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Continence management after a stroke

Continence management after a stroke. Urinary Incontinence is common post stroke. 40-60% of stroke survivors are incontinent after having their stroke . Upon discharge from hospital: 25% of stroke survivors are incontinent 1 year on 15% of stroke survivors are incontinent.

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Continence management after a stroke

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  1. Continence management after a stroke

  2. Urinary Incontinence is common post stroke 40-60% of stroke survivors are incontinent after having their stroke. • Upon discharge from hospital: 25% of stroke survivors are incontinent • 1 year on 15% of stroke survivors are incontinent

  3. The Impact of Urinary Incontinence on Quality of Life • Distressing • Embarrassing • Low Self-esteem • Loss of confidence • Disrupts work activities • Leads to social exclusion • Can lead to bullying • Affects recreational activities • Affects personal, physical & social relationships To the Individual

  4. The Impact of Urinary Incontinence on Quality of Life • Makes extra work • Has cost implications • Disruption to carers work commitments • Affects family relationships • Creates feelings of frustration, anger, guilt, sadness and grief • Can be a trigger that results in carers being unable to cope To the partner, friend or relative

  5. Common Continence Problems After a Stroke • Urgency • Frequency • Urge Incontinence (often sensation is in tact) • Bedwetting • Involuntary passage of urine • Loss of feeling in the bladder • Incomplete bladder emptying • Constipation

  6. Outcome Measurement Scale for Bladder Function in stroke patients at the acute stage • Total urinary retention • Partial urinary retention • Functional incontinence • Urge incontinence • Continence These form the basis for bladder management Chan , H 1993

  7. The Problem With Indwelling Urinary Catheters • Infection and other urinary tract complications • Much more difficult to regain bladder control • Loss of bladder capacity over time • Prevents regaining independence & going home • Blockage through encrustation People with an indwelling urinary catheter are 3 times more likely to need antibiotics 3 times more likely to be hospitalised 3 times more likely to be dead at the end of a year

  8. A bladder management flow chart for acute stroke patients was devised • Adapted from Chan H non-invasive bladder volume measurement - J Neuroscience nursing 1993; 25(5); 309-312 • A guide for managing bladder problems in patients with an acute stroke • To prevent patients being catheterised unnecessarily (12% of all stroke admissions in GRH/CGH Trust in 2004 were catheterised because of incontinence and a further 7% were catheterised without any evident reason)

  9. Bladder Management in acute stroke patients

  10. Managing Bladder DysfunctionAfter the Acute Phase Detailed Continence Assessment (using Trust Documentation) Assessment to include: • Urinalysis • Check for constipation • Bladder chart • Post void bladder scans • Review of medication • Check of fluid intake • Assessment of mobility, dexterity & cognitive function • There is a range of documentation to support patient assessment No intervention until assessment is completed and intervention is indicated

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