Stroke Urinary incontinence is a common issue among stroke patients. This condition arises due to the multifaceted impact of stroke on the brain and nervous system, which compromises the brain’s capacity to regulate bodily functions, including bladder control.
Strokes can inflict damage to the central nervous system, particularly the regions of the brain that oversee the bladder and urethral sphincter muscles. These areas, situated in the cerebral cortex, cerebellum, and spinal cord, are crucial for transmitting signals that instruct the bladder on when to retain or expel urine. Damage to these critical areas can disrupt the usual communication pathway between the brain and the bladder, resulting in incontinence.
Moreover, strokes can impair the sensory feedback mechanism that the brain relies on to gauge the bladder’s fullness and prompt the need for urination. This disruption in sensory feedback can hinder the individual’s ability to perceive the urgency to void, potentially leading to overflow incontinence or delays in voiding.
Physical impairments are another significant factor contributing to urinary incontinence in stroke survivors. Common physical disabilities following a stroke, such as weakness or paralysis on one side of the body, mobility issues, or coordination problems, can make it challenging for individuals to reach the toilet promptly. These physical constraints can exacerbate incontinence if the person is unable to attend to their toileting needs without assistance.
Cognitive and emotional changes resulting from a stroke can also disrupt normal bladder control. Strokes can affect cognitive functions like memory, attention, and problem-solving, which are essential for managing daily activities, including toileting. Additionally, emotional changes such as depression or anxiety can interfere with regular bladder function.
Medications prescribed to stroke patients can sometimes have side effects that impact bladder control. These side effects may include increased urine production or relaxation of the bladder muscles, further complicating the management of incontinence.
Lastly, stroke patients are at an increased risk of developing urinary tract infections (UTIs), which can irritate the bladder and induce a sudden, compelling urge to urinate.
Addressing urinary incontinence in stroke patients necessitates a comprehensive, multidisciplinary approach. This may involve medical management, physical therapy, and possibly tailored bladder training programs. Healthcare providers must collaborate closely with stroke survivors and their caregivers to formulate an individualized plan to effectively manage this complex complication.
Stroke Urinary Incontinence Care
Skin Care
Keep the skin clean and dry, wash the perineal area with warm water daily. Add a layer of rubber or waterproof bedding, and place a highly absorbent cloth pad on top. Change the pad promptly when it gets wet.
Collecting Urine
Female patients can use a female urinal to collect urine closely against the external genitalia. Male patients can use a urinal or a condom connected to a rubber tube and drainage bag to collect urine (this method can only be used for a short time).
Indwelling Urinary Catheter
Replace the indwelling urinary catheter weekly. The catheter should be properly placed to avoid compression, twisting, and blockage, which can cause poor drainage. Keep the urethra clean by washing the urethral opening with disinfected cotton balls 1-2 times daily. Drain the urine every 2-4 hours, and frequently change bedsheets and urinary pads to prevent urinary tract infections.
Using the commode
First, position the patient in a supine position, bend the knees, and then use force to lift the hips off the bed, performing the “bridge movement”. In the initial stage, family members are needed to help lift the hips off the bed, and the commode is quickly placed under the hips while they are still off the bed. Patients who can sit should do so.
Urination training
At first, encourage the patient to urinate every 1-2 hours, applying a gentle pressure from the upper bladder with the palm of the hand to encourage passive urination. Gradually increase the time between urination sessions, focusing the patient’s attention and training them to report to family members. Family members should pay attention to the patient’s movements and expressions, especially for those with impaired consciousness or speech difficulties, and remind them to use the commode in a timely manner. Diapers should be removed as soon as possible to prevent dependency.
Indoor environment
Open the doors for ventilation and fresh air daily in the morning and evening, eliminate unpleasant smells, and keep the indoor air fresh for patient comfort.
Psychological care
Patients with urinary incontinence often experience significant psychological stress, feelings of inferiority, and desire for understanding and help. Family members should provide comfort and encouragement to help the patient build confidence and cooperate with care.
