Helping residents manage urinary incontinence following a stroke

Bladder training can help correct habits of frequent urination, control the urge to urinate, increase time between bathroom visits and expand bladder capacity. A voiding diary can help track toileting times, identify triggers and provide important information for care plans.

Pelvic floor exercises are one of the most effective ways to improve continence. They strengthen the pelvic floor and can improve feelings of urgency, reduce nighttime urination and also improve or even eliminate stress incontinence.

For residents who have difficulty fully emptying the bladder, double or triple voiding techniques are recommended. Encourage the resident to sit and void normally. Once finished, help them stand and then sit down again to void any residual urine.

Timed voiding at regular intervals – usually every three hours during the day – may effectively minimise or eliminate incontinence. With prompted voiding, caregivers remind and encourage residents to ask for help with toileting. By shortening the intervals between voiding, caregivers can help minimise incontinence and involuntary bladder contractions.

For residents with functional impairments such as impaired mobility, and/or impaired cognition, regular toileting assistance is essential. Ensure the bathroom is easily accessible while toileting aids such as grab bars and a raised toilet seat are also helpful. Residents’ clothing should be easy to take off and put back on.

Constipation can make incontinence worse. Ensuring residents eat enough fibre, stay hydrated and exercise regularly can all help prevent constipation. To facilitate bowel movement, ensure residents sit in a relaxed position when toileting. They should lean forward with knees above hips and elbows on knees. Provide foot support if needed.

To prevent needing to get up at night to urinate, try to avoid drinking 2-4 hours before going to bed and wear compression stockings during the day. Avoid or reduce caffeine as this stimulates the kidneys to produce urine and irritates the bladder. It is also important to ensure residents maintain a healthy weight as obesity increases the risk of incontinence.

Maintaining skin health is essential for preventing skin irritation and infection. Inspect skin daily, especially the groin and between skin folds. Avoid exposure to faeces and urine as much as possible and ensure the perineal area stays clean and dry. Use gentle cleansers rather than harsh soaps.

High-quality incontinence products with the right type, size and absorption level are essential for keeping skin dry and maintaining skin health. If the skin is sensitive or shows signs of inflammation, apply barrier cream or zinc cream for extra protection. Ensure regular toilet visits and ensure any incontinence products are changed when needed.