Abstract: Bladder Dysfunction After Stroke

Jan Coleman Gross, RN, C, MSN, CS. "Bladder Dysfunction After Stroke." Urologic Nursing 12 (June 1992) 2: 55-63.

Objectives:
* Gross discusses the problem of bladder dysfunction after stroke. She provides a brief overview of the different types of stroke, and discusses why bladder dysfunction often follows. She then describes how voiding is affected and what strategies are useful in assessing and managing stroke-induced bladder dysfunction.

Conclusions:
* Bladder dysfunction after stroke is one of the major factors affecting recovering patients' quality of life. Sixty to Eighty percent of patients in the acute phase of hospitalization after stroke have incontinence.
* Physical complications of incontinence include infections, skin breakdown, and urosepsis. Such complications "may adversely affect recovery and rehabilitation efforts."
* Incontinence also has a powerful, negative effect on social and emotional well-being. "Continence is a major factor in deciding whether a person can be cared for at home" after experiencing a stroke.
* "Voiding problems resulting from a stroke include uninhibited neurogenic bladder, urgency and frequency, retention, urge incontinence, and overflow incontinence. Because a variety of causative and contributing factors are involved, comprehensive and ongoing evaluation is necessary." Problems with physical mobility and communication skills after stroke can also contribute to bladder dysfunction.
* Nurses should try to achieve the following goals through treatment of post-stroke bladder dysfunction: discontinuing indwelling catheters, activating voiding activity, assuring complete bladder emptying, facilitating urinary control, establishing functional voiding patterns, preventing complications of bladder dysfunction, and educating patients and family members to independently manage the bladder regimen.
* "Use of a portable bladder ultrasound offers noninvasive, low-risk alternative to intermittent catheterization for measuring residual volumes. . . . This technology offers a means to evaluate ability to empty on an ongoing basis without the cost in time, supplies, and discomfort that is associated with catheterization."
* Gross discusses at length bladder retraining programs and measures to activate normal voiding activity. She also describes how educational programs concerning bladder management should be tailored to the communicative and cognitive needs of stroke patients. She emphasizes the importance of maintaining proper hygiene in caring for patients, and insuring that their fluid intake is adequate.
* "Increased use of catheterization in stroke patients raises concern about an increase in infection from this invasive procedure. . . . When possible, portable ultrasound appears to be a valuable resource to prevent overdistention and infection."

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