Module 4: Urinary Retention

Urinary retention is a significant medical challenge encountered by stroke survivors. You play an important role in managing urinary retention and minimizing the invasiveness of urinary catheterization. In this section, we review recommendations for the management of urinary retention. These include: a) ensuring optimal patient positioning; b) intermittent catheterization; and, c) using the smallest possible catheter size.

3.1 Ensure Optimal Patient Positioning
Ensure optimal patient positioning to promote voiding according to the stroke survivor’s preferences and impairments. Consider the stroke survivor’s abilities in order to see if optimal patient positioning is possible. The following positions are recommended:

• Position male stroke survivors so that they are standing or sitting. Bed toileting positions leave men with higher PVRs (Cook et al, 1998).
• Position women in a sitting position when possible.

3.2 Intermittent Catheterization
We recommend that you use intermittent catheterization to manage urinary retention among stroke survivors. Adhere to the following protocol for intermittent catheterization when stroke survivors are medically stable (IC5, 2005):

• Monitor intake and output of fluid using a voiding record, including caffeinated beverages;
• Encourage healthy intake levels of at least 1500 to 2000ml of fluid per day; and,
• Optimize catheterization intervals by developing individualized plans according to the stroke survivor’s intake and output levels.

Follow this link to view the complete recommended intermittent catheterization protocol.

Important

While we recommend that intermittent catheterization is the preferred management option, it may be necessary to use indwelling catheters in certain circumstances. Indwelling catheters should be limited to the following: stroke survivors with intractable urinary retention; urinary retention that causes persistent overflow incontinence, infection, and/or renal dysfunction; stroke survivors with urinary retention that cannot be managed with intermittent catheterization; stroke survivors experiencing pain during catheter insertion due to enlarged prostate; stroke survivors with skin breakdown, continuous wetness, and the need for urinary monitoring; and, stroke survivors with palliative diagnoses for whom clothing changes are uncomfortable or disruptive (American Medical Directors Association, 2005; Teasel, 2007).

3.3 Use Smallest Possible Catheter Size
Stroke survivors may experience discomfort due to catheterization. Use the smallest possible catheter size in order to minimize stroke survivors’ discomfort and risk of injury (IC5, 2005).

It is recommended that catheters 10-12 F are used for women and catheters 14F are used for men (Cassel, 2006).
Conclusion
We hope that these recommendations will help you to manage urinary retention among stroke survivors. If you have any questions or comments, please leave them below so that we can continue to work with you to provide improved urinary continence care.
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