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Post-stroke care management for bladder and bowel problems
It is common to experience bladder and bowel problems after a stroke. This can be a sensitive issue to many people and affect their overall well-being.
Talk to your Stroke Care Team if you are having difficulty with bladder or bowel control after stroke. Continence problems can be managed discreetly with good advice and preparation.
You may develop continence problems after a stroke for various reasons.
Central CauseDue to damage in parts of the brain from stroke. | DrugsSome medications may affect bladder or bowel control. | ComplicationsYou may be at risk of urinary tract infections which can cause urinary incontinence. |
Physical ChangesPhysical weakness and loss of sensation may affect your ability to move around. You may not be able to go toilet on time or may have difficulty maintaining control. Cognitive changes and speech difficulty after stroke may affect your ability to communicate your toilet needs to your carer. You may eat or drink less with changes in your diet consistency due to swallowing problems after stroke. Constipation can happen as a result of dehydration and lack of nutrition. | Reduced Physical ActivitiesYour physical activities may be temporarily reduced due to disabilities after stroke. You may be at risk of experiencing constipation. |
Initial care after stroke
Intake and Output Chart The nurses will monitor the amount you drink, eat, void and the number of bowel movement for several days. Post-void residual urine measurement The doctor or nurse may check the amount of leftover urine in your bladder using a bladder scanner or urinary catheter (tube). A large amount of leftover urine may indicate a urinary tract obstruction or bladder muscles problem. | |
Urinalysis If a urinary tract infection is suspected, a sample of your urine may be sent for testing. | |
| If you require mild to moderate physical assistance, the nurses may offer you bedpan / urinal at bedside or transfer you to the toilet via a commode chair. | |
If you require maximum physical assistance or are not well enough to regain control of your bladder and bowel, you may be offered to wear diapers. If you are not able to empty your bladder completely, a urinary catheter may be inserted to drain the urine out into a bag. This may be inserted and kept for a short period of time or to be done several times a day to keep you comfortable and reduce the risk of urinary tract infection. |
Bladder and bowel training can improve the symptoms and restore normal function pattern of continence. Bladder and bowel training programs are usually customized to each individual.
Bladder Issues
Bladder training by holding off your urine for an amount of time after having the urge to urinate. This is to strengthen the bladder’s ability to hold more urine and lengthen the time between toilet visits. Schedule toilet visits every 2 to 3 hours instead of visiting when needed. | |
Pelvic floor exercises help to strengthen the pelvic floor muscles. This can improve bladder control and reduce urine leakage. How to do it?
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| There are several medical devices and surgical procedures to treat bladder incontinence. Discuss with your stroke care team, you may be referred to a specialist if required. | |
| Some medications may be prescribed to help and reduce urine production, urgency and frequency. |
Bowel Issues
| Bowel training may be done through scheduled regular visits to the toilet (eg. after a meal when the bowel are stimulated to move by a natural reflex). It may help to improve your ability to hold and delay bowel movement till you reach the toilet. | |
| There are several surgical procedures to treat bowel incontinence. Discuss with your stroke care team, you may be referred to a specialist if required. | |
| Laxatives or stool softeners may be prescribed to treat constipation. |
For some people who have suffered a severe stroke, a full recovery may be less likely. In such instances, your stroke care team will assess and recommend according to your needs (For example, diapers, permanent or intermittent
urinary catheter).
Good hygiene and skin care is important to protect you from urinary infection and skin damage.
| Speak to a doctor or nurse about your concerns. They can advise you the appropriate options, and refer you to a continence specialist advisor if needed. | |
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