Stroke Training and Awareness Resources (STARs)

Let’s hear about Hannah

photo portrait of womanYou are working with Hannah who has had a stroke and has mild weakness in her right arm and leg. You notice that she has damp underwear and are aware that this has been happening on several occasions.

The physiotherapist has noted that Hannah has been refusing to attend therapy for the last 3 days. You are informed that Hannah was up to the toilet every half hour overnight, passing only small volumes of urine. Hannah is not suffering from constipation and has not had continence problems before.

It is important to remember in cases where continence problems have been thoroughly investigated but remain unresolved, there are many continence aids which may help the person manage the problem. Again, a continence specialist may also be able to assist in making the appropriate treatment choices.

Asking Hannah if she is aware that her underwear is damp

It is important to establish whether or not Hannah is aware of her incontinence.

Giving Hannah laxatives

This would not be appropriate as you know that Hannah is not suffering from constipation so this is not a cause of her incontinence.

Telling Hannah to go to the toilet every 15 minutes

This would not be appropriate as it could make the problem worse by making Hannah feel the need to go to the toilet even more frequently and reinforce an inappropriate bladder pattern.

Examining Hannah to check whether her bladder appears full

If Hannah’s bladder is not emptying properly after each visit to the toilet this may cause her to be incontinent of urine. If you think that this may be the problem you need to report it to a senior member of staff. A bladder scan would also identify this problem.

Encouraging her to drink less

This is not appropriate as it may lead to Hannah becoming dehydrated and subsequently very ill. Adequate hydration (2 litres a day) is required to help prevent problems such as urinary infections and constipation.

Obtaining a specimen of urine from Hannah

A urinary infection may cause Hannah to need the toilet frequently and to be incontinent. If the urine tests positive for infection Hannah will need a course of antibiotics and must drink lots of fluids.

Giving Hannah incontinence pads and tell her not to worry about it

It is not appropriate to give Hannah incontinence pads without fully investigating the cause of her continence problems. Sometimes though people feel reassured by using pads in the short term until their continence issues are fully investigated.

Advising Hannah to go to the toilet only once every 3-4 hours

This is not appropriate as Hannah has been going to the toilet every half hour and waiting 3-4 hours would cause her to be frequently incontinent. Although bladder ‘re training’ is used as a technique to help resolve some continence problems, this would need to be carefully managed and the time gradually increased.

Page last reviewed: 30 Jan 2020