Module 5: General Recommendations

We have thus far touched on the management of urinary incontinence and retention among stroke survivors. In this section we review general recommendations intended to promote urinary continence. These include the following: a) promoting privacy while toileting; b) implementing a bowel protocol and promoting healthy intake of fluids; and, c) consulting with the circle of care to improve care for stroke survivors with complex continence care needs.

4.1 Implement Bowel Protocol and Promote Healthy Intake of Fluid
Constipation contributes to urinary retention due to the impact that it may have on detrusor contractility. We recommend that you implement a bowel management protocol if stroke survivors are experiencing fecal incontinence or constipation to minimize the impact that bowel dysfunction has on urinary continence care (Gray, 2000a; Charach et al., 2001). You may find the following guidelines to be helpful:

• Prevention of Constipation in the Older Adult Population, Registered Nurses of Ontario (2005)
• Practice Guidelines for the Management of Constipation in Adults, Rehabilitation Nurses Foundation (2002)

Healthy intake levels of fluid may decrease bladder irritation caused by a higher concentration of urine. This may cause both urinary retention and overflow incontinence. We recommend that stroke survivors consume at least 1500 to 2000ml/day and minimize the intake of bladder irritants, such as caffeine, alcohol, and artificial sweeteners.

4.2 Promote Privacy While Toileting
Promoting privacy for stroke survivors while they are toileting helps to uphold their dignity. We recommend that you do this whenever possible. This may not, however, be possible for stroke survivors at risk of falling.

4.3 Consult with the Medical Team
If urinary retention persists or the stroke survivor has complex management needs that you are unable to address, consult with the medical team to develop an appropriate individualized plan of care.

Conclusion
By completing this section, you have have reviewed all of the practice recommendations for the urinary continence care of stroke survivors. We hope that this learning package has increased your understanding of urinary continence care and started you on a journey in continence nursing. If you have any questions or comments, please leave them below so that we can continue our dialogue on urinary continence care.

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