From the Guidelines
To help with incontinence following a Foley catheter removal, start with pelvic floor exercises (Kegels) and establish a timed voiding schedule, as these interventions can improve bladder control and reduce incontinence episodes, as recommended by the most recent guidelines 1.
Key Interventions
- Pelvic floor exercises (Kegels) by contracting the muscles that stop urination for 5-10 seconds, repeating 10-15 times, three times daily
- Timed voiding schedule, urinating every 2-3 hours regardless of urge
- Bladder training to gradually increase the time between voids
- Limit fluid intake 2-3 hours before bedtime and avoid bladder irritants like caffeine, alcohol, and spicy foods
Additional Strategies
- Absorbent products such as pads or briefs can manage leakage while regaining control
- Medications that may help include anticholinergics like oxybutynin (5mg twice daily) or tolterodine (2mg twice daily), or beta-3 agonists like mirabegron (25-50mg daily)
- Discuss incontinence management strategies with patients, including the use of liners, pads, diapers, barrier creams, external catheters, and absorbent washable protective briefs or underwear, as recommended by the American Urological Association 1
Importance of Early Intervention
Early intervention with these strategies can improve outcomes and reduce the risk of complications, such as urinary tract infections and skin breakdown, as highlighted in the guidelines for adult stroke rehabilitation and recovery 1
Monitoring and Follow-up
Regular monitoring and follow-up with a healthcare provider are essential to assess the effectiveness of these interventions and adjust the treatment plan as needed, as recommended by the American Heart Association/American Stroke Association 1
From the Research
Managing Incontinence after Catheter Removal
To manage incontinence following the removal of a urinary catheter, such as a volley catheter, several strategies can be considered:
- Assessing the need for catheter removal: Healthcare practitioners should regularly assess whether the catheter is still necessary and if it can be removed, as urinary catheters are associated with potential complications, including healthcare-associated infection and trauma to the bladder neck 2.
- Preventing urinary tract infections (UTIs): Antibiotic prophylaxis at the time of catheter removal may reduce the risk of subsequent symptomatic UTIs, with studies showing an absolute reduction in risk of 5.8% between intervention and control groups 3.
- Using antimicrobial-coated catheters: These catheters have been proposed as a method to prevent CAUTI, although evidence of their clinical efficacy is limited, and they may not provide clinically meaningful benefits 4.
- Prophylactic antibiotics during clean intermittent self-catheterization (CISC): Decision analysis models suggest that prophylactic antibiotics may be favored for preventing UTIs during CISC for voiding dysfunction after prolapse/incontinence surgery 5.
- Antibiotic prophylaxis after catheter removal: A systematic review and meta-analysis found that antibiotic prophylaxis after extraction of urinary catheters can prevent UTIs, particularly in patients over 60 years old or those with long-term catheterization 6.
Considerations for Antibiotic Prophylaxis
When considering antibiotic prophylaxis, the following factors should be taken into account:
- Patient age: Patients over 60 years old may benefit more from antibiotic prophylaxis after catheter removal 6.
- Catheterization duration: Patients with long-term catheterization (over 5 days) may benefit more from antibiotic prophylaxis 6.
- Type of antibiotic: Trimethoprim/sulfamethoxazole (TMP/SMX) may be a good choice for prophylaxis against UTIs after catheter removal 6.
- Potential risks and benefits: The potential benefits of antibiotic prophylaxis should be weighed against the risks of side effects and bacterial resistance 3, 6.