hemiplegia

[stalinphysio]

Hello to all,

i am working in khm hospital as a junior physio and i have the patient with right side hemiplegia for past 2 month.In my patient,he has got oritention,sitting balance,moderate stanting balance and he can able to walk with support. Problem is,urinary and faecal incontience.for that we have any physio treatment . please give any idea to me.

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[sbbb]

u should go for bowel nd bladder training. for this u refer sullevian book. it all include timed voiding,, intermitent catheterizationetc. u read from this book nd still have any problem then tel me

[sdkashif]

Urinary incontinence is a common problem after stroke. Approximately 50% of stroke patients have incontinence during their acute admission for stroke. However, that number decreases to 20% by 6 months after stroke. Increased
age, increased stroke severity, the presence of diabetes, and the occurrence of other disabling diseases increase the risk of urinary incontinence in stroke.
Most patients with moderate-to-severe stroke are incontinent at presentation, and many are discharged incontinent. Urinary and fecal incontinence are both common in the early stages. Incontinence is a major burden on caregivers once the patient is discharged home. Management of both bladder and bowel problems should be seen as an essential part of the
patient’s rehabilitation, because they can seriously hamper progress in other areas. Acute use of an indwelling catheter may facilitate management of fluids, prevent urinary retention, and reduce skin breakdown in patients with stroke; however, the use of a Foley catheter for more than 48 hours after stroke increases the risk of urinary tract infection. Fecal incontinence occurs in a substantial proportion of patients after a stroke, but clears within 2 weeks in the majority of patients.90 Continued fecal incontinence signals a
poor prognosis. Diarrhea, when it occurs, may be due to medications, initiation of tube feedings, or infections; it can also be due to leakage around a fecal impaction. Treatment should be cause-specific. Constipation and fecal impaction are more common after stroke than incontinence. Immobility and inactivity, inadequate fluid or food intake, depression or anxiety, a neurogenic bowel or the inability to perceive bowel signals, lack of transfer ability, and cognitive deficits may each contribute to this problem. Goals of management are to ensure adequate intake of fluid, bulk, and fiber and to help the patient establish a regular toileting schedule. Bowel training is more effective if the schedule is consistent with the patient’s previous bowel
habits. Stool softeners and judicious use of laxatives may be helpful.

Recommendations

1. Recommend assessment of bladder function in acute stroke patients, as indicated. Assessment should include the following:

• Assessment of urinary retention through the use of a bladder scanner or an in-and-out catheterization
• Measurement of urinary frequency, volume, and control
• Assessment for the presence of dysuria

2. Recommend considering removal of the Foley catheter within 48 hours to avoid increased risk of urinary tract infection; however, if used, it should be removed as soon as possible.

3. Recommend the use of silver alloy– coated urinary catheters, if a catheter is required.

4. There is insufficient evidence to recommend for or against the use of urodynamics over other methods of assessing bladder function.

5. Recommend considering an individualized bladder training program be developed and implemented for patients who are incontinent of urine.

6. Recommend the use of prompted voiding in stroke patients with urinary incontinence.

7. Recommend that a bowel management program be implemented in patients with persistent constipation or bowel incontinence.