combined with the CINAHL search from the Cochrane Stroke Group.

Recent unpublished trial data were also searched for on national and international databases i.e. NHS National Research Register, NHS Research Findings Register, US Community of Science NIH Grants, MetaRegister of Controlled Clinical Trials and CRISP, by adapting terms drawn from the existing search strategies of the Incontinence and Stroke Review Groups.

The reference lists of all relevant reviews and trial reports were searched to identify further relevant studies. Major investigators were contacted to ask for any other possible relevant trials, published or unpublished. In addition, contact was made with the authors of other relevant Cochrane reviews to ascertain whether defined subgroups of stroke survivors were identified in trials testing methods of promoting continence in a general population.

We did not impose any language or other restrictions on any of these searches.

Managing Urinary Incontinence After Stroke

After a stroke, tell your health care provider if you have leaking urine and practice good personal hygiene by wearing clean, dry clothing and cleaning daily your perineal area.

Following a stroke your bladder might not function as smoothly as it did before the stroke. Incontinence is the loss of voluntary control over urination or wetting your pants. Incontinence is a treatable medical condition.

Functions of your Bladder

The bladder has two functions: to store urine and to pass urine.

What are medical reasons for Urinary Incontinence?

  • Chronic illnesses such as stroke can slow your physical function, like walking, and ease of getting to the toilet.
  • You may have a bladder infection. Check to see if you have a fever, cloudy urine, bad smelling urine, burning with urination, feeling confused or disoriented.
  • Urethritis in men or women and vaginitis in women can cause loss of bladder control.
  • An enlarged prostrate gland in men can cause the bladder to not empty all the way.
  • You may not be drinking enough fluids. Low fluid intake could affect the signals to urinate.
  • Medications such as tranquilizers, sedatives, hypnotics, and antidepressants may cause changes in bladder muscle function and decrease your sensitivity to body signals.
  • Use of diuretics, water pill, should be timed around activities where you plan to leave home. Taking the pill in the morning and not at bedtime will help avoid incontinence.

What Causes Incontinence?

The distance to the bathroom may be too far.

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Urinary Incontinence Poses Burden To Long

The impact and management of urinary incontinence related to overactive bladder is a substantial burden to long-term care residents and staff, according to a study published online July 1 in the Journal of Gerontological Nursing.

Richard G. Stefanacci, D.O., from Thomas Jefferson University in Philadelphia, and colleagues assessed the impact of UI on residents, staff, care processes, and quality measures in LTC settings. The analysis included responses from directors of nursing who had worked for at least one year in a 100-bed facility.

The researchers found that of the 62 percent of residents with UI, 40 percent were always incontinent and 81 percent used incontinence products for UI. Nearly six in 10 respondents reported that UI management contributes to certified nursing assistant turnover. More than one-third of resident falls occur while the resident is trying to get to the bathroom, and LTC quality measures significantly impacted by UI included urinary tract infection and falls with major injury. Few residents with UI were treated with medication.

“The impact and management of UI related to overactive bladder is a substantial burden to LTC facilities, as well as to their residents and staff,” the authors write. “These results highlight the need for improved UI treatment, awareness, and management in this population.”

Explore further

Ethical Approval And Trial Registration

Incontinence: Tips to Manage

This study was performed according to the ethical guidelines of the Declaration of Helsinki and approved by the Eastern Switzerland Ethics Committee responsible for the same. All participants or their representatives provided oral and written informed consent. The study was registered in the German Clinical Trials Register .

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Tips For Dealing With Incontinence After Stroke

Because incontinence after stroke can significantly affect ones quality of life, its essential to be prepared to prevent or handle accidents.

Based on feedback from other stroke survivors, here are some useful tips for dealing with the symptoms of incontinence:

  • Add waterproof pads beneath bedsheets
  • Protect furniture with plastic covers
  • Keep an extra set of garments in all bathrooms
  • Give yourself extra time to get to the bathroom
  • Use undergarments that you dont mind tossing out
  • Keep an extra set of clothes in your car
  • Have hand wipes and sanitizer nearby at all times

These tips help you deal with the unavoidable results of incontinence. Now lets move onto some treatment options that can lessen these effects.

Transcutaneous Electrical Nerve Stimulation

The use of TENS therapy to treat urge incontinence in the non-stroke population has a growing body of evidence to support it.18,19 There have, however, only been two small RCTs that have reported on its use in stroke survivors.21,22 Guo et al. randomised 61 participants to 30 minutes of TENS therapy at 75Hz once daily for 60 days or usual therapy. The results demonstrated a positive impact in favour of the treatment arm in all three primary outcomes of improved pre-/post-overactive bladder symptom score, Barthel Index of activities of daily living score and urodynamic values.

The statistically significant results also suggested improved bladder capacity for those in the treatment arm.21 The second RCT in 81 participants aimed to study what effects TENS therapy at two different frequencies had on post-stroke UI.22 A group receiving basic rehabilitation and no TENS therapy was used as a control. The study protocol maintained that both treatment arms received 30 minutes of TENS therapy a day for 90 days at their respective frequencies. Primary outcomes were identified as pre-/post-overactive bladder symptom scores, Barthel Index of ADL scores and urodynamic values as well as the number of UI episodes within a 24-hour period. The results again demonstrated statistically significant improvements in all primary outcomes in favour of both treatment arms when compared with control.

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What Causes Urinary Incontinence After A Stroke

There are multiple causes for UI after a strokeAlso called a brain attack and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a schemic stroke, or the formation of a blood clot in a vessel supplying blood to the brain. More:

Pelvic Floor Muscle Training

Nursing care across the acute stroke

PFMT is recommended as an intervention to manage post-stroke UI14 with RCT evidence confirming its importance within the female population.23 Shin et al. randomised 35 female participants to either an experimental group or control . The experimental group received 50 minutes of PFMT, three times per week for six weeks, while the control group only received basic education around the pathophysiology of UI and the function of the pelvic floor muscles. Both groups were assessed using pre-/post-maximum vaginal squeeze pressure , pelvic floor muscle activity and the Bristol Female Urinary Questionnaire to ascertain the inconvenience of lower urinary tract symptoms on their ADLs. In all outcome measures, results significantly favoured the intervention over the control group vs 8.83 mmHg post-PFMA: 12.09 µV vs 9.33 µV post-BFUQ results: 15.92 vs 0.08 .23

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Potential Biases In The Review Process

The original protocol for this review specified inclusion criteria for participants as having had a stroke in the previous 12 months, but this definition proved unworkable, because most of the trials did not specify or report time since stroke. There was also a lack of clarity about whether urinary incontinence was subsequent to stroke. Only three trials specified that urinary continence problems were subsequent to stroke, and detailed the time since stroke onset. For this reason, the extent to which the results for the remaining trials can be generalised to people with continence problems solely as the result of a stroke is unclear.

Other Things You Can Do

A dietitian can help you get the right balance of fibre and fluid in your diet. If you increase the fibre in your diet you may need to increase the fluid you drink too.

Drink up to eight to ten cups of fluid a day. Water is best. This can help stop bladder irritation and make it easier to pass faeces. Try to reduce your intake of drinks that make you need to go to the toilet more often. This includes drinks with caffeine such as tea and coffee.

Set up your toilet and bathroom so you can get in quickly and safely. Wear clothing that can be undone quickly.

Before you leave hospital make sure:

  • You know how to manage your incontinence.
  • You can access any continence aids you may need.
  • You know about follow up appointments you may have.
  • Your family know about your difficulties and the plan to manage them.

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Physiotherapy And Occupational Therapy

Physiotherapists can help with exercise routines designed to improve strength, mobility and coordination following a stroke. They can help to teach pelvic floor muscles exercises to gain continence and help the person to learn the best way for to transfer from the bed to the toilet or a commode.

Occupational therapists can help assess a persons home situation and see whether they would benefit from any medical aids that can help make life easier such as handrails in the bathroom for balance, walking aids, commodes or wheelchairs.

How Does Urination Work

Incontinence, Urinary Tract Infection (UTI), Pyelonephritis – Medical-Surgical (Med-Surg) – Renal

When we eat or drink, liquid is absorbed into the bloodstream. The kidneys then filter the blood and get rid of liquid waste by way of urine. Special tubes called ureters bring this waste to the bladder.

The bladder is a muscular sac that serves as a reservoir for urine. When the bladder becomes full, your brain triggers the urge to void. Once you make it to the bathroom, your brain does two things to allow urination:

  • It tells the bladder muscles to squeeze the urine out.
  • It tells the muscles of the urethral sphincter to relax.
  • You can think of the urethral sphincter and pelvic floor muscles as a faucet that controls urination. Together the urethral sphincter and the pelvic floor muscles tighten around the urethra to hold urine. These muscles loosen to let it flow out, just like a faucet.

    UI occurs if the bladder muscles contract uncontrollably or if the sphincter and pelvic floor muscles relax before you reach a bathroom.

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    Incontinence Is Usually Temporary And Always Manageable

    Thankfully, long-term incontinence is uncommon following a stroke and the latest research suggests that only about 15 percent of stroke patients will continue to experience incontinence issues one year after suffering a stroke. Nonetheless, even short-term incontinence can be upsetting and embarrassing for survivors. Here at Saebo, we are committed to stroke support and recovery for all survivors and their families. Saebo offers a wide range of products that combine cutting-edge technology with evidence-based rehabilitation techniques. Our offerings and network of Saebo-trained therapists can help you or a loved one to obtain all the necessary tools to maximize stroke recovery.

    All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

    Products Than Can Help

    Products that can make going to the toilet safer and easier include raised toilet seats, rails on the wall, commode chairs and portable urinal bottles. Your occupational therapist, nurse or continence nurse can help you with these.

    There are a number of products that can help you stay dry and comfortable. These include pads, liners, pants and absorbent underclothing. Mattress protectors and water-resistant doona covers and bed sheets can also help.

    You can buy some of these products at your local supermarket, chemist or specialist retailer. For more significant problems, you may need to purchase products from a medical supply company.

    The National Continence Helpline can advise if you are eligible for financial assistance for continence products.

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