Stroke survivors’ and carers’ experiences of a systematic voiding programme to treat urinary incontinence after stroke

Abstract

Aims and objectives
To explore the views and experiences of stroke survivors and carers about a systematic voiding programme for post-stroke incontinence.

Background
Urinary incontinence after stroke is common and associated with poorer functional outcome. Structured assessment and management are potentially effective interventions but it is important that there is a good understanding of stroke survivors’ and carers’ views of their acceptability and implementation.

Design
Qualitative study within a feasibility trial.

Methods
16 participants (12 stroke survivors, 4 carers) were interviewed using a structured schedule shortly before discharge from one of six inpatient stroke units across six hospitals. Interviews were audiorecorded, transcribed verbatim, and thematic analysis was conducted.

Findings
Participants included seven male and five female stroke survivors (mean age 76 years), and four female carers (two wives, two daughters). Themes relating to the preliminary (assessment) phase of the programme were: physical impact, psychological impact, beliefs about incontinence, and the assessment process itself. Main themes relating to the implementation of the programme included: Timed voiding decisions, adapting the programme or the timed voiding schedule, and urinary incontinence management techniques. Participants felt that the programme helped them to re-establish a regular pattern of micturition and to regain autonomy.

Conclusions
The effectiveness of a systematic voiding programme may partly lie in its educational component, challenging patients’ and carers’ assumptions that post-stroke incontinence is inevitable. Individual adaptation of the programme, and the ability to incorporate it alongside other aspects of care, are likely to be key factors influencing implementation.

Relevance to clinical practice
Urinary incontinence is common after stroke. In order to maximise benefits from a systematic voiding programme, nurses should support stroke survivors to overturn erroneous beliefs, to participate in tailoring of the programme, and in self-management where appropriate.