About half of stroke patients lose bladder control with the event. One-fourth leave the hospital with the problem. Still, 15 per cent deal with it at the year’s end.

Standard evidence-based guidelines recommend two approaches to improve bladder control post-stroke.

Those were,

• Bladder re-training with timed tioleting.
• Pelvic floor muscle strengthening.

Bladder re-training with “timed toileting (voiding):

The 2023 UK National Clinical Guidelines for Stroke recommend “timed toileting” to improve bladder control after a stroke.

“Timed toileting” helps to “re-train the bladder after a stroke. It is a behavioural technique. The caregiver needs to set a timetable for toileting and gradually increase the time in between the voids.

To achieve that, we need a timetable.

The following infographic list steps you can follow to create a bladder time table. It is available at the the UCSF³ (the University of California San Francisco) Health website.

• Step 1: Create a three-day bladder diary to understand the nature of the problem
• Step 2: Create a urine void timetable
• Step 3: Increase the interval by 15-minute increments weekly until you reach the 3-4 hour interval; when you feel the urge before the time suppress it; use relaxation methods
• Step 4: Continue the exercise for 6-12 weeks; there will be good days and bad days in between.
• Step 5: Complement it with daily pelvic floor muscle exercises

The guidelines also recommend training pelvic floor muscles.

How to train pelvic floor muscles

• Step 1: Locate pelvic floor muscles (read the next section)
• Step 2: Create a timetable for exercises: At breakfast, lunch, dinner, and before bedtime; make it a habit
• Step 3: Squeeze the muscles for a slow count of three; then relax in the same way; do 15 times in one set; increase the count gradually.
• Step 4: Maintain a bladder diary (download the template from their website, and modify it to suit your needs)

How to locate pelvic floor muscles (Figure 1 below)

• Method 1: Tighten the anus as if not to pass gas
• Method 2: insert a finger into the vagina and try to squeeze the finger
• In both situations do not tighten the abdominal, buttock, or thigh muscles

An educational graphic tool (Figure 1)

• Pelvic floor muscles: A graphical presentation

Do you know how a stroke causes bladder problems?

Read the following posts…

• How stroke robs bladder control: strokecarer.com
• What bladder problems stroke can cause: strokecarer.com
• How measuring urine leak helps in bladder control activities
• University of Health Network: How to do pelvic floor muscle exercises: University Health Network: This includes a graphical presentation of pelvic floor muscles and some other methods of locating the muscles.

References

1. Jo Booth (2019): Bladder rehabilitation in stroke survivors: who don’t nurses do it? The British Medical Journal blog/Evidence-based nursing
2. Royal College of Physicians (2016): National Clinical Guidelines for Stroke, NICE accredited
3. University of California San Francisco (UCSF Health): University of California San Francisco; bladder re-training.
4. University of California San Francisco (UCSF Health): University of California San Francisco; pelvic muscle exercises
5. Stroke Network, SouthWest Ontario: Module 4: Incontinence.