Assessment-Guided Therapy of Urinary Incontinence After Stroke

Abstract

Urinary incontinence (UI) frequently occurs after stroke and often remains an extensive problem for these patients and their relatives even after discharge from the hospital. Therapeutic interventions, such as behavioral training, can help manage UI. Recently, a multimodal application of nursing interventions was recommended (Wilbert-Herr, Hürlimann, Imhof & Wilbert, 2006). The primary goals of the study discussed in this article were to introduce therapeutic interventions of UI management into clinical rehabilitation practice based on a structured process of interdisciplinary caregiving and test the treatment effect. Forty-four patients who had suffered a cerebrovascular accident (CVA) were included in the study. Nursing interventions included distinction of stress or urge UI and the assessment of different forms of UI. The latter intervention was based on the functional independence measure (FIM Item G-bladder management), the protocol of micturition, urine dipstick, and ultrasound measurement of post-void residual urine (PVR). Interventions were applied according to the recommendations of the 3rd International Consultation on Incontinence. An algorithm of the interdisciplinary process was implemented, and the nursing staff received specific education regarding the interventions. Twenty-one (47%) of the patients in the study were diagnosed with UI; 67% of these patients achieved the targeted level of continence by individually tailored interventions, which consisted of a systematic nursing assessment and standards for prompted voiding, timed voiding, and habit training. Planned processes, including screening procedures, assessment, profile of continence, intervention, and education and evaluation, increase the likelihood of positive results of rehabilitation of patients after CVA. Additional intervention studies are suggested to investigate the effectiveness of the algorithm used in this study.