It is essential to monitor the following factors in order to prevent bladder problems in stroke patients:
Fluid balance – functional difficulties may prevent adequate intake of fluids. A daily intake of 2-3 litres per day can prevent urinary tract infections that may occur due to immobility in inability to adequately empty bladder.
Urinary output or episodes of incontinence should be monitored as these can reveal problems with bladder emptying (eg. urinary retention or retention with overflow).
Mobility – the ability to walk unaided is the most important factor in maintaining or regaining continence after a stroke. Assisted mobility should begin as soon as possible after the stroke. This will help facilitate bladder emptying as well as improving morale, appetite, bowel and bladder function, muscle strength, joint mobility and is therefore a crucial part of rehabilitation.
Blood sugar levels - If a person is diabetic, hyperglycaemias (high blood glucose) can cause polyuria (production of large volumes of urine)
Communication – Many people will have communication difficulties after a stroke. In the early stages, patients may experience urgency when they want to pass urine, but may not be able to adequately express this need. Consideration therefore needs to be given to strategies to improve or facilitate communication.
Drug therapy – careful attention should be paid to prescription drugs as some of these can cause, or worsen existing incontinence. These include diuretics, muscle relaxants and some antihypertensives.
Bowel management – constipation can cause or worsen existing continence problems and attention therefore needs to be paid to fluid intake and a fibre rich diet.
