Bladder Training After Stroke: Concerns About Catheter Use and Function

Q: Bladder Training After Stroke: Concerns About Catheter Use and Function

Kimi： Hello, after a stroke, if it causes urinary dysfunction, the approach depends on the severity of the stroke. <br>For severe or extensive strokes, it is recommended to place a urinary catheter for 6 months before starting bladder training. <br>When there is a urinary tract i

Bladder training after a stroke?

Hello, my father had a stroke in mid-August and had a catheter inserted on August 20.
During his hospitalization (from August 13 to August 31), the attending physician instructed us on how to secure the catheter and train the bladder.
However, during yesterday's follow-up visit to the urology department, the urologist indicated that there are bacteria in my father's urine, making bladder training inappropriate at this time.
He suggested that we should use a machine to test directly during the next visit next week.

I would like to inquire whether long-term catheterization can lead to a loss of bladder function.
If bladder training is not performed, how can the catheter be removed? I am concerned that prolonged catheterization may result in a loss of bladder function.
Thank you for your response!

kimi, 60~69 year old female. Ask Date: 2014/09/10

Dr. Xu Weikai reply Urology

Kimi: Hello, after a stroke, if it causes urinary dysfunction, the approach depends on the severity of the stroke.
For severe or extensive strokes, it is recommended to place a urinary catheter for 6 months before starting bladder training.
When there is a urinary tract infection, even individuals with normal bladder function may experience abnormal sensations, making bladder training inaccurate.
Additionally, if bacteria are retained in the bladder for an extended period, it can lead to significant bacterial proliferation, resulting in more severe infections.
Therefore, bladder training should not be conducted when an infection is present.
Regarding long-term catheterization: if there are no other urinary-related complications and the bladder is not further damaged, it will not lead to loss of bladder function.
Bladder training can only be initiated when there is no infection in the urine.
If you have any further questions, feel free to ask, and we can discuss and research together.
Online responses should only be used as a reference; it is essential to seek medical attention at healthcare facilities when necessary.
This message is from Dr.
Hsu Wei-Kai, Director of Urology, Taitung Hospital, Ministry of Health and Welfare, who cares about your well-being.

Reply Date: 2014/09/10

More Info

Bladder training after a stroke is a critical aspect of rehabilitation, especially for patients who have experienced urinary incontinence or other bladder dysfunctions. Your father's situation, where a catheter was placed following his stroke, raises several important considerations regarding bladder function and the potential impact of long-term catheter use.

When a catheter is used for an extended period, there is a risk that the bladder may become less responsive or lose its ability to contract effectively. This phenomenon is often referred to as "bladder atony," where the bladder muscles weaken due to disuse. The bladder relies on regular filling and emptying to maintain its function, and prolonged catheterization can disrupt this natural cycle. Consequently, the bladder may not respond appropriately when the catheter is removed, leading to difficulties in urination.

In your father's case, the urologist's recommendation to avoid bladder training due to the presence of bacteria in the urine is prudent. Urinary tract infections (UTIs) are a common complication associated with catheter use, and they can exacerbate bladder dysfunction. Training the bladder while an infection is present could lead to further complications and discomfort. Therefore, it is essential to address the infection first before considering bladder training.

Once the infection is resolved, bladder training can be initiated. This process typically involves scheduled voiding, where the patient is encouraged to urinate at regular intervals, gradually increasing the time between voids as the bladder becomes more accustomed to filling and emptying. This method can help retrain the bladder and restore its function over time.

If bladder training is not implemented, and the catheter remains in place for an extended period, the risk of bladder dysfunction increases. To remove the catheter safely, it is crucial to assess the bladder's ability to function independently. This assessment can be done through urodynamic testing, which evaluates how well the bladder and urethra are storing and releasing urine. If the bladder shows signs of adequate function, the catheter can be removed, and the patient can be monitored for any difficulties in urination.

In summary, while long-term catheter use can lead to a decline in bladder function, addressing any infections and implementing a structured bladder training program post-infection can help mitigate these risks. It is essential to work closely with healthcare providers, including urologists and rehabilitation specialists, to develop a tailored plan that considers your father's specific needs and circumstances. Regular follow-ups and assessments will be crucial in ensuring the best possible outcomes for bladder health and overall recovery after a stroke.

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