Strategies for Managing Urinary Incontinence After Stroke: Report

This report delves into the management of urinary incontinence (UI) in older adults following a stroke, examining various themes and evidence-based strategies. The findings highlight the importance of implementing the SVP (Systematic Voiding Program) with proper staff training and flexible protocols. The report discusses the impact of stroke type on urodynamic parameters and the effectiveness of behavioral interventions like timed voiding, pelvic floor muscle exercises, and complementary therapies such as acupuncture. It emphasizes the need for larger trials to evaluate the SVP's efficacy and the importance of addressing implementation strategies. Recommendations include implementing appropriate clinical practices, utilizing effective medicines, and considering surgical options when necessary. The limitations of the research, such as time constraints and limited access to resources, are also acknowledged. This report provides valuable insights into the comprehensive management of UI in this specific patient population, supported by references to relevant studies and clinical practices.

The Management of
urinary incontinence
in older adults
following stroke

Table of Contents
Chapter 4: Findings..........................................................................................................................3
4.1.5 Theme 5: Evidence-based strategies to manage urinary incontinence in older adults. .3
Discussion........................................................................................................................................1
4.1.1. Theme 1: To be effectively implemented, the SVP needs to be explained to all
healthcare staff and patients, needs to have a flexible protocol and specific training of nurses
and health care assistants is necessary....................................................................................1
4.1.2 Theme 2: To be successful in an acute care setting, the SVP must be supported by the
provision of adequately trained staff and reduction in the paperwork involved....................1
4.1.3 Theme 3: A further larger trial to evaluate the efficacy of the SVP in the management of
UI in stroke patients in an acute setting is warranted and feasible but more attention is needed
to implementation strategies...................................................................................................3
4.1.4 Theme 4: The type of stroke may influence the urodynamic parameters (detrusor
overactivity, detrusor overactivity with impaired contractility and detrusor underactivity). The
pattern of these parameters may dictate the most effective treatment for UI and provide a
functional prognostic indicator...............................................................................................3
4.1.5 Theme 5: Evidence-based strategies to manage urinary incontinence in older adults. .4
RECOMMENDATIONS.................................................................................................................4
LIMITATIONS................................................................................................................................5
References........................................................................................................................................6

Chapter 4: Findings
4.1.5 Theme 5: Evidence-based strategies to manage urinary incontinence in older adults
The urinary incontinence can be considered as common disabling problem after stroke. It
is necessary to treat urge & stress incontinence and manage or prevent urinary retention as well
as overflow incontinence. As per views given by Lois H. Thomas and et. al. (2019), several
evidences based practices are helpful to treat the problem of incontinence along with having
issue of stroke. Initially, behavioural interventions are favourable including timed voiding and
pelvic floor muscle in order to reduce problem of incontinence in older adults after strike.
However, the another strategy consist complementary therapies are effective to solve this
problems including acupuncture therapy in order to treat the problem of incontinence after stroke
(Shin and et. al., 2016). In addition to this, pharmacotherapy & hormonal interventions consist
several medications such as meclofenoxate, oxybutinin and oestrogen which can be applied to
treat the issue of incontinence started after stroke accordingly. Moreover, it is necessary to make
an appropriate plan of action including desired interventions to solve problem of incontinence
after stroke.
According to the opinion of Kathryn L Burgio (2019), behavioural therapy consists a
kind of behavioural training that involves pelvic floor muscle rehabilitation and focus less on
voiding habits. It consist more utilisation of pelvic muscles in order to prevent stress as well as
urge accidents and this training exercise provide support to patients to control peri urethral
muscles. However, it consist an objective of utilising voluntary contraction of these muscles in
terms of occluding the urethra at the time of physical activities which are responsible for causing
stress incontinence. In addition to this, bladder training, Kegel exercise and several medications
can be utilised for patient having problem of incontinence after stroke to remain relieved.

Discussion
This section basically plays a crucial role within an investigation. In present research
report where investigator has chosen to perform the investigation in a rightful manner.
Discussions of a range of themes has been given below.
4.1.1. Theme 1: To be effectively implemented, the SVP needs to be explained to all healthcare
staff and patients, needs to have a flexible protocol and specific training of nurses and
health care assistants is necessary.
Based on the information given under this theme where SVP will be implemented and would
require to offer or develop flexible protocol to healthcare staff and patients as this will directly
help them in gaining motivation towards their own businesses. Along with this, offering training
to nurses and health care assistants can also be considered as one of a crucial part which might
aid them in reaching to new heights where they could easily offer patients that are suffering from
urinary incontinence, who has experienced a stroke in there past. If it is discussed, then it can
easily be said that SVP will help both patients and doctors, staff and more to be managed not just
at small level but at a large scale considering all the uncertainties. The information which was
pulled out of Pizzi et al. (2014), which basically shows number of strokes and these are 51
(patients). Considering the investigation related to UI management is much more effective that
may aid in pulling out favourable outcomes. Along with this, Thomas et al. (2014a & b) has
showed a proper programme integrated with a formalised timed voiding system. This has helped
in managing the UI in older and elderly stroke patients and then evaluated its efficacy. With the
help of this, it can easily be said that ample number of benefits could easily be improvised in
specified time frame. On the other hand, company would also require to make alterations as per
the requirements.
4.1.2 Theme 2: To be successful in an acute care setting, the SVP must be supported by the
provision of adequately trained staff and reduction in the paperwork involved.
If it is talked about maintaining the overall administration, SVP could effectively be
utilised which will directly aid with a range of benefits. Here, it can be said that SVP would help
staff ward towards SVP, in giving proper assistance to urinary incontinence, who has
experienced a stroke in there past. This directly shows agencies consist with nurses to protect the
ward considering temporary basis in order to fulfil shortages. Therefore, it can easily be said that

use of SVP in offering individuals with a range of benefits which will aid both staff and
consumers with a range of benefits in specified time frame. Along with this, application of SVP
would directly help in recognising the framework suitable for the analysis of complex
interventions. This might directly aid in hitting targets in specified time frame. Therefore all the
risks could easily be reduced through, if SVP will be utilised at workplace. On the other hand,
nurse leaders among secondary care to manage different diseases or problems like (manage
urinary incontinence in older adults who have experienced a stroke), through minimising all the
challenges (Aggarwal and Zimmern, 2016). This could effectively be improvised through
collecting relevant data, focusing on the judgements considering the values and so on, through
giving all the details related to safe nursing practice that implements the SVP in stroke patients.
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4.1.3 Theme 3: A further larger trial to evaluate the efficacy of the SVP in the management of
UI in stroke patients in an acute setting is warranted and feasible but more attention is
needed to implementation strategies.
Larger trial to evaluate the efficacy of the SVP in the management of UI in stroke
patients in an acute setting is warranted and feasible but more attention is needed to implement
different strategies so that effective results could easily be gained right on time. As the two
different range of clusters (RCT’s) has been mentioned who has given different range of details
related to inclusion and exclusion criteria which are applied at while offering different range if
services like urinary incontinence in older adults that has experienced a stroke. Neither study is
blinded, presumably due to the need for informed consent of all participants. However, data
analysis could have been conducted by an independent researcher to include an element of
blinding. This would have benefited the validity of both RCT’s because blinding is a key feature
of RCT’s that confers quality in terms of reliability and validity. Although randomisation reduces
the risk of selection bias, the biased assessment of outcomes is not excluded by this process and
it is difficult to determine if bias has been introduced into the data analysis of both studies ( Liu
and et. al., 2016). Thus, the conclusions made by the authors of both studies, that a more
substantial trial is warranted and that this would require further development in the
implementation of the SVP, may not be reliable. Despite the fact that randomisation decreases
the danger of determination predisposition, the one-sided evaluation of results isn't prohibited by
this procedure and it is hard to decide whether inclination has been brought into the information
investigation of the two examinations. Along these lines, the ends made by the creators of the
two examinations, that an increasingly considerable preliminary is justified and this would
require further advancement in the usage of the SVP, may not be dependable.
4.1.4 Theme 4: The type of stroke may influence the urodynamic parameters (detrusor
overactivity, detrusor overactivity with impaired contractility and detrusor underactivity).
The pattern of these parameters may dictate the most effective treatment for UI and
provide a functional prognostic indicator.
According to the analysis of number of cases, The type of stroke may influence the
urodynamic parameters (detrusor overactivity, detrusor overactivity with impaired contractility
and detrusor under activity). It has been observed that various design of the parameters may have
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a significant restriction on the effective treatment for UI and can provide a noticeable prognostic
indicator.
In the analysis, a comparison has been done to see the degree of parameters between
continent and incontinent stroke patients by setting neurological deficit as a base. The findings
suggested that incontinence is directly affected by functional status which is evaluated through
Barthel Index (BI). Also, Functional Independence Measure Scale which is improved with
rehabilitation treatment. Furthermore, the observations stated that the outcomes obtained from a
comparison of functional status with urodynamic parameters there is a neurogenic factor in UI
(Gibson, Wagg and Hunter, 2016).
4.1.5 Theme 5: Evidence-based strategies to manage urinary incontinence in older adults
Considering above discussion including evidence based strategies in order to manage
urinary incontinence in older adults, it has been analysed that suitable technique should be
applied to reduce the issue in sick people. However, it is observed that number of medications
and treatment procedures are available such as behavioural therapy, bladder training, Kegel
exercise and many more in which more favourable method must be applied for well-being of
patient facing urinary incontinence after stroke (Damián and et. al., 2017). It has been evaluated
that this problem can be solved by proper clinical practices and therapies in order to make an
individual healthy.
RECOMMENDATIONS
Considering above discussion, it has been recommended that urinary incontinence is
required to be managed by implementing appropriate clinical practices. It is suggested that
professionals can manage urinary incontinence by some of effective medicines which can help
bladder empty that is more filled during urinations and other drugs that tighten muscles and
which will help to reduce leakage. It is suggested to utilise surgery in future practices as it can
also cure or improve incontinence if it is caused by change in position of blockage or bladder due
to enlarged prostate. It has been recommended that professionals advice to women for using
medical devices like urethral insert which is small disposable device inserted into urethra this
may prevent leakage. It is suggested that physicians should focus assessment, rehabilitation and
management clinical practices in future because earlier stage of stroke can be reduced by
structured assessment, rehabilitation and management of care. Meanwhile, the later stage can
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recover by utilising advices and suggestions of specialist in order to provide accurate care
services in future. In addition to this, it is recommended to implement systematic voiding
programme in the multi-site qualitative process which helps in evaluation in stroke services and
help to reduce urinary incontinence. It is necessary to provide proper learning and training for
Staff and nurses who are involved in delivering SVP. With the use of these recommendation
health care users can implement use of SVP.
LIMITATIONS
Considering above research, it has been analysed that there are several limitations
including lack of sufficient duration of time which is required to carrying out overall
investigation. However, there is an issue create that accurate articles and books are not available
then it consumes much time to analysed the overall articles and then selected desired information
them. Meanwhile, some of other methodological limitations includes lack of available & reliable
information, lack of prior research studies on the topic and problem in self analysed information.
In addition to this, some of limitations of researchers consist access of data, longitudinal effects,
cultural & other types of bias, fluency in language and ethical & legal restrictions.
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References
Books and journals
Shin, D. C. and et. al., 2016. Pelvic floor muscle training for urinary incontinence in female
stroke patients: a randomized, controlled and blinded trial. Clinical
rehabilitation, 30(3), pp.259-267.
Aggarwal, H. and Zimmern, P.E., 2016. Underactive bladder. Current urology reports, 17(3),
p.17.
Liu, Y. and et. al., 2016. Effects of transcutaneous electrical nerve stimulation at two frequencies
on urinary incontinence in poststroke patients: a randomized controlled trial. American
journal of physical medicine & rehabilitation, 95(3), pp.183-193.
Gibson, W., Wagg, A. and Hunter, K.F., 2016. Urinary incontinence in older people. British
Journal of Hospital Medicine, 77(2), pp.C27-C32.
Damián, J. and et. al., 2017. Urinary incontinence and mortality among older adults residing in
care homes. Journal of advanced nursing, 73(3), pp.688-699.
Online
Thomas L. H. and et. al., 2019. Treatment of urinary incontinence after stroke in adults.
[Online]. Available through:
<https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004462.pub3/full>
Burgio K. L., 2019. Behavioural treatment options for urinary incontinence. [Online]. Available
through:<https://www.gastrojournal.org/article/S0016-5085(03)01613-5/fulltext>
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