How to manage post-stroke urinary incontinence in males?

From the Guidelines

Managing post-stroke urinary incontinence in males requires a comprehensive approach combining behavioral, pharmacological, and mechanical interventions, with the goal of minimizing morbidity, mortality, and improving quality of life. The most recent and highest quality study, 1, recommends assessing all stroke patients for urinary incontinence and retention, and developing an individualized management plan.

Key Components of Management

• Behavioral strategies:
  • Scheduled voiding every 2-3 hours
  • Pelvic floor exercises (Kegel exercises performed 3 sets of 10 contractions daily)
  • Fluid management by limiting intake 2-3 hours before bedtime while maintaining adequate hydration during the day
• Pharmacological interventions:
  • Antimuscarinic medications such as oxybutynin (5mg 2-3 times daily), solifenacin (5-10mg once daily), or tolterodine (2-4mg daily) to reduce bladder overactivity
  • Beta-3 agonists like mirabegron (25-50mg daily) as an alternative with fewer side effects
  • Alpha-blockers such as tamsulosin (0.4mg daily) for overflow incontinence due to urinary retention
• Mechanical interventions:
  • External collection devices like condom catheters for continuous leakage
  • Indwelling catheters as a last resort due to infection risk
  • Absorbent products specifically designed for men to manage symptoms while pursuing treatment

Importance of Regular Reassessment

Regular reassessment is essential as recovery from stroke may improve continence over time, and adjustments to the management plan can be made accordingly, as recommended by 1 and 1.

Considerations for Best Practice

Best practice guidelines, such as those outlined in 1 and 1, emphasize the importance of a structured functional assessment to determine the cause of incontinence and develop an individualized management plan, as well as the use of a bladder-training program and appropriate intermittent catheterization schedules. By prioritizing a comprehensive and individualized approach to managing post-stroke urinary incontinence in males, healthcare providers can minimize morbidity, mortality, and improve quality of life for these patients, as supported by the recommendations in 1, 1, and 1.

From the Research

Management of Post-Stroke Urinary Incontinence in Males

To manage post-stroke urinary incontinence in males, several strategies can be employed, including:

• Behavioural interventions: such as timed voiding and pelvic floor muscle training 2
• Specialised professional input interventions: including structured assessment and management by continence nurse practitioners 3, 4
• Complementary therapy: such as traditional acupuncture, electroacupuncture, and ginger-salt-partitioned moxibustion plus routine acupuncture 2
• Physical therapy: using transcutaneous electrical nerve stimulation (TENS) 2
• Pharmacotherapy interventions: such as oestrogen therapy and antimuscarinics 2, 5

Assessment and Diagnosis

Assessment and diagnosis of post-stroke urinary incontinence is crucial in determining the best course of treatment. This can be achieved through:

• History and physical exam: to diagnose the type of urinary incontinence 5
• Urodynamic studies: to assess detrusor overactivity and other types of incontinence 5
• Functional independence measure (FIM): to assess bladder management 6

Treatment Outcomes

The treatment outcomes for post-stroke urinary incontinence vary depending on the intervention used. Some studies have reported:

• Reduction in the number of incontinent episodes: with behavioural interventions and physical therapy 2
• Improvement in quality of life: with specialised professional input interventions and complementary therapy 3, 2
• Increase in the number of participants continent after treatment: with complementary therapy and physical therapy 2

Limitations and Future Directions

There are several limitations and future directions in the management of post-stroke urinary incontinence, including:

• Insufficient data: on the effects and benefits of non-pharmacologic and pharmacologic treatments in post-stroke patients 5
• Need for more research: on the range of interventions that have been suggested for continence care after stroke 4, 2
• Importance of multidisciplinary approach: in the management of post-stroke urinary incontinence, including input from continence nurse practitioners, physical therapists, and pharmacists 3, 6, 2