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Caregiver Guide to Bowel and Bladder Function after Stroke

In this episode of Kessler Foundation’s podcast, Lizette Hocbo-Balin, BSN, CRRN, of Kessler Institute for Rehabilitation presents “Caregiver Guide to Bowel and Bladder Function after Stroke.”  



This is part six of an eight part series. Listen to the series as it's posted. 

Listen to the podcast, view the transcript and download this episode and others for free on Apple PodcastsSoundCloudPodbeanor where ever you get your podcasts.

Below is an excerpt from the lecture.

My name's Lizette Balin, and I'm a nurse manager at Kessler in West Orange. I've been a nurse manager for eleven years. And I was a night manager for five of those eleven years, so I've handled night shift and day shift. And so I've seen the patients both during the night and during the day, when they're having their bowel programs and when they're doing their bladder retraining programs. So I've seen most of it. Learning is a continuous process. So I know that as soon as I know something, I know things that I still need to learn. All right. So one of the things I want to learn is who you are.

How many here are therapists: speech, PT, OT? Oh, a lot of you. Nurses and nursing students? Case managers? Okay. So hello, everyone. So the slides that I will show you and also in your handout would be a caregiver guide. So it's very simply written, simple language. And when you print it, you can actually give it to your patients or your patients' care partners or caregivers so that they will be more comfortable in handling bowel and bladder issues for their stroke patients.

So my goal today-- first of all, my goal is not to cough. I'm eating a cough drop right now. And so, if I do that, pardon me. I'm the one who is loud back there barking at all the speakers today. So my objectives would be to review the common problems of bowel and bladder after a stroke, understand underlying causes of bladder and bowel problems, know how a rehab nurse - I am also part of the Association of Rehab Nurses here in the Northern New Jersey chapter - how we can help with bowel and bladder management in the acute rehab setting and identify strategies for a patient's self-management of urinary and fecal incontinence, so what our patients and their care partners can do at home. I have nothing to disclose. You didn't pay to come here, so they're not paying me either [laughter]. So hopefully, this will be a topic that will be in the front line of our taking care of the patients when they go home. Because as Dr. Adler did say, one of the barriers-- they probably can transfer from wheelchair to the toilet. They can probably do all those wonderful things in therapy. But if they have bowel and bladder issues, particularly incontinence, that is one of the main barriers for patients not going home, right?

Definitions Related to Bowel and Bladder 
So let's go to definitions. Urinary incontinence is poor bladder control. Frequency is the need to go to the toilet often. Urge incontinence is a sudden, uncontrollable need to pass urine, what we call wetting accidents. Functional incontinence is difficulty getting into the toilet on time or getting clothing undone in time. So you will see these patients. Sometimes they cannot express themselves because of the stroke, so they are pounding like this on their table or wheeling themselves to the bathroom.

Sometimes they have control of their bladder, but because they cannot get to the toilet in time or they don't have the dexterity of their hands to unbutton and unzip their pants or they cannot physically stand up and pull down their pants or undergarments, then they have these kinds of accidents. This is actually one of the things why we have the bladder retraining program. Nocturnal incontinence is the need to go to the toilet several times at night. This is sometimes seen in patients with other comorbidities such as diabetes sometimes, right? So when a patient has a concomitant diabetes with a stroke, sometimes they actually already have nocturnal incontinence or functional incontinence at night because of their need to go to the bathroom really frequently.

Urinary retention, this is more common because of the stroke, detrusor areflexia. It is a condition where a patient is not able to fully empty the bladder or when someone is holding an increasing amount of urine in the bladder. So they don't know; because of the stroke, there's this disconnect between the brain and the bladder. The bladder becomes full. The patient doesn't know that it's full, so there is urinary retention because of that. So once you have that urinary retention, you know the urine goes up to the ureters and back to the kidneys, and sometimes that causes the infection, right? So what are the symptoms of urinary tract infection? It would be a urine with bad smell, cloudiness, blood, or sediment; a patient experiences burning when urinating; fevers and chills; cramps in the lower abdomen or side; pain in the lower back; or frequent urination or feeling like you have to go again, even if you've already gone to the bathroom or you feel like you've already emptied your bladder.

Post Stroke Constipation
Post-stroke constipation may be caused by inactivity, lethargy, insufficient water or nutrition intake, depression, lack of exercise capabilities, cognitive impairment, reduced consciousness, and drug intake. So again, the two problems would be-- the bowel is so full because when you're at least two days in the hospital, you're somewhat debilitated. So the functions of the bowel-- the functions of the bowel are not there. So you have to reactivate that. So either there is fecal impaction there or you cannot hold it because of the stroke, right? Okay. I have a story about bowel incontinence. And I may or may not deny that this actually ever happened because it is my friend.

So we are in a queue going on a-- I recently went on a trip to Israel, and there is a park there called Masada National Park. Have anyone been to Israel? Right. So the Masada is a national park where it is a plateau. So it is a mountain, and then there is a plateau, a flat-- this was the last stand of the Jewish people during the Jewish-Roman War. So we are going there for the excavations, for the old Roman palaces. But before we get to that park, we have to fall in line to get to a cable car to go up there. Now, when we were in line, my friend, who has a husband who's also a nurse, ate something bad the day before. So she didn't know it. She had to go to the bathroom the day before several times.