Module 1: Stroke & Continence

Nurses play an important role in identifying and managing post-stroke continence challenges. In this post, we provide an overview of continence nursing, post-stroke urinary continence challenges, how the bladder works, and review types of urinary incontinence and urinary retention in order to strengthen your foundational knowledge. We hope that this information is helpful in helping you to better understand the continence care needs of stroke survivors.

Continence Nursing and Post-Stroke Urinary Continence Challenges

Continence nursing is an advanced specialist role that is fulfilling because it allows you to assume a leadership role in patient care and greatly improve patient well-being. In the video below, an Australian continence nurse, Fran, discusses her experiences working in a nurse-initiated clinic specializing in the diagnosis and management of urinary incontinence.

Many patients, as Fran notes, are embarrassed by continence challenges. Many individuals feel too embarrassed to seek treatment, although treatment and management options may help to reduce the occurrence of incontinent episodes. This may be in part due to many of the myths associated with urinary continence care, such as the following:

• Urinary continence is a natural part of the aging process;
• Nothing can be done to effectively manage and resolve urinary continence challenges; and,
• Urinary continence challenges do not happen to otherwise healthy people.

Nurses have a great opportunity to improve patient well-being by demystifying and addressing urinary continence challenges. This is especially important for stroke survivors due to the high prevalence of urinary continence challenges among this patient population.

The National Sentinel Stroke Audit reports that 44% of stroke survivors suffer from urinary incontinence at one week post-event (Royal College of Physicians, 2002). The impact of urinary incontinence on stroke survivors has been shown to have an adverse affect on stroke survival, disability and institutionalization rates (Devroey et al, 2003; Patel et al., 2001). A previous study has reported that 29% of stroke survivors experience urinary retention (Kong, 2000). Managing stroke survivors’ urinary continence challenges is a key way to prevent complications such as skin breakdown and urinary tract infections, which may result in prolonged hospital stays.

How the Bladder Works

The video below provides an overview of the micturition reflex, the process of expelling urine from the bladder.

Urinary incontinence is the involuntary loss of urine resulting from a loss of bladder and/or sphincter control (RNAO, 2005). Stroke survivors may experience any one of several types of urinary incontinence.  Urinary incontinence may be a complication of stroke or it may be due to a previous condition. Better understanding the types of urinary incontinence listed below may help with diagnosis and management:

• Transient incontinence: This is the involuntary loss of urine due to outside factors affecting bladder management, such as medications, vaginitis, urethritis, and constipation (RNAO, 2005).
• Urge Incontinence: Involuntary loss of urine after feeling the sudden urge to void (RNAO, 2005).
• Stress Incontinence: Involuntary loss of urine due to an increase in intraabdominal pressure, which occur when sneezing, coughing, or other movements (RNAO, 2005; Skelly, 2007).
• Mixed Incontinence: Loss of urine displaying the characteristics of both urge and stress incontinence (RNAO, 2005).
• Overflow incontinence: Involuntary loss of urine due to over-distension of the bladder (RNAO, 2005).
• Functional incontinence: Urinary leakage occurring as a result to an inability to access toileting facilities due to functional and/or cognitive impairments (RNAO, 2005).
• Total incontinence: Involuntary, unpredictable, and continuous loss of urine (RNAO, 2005)

Urinary Retention
Urinary retention is incomplete bladder emptying, typically defined by abnormally high postvoid residual volumes (Doughty, 2000). There are two types of urinary retention:

• Acute Urinary Retention: Urinary retention characterized by a sudden and painful inability to void (Fitzpatrick and Kirby, 2006).
• Chronic Urinary Retention: Patients experiencing chronic urinary retention have a non-painful bladder that remains palpable and percussible after voiding (Abrams et al, 2002).

Conclusion

In this section, we discussed post-stroke urinary continence challenges and reviewed how the bladder works and types of urinary incontinence and retention.  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.

Click here to advance to Module 2: Urinary Continence Assessment Recommendations.

Click here to return to the main page.