**5.2 Improving the ability to do ways to deal with post-stroke UI**

This action needs to be done in management of post-stroke UI. The results of our qualitative study showed that the informants/patients did several ways to overcome their post-stroke UI such as bladder retraining, pelvic floor muscle exercises, distraction technique, and ROM exercises. These ways describe the knowledge, skills, and ability to decide what the patient should do in dealing with his illness. Based on these findings, it appears that the patient is not only focused on improving the functional ability to urinate but also improving the functional ability to walk. In dealing with post-stroke UI, patients need to be trained to improve the functional ability to urinate as well as the functional ability to walk [16].

Such exercises can be provided through health education and demonstrations to patients and caregivers. Skills exercises taught to patients and caregivers include bladder retraining, pelvic floor muscle exercises, and deep breathing relaxation exercises to divert the urge to urinate. In addition, ROM exercises are also done to train the patient's muscle strength so that it can help the patient walk to urinate in

the bathroom. Patients and caregivers are given the opportunity to practice and demonstrate the skills that have been taught independently, but are still given continuous supervision to achieve the goals that have been set. This education and skills training can be provided in the hospital after the patient has passed the acute phase of stroke and then continued at the patient's home.

Continental training begins as soon as the patient's condition stabilizes. It is also important to prevent incontinence which may be reversible [1]. Bladder retraining requires that patients be independent and motivated to actively participate in treatment [34]. Bladder retraining trains the patient to empty the bladder at regular intervals. Emptying the bladder at regular time intervals in post-stroke UI patients is a more effective method for treating incontinence [1].

Consider that there is strong evidence that bladder retraining with urge suppression is effective in treating urge incontinence, stress incontinence, and mixed incontinence in adult women. Bladder retraining exercise is also often combined with pelvic floor muscle training (detrusor contraction inhibition) in adults with UI without neurologic disease. This exercise has been shown to be effective in reducing incontinence episodes for three months, compared to bladder retraining with urge suppression alone [34]. Pelvic floor muscle exercises seek to reduce uncontrolled detrusor muscle contractions in patients with better cognitive abilities. Individuals/patients who perform pelvic floor muscle exercises must have confidence and be motivated to perform exercises regularly despite obstacles or difficulties in daily life [33].

Before starting pelvic floor muscle training, it is necessary to ensure that the patient can perform pelvic floor muscle contractions. More than 30% of patients are unable to contract the pelvic floor muscles at the first meeting of educational exercises [40]. So that training and education repeatedly need to be done. Patients and caregivers are also encouraged to always pay attention to environmental conditions, avoid wet floors, pay attention to room lighting during exercise, including eating nutritious foods, and avoiding drinks containing alcohol and caffeine such as tea, coffee, and cola especially before bedtime. Also avoid drinking too little because it can make the urine color dark and can irritate the bladder. Avoid drinking too much and too fast. Advise the patient to drink 500 milliliters at each meal and 200 milliliters between meals, and to drink more fluids in the morning and evening.

The ways that patients do in dealing with post-stroke IU describe the patient's ability and skills to achieve healing. This is based on the knowledge and desire of the patient to recover, so that the patients carry out the process of transferring (transformation) health patterns with the choice to change attitudes in living daily life. In human becoming theory, it is stated that the transformation of health patterns can occur when individuals find insights about themselves that were previously unclear, when they find ways to change towards the hopes and dreams they cherish [28, 41]. The hope for recovery makes the patients always do ways to overcome the poststroke UI and become the patient's strength when facing the post-stroke UI.

## **5.3 Improving self-control and stay motivated**

Self-control is the inhibiting force that enables the person to adjust decisions and behavior towards long-term targets [42]. Self-control describes how a person chooses and finds ways to deal with the situations they experience. This relates to the values of beliefs held. In Human becoming theory, it is stated that beliefs reflect what is important in a person's life regarding his health, which is the basic for a person to make choices about how to think, act, and feel [43].

Self-control is done by thinking positively and controlling emotions [36]. Positive thinking is done by cultivating positive thoughts, eliminating the burden of thinking

about the disease, getting closer to God, and growing belief in healing, including belief related to spirituality in interpreting post-stroke UI [36]. Patients are always reminded of the goals to be achieved and focus on achieving these goals. The success of self-control can be seen in increasing physical activity, improving general health, feeling happy, increasing physical and emotional roles. Positive thinking can be used to improve the quality of live [44]. Other studies have shown that self-control training has a significant effect in improving the quality of life in patients with migraine [42] and improving the quality of life of asthma patients [45].

Positive thinking is the practice or result of a firm mind about what is constructive and about something good, so that it can eliminate negative thoughts and emotions [46]. Positive thinking helps to know and understand self-concept better, and helps to see yourself better. Positive thinking is very important in achieving goals and making a person constructive and creative. Positive thinkers face situations optimistically and if they face stressful situations, then they judge it to be controllable and use coping strategies that are functional, efficient, and problemfocused [47].

Positive thinking is supported by internal cognition, beliefs, and relationships [46]. Beliefs including religious beliefs can help a person cope with a state of uncertainty, including in dealing with stressful life events [48]. Positive thinking is also associated with optimism, perception, and self-esteem [46].

Based on this, the interventions/steps that need to be taken to increase positive thinking include:


*Development of Management Model Post-Stroke Urinary Incontinence DOI: http://dx.doi.org/10.5772/intechopen.99700*

Emotional factors also affect the recovery of stroke patients, even patients who are have considered functionally independent at three months after stroke still experience social isolation, difficulty social participation, and depression [35]. Early adaptation can predict depressive symptoms six months after stroke [35]. Emotional contro/emotional regulation is the process by which individuals influence the emotional that they have, when they have them, how they experience and express those emotions [49]. Emotional regulation is closely related to coping, emotional resilience, emotional intelligence, emotional expressiveness, and emotional energy.

In emotional control there are two strategies that are commonly used, namely reappraisal (reassessment) and suppression. Reappraisal occurs when the person changes the way he or she thinks about a potentially emotional situation and turn the experience into a non-emotional situation, whereas suppression is referred to as an obstacle to the way a person responds or behaves in an event that evokes emotion. In addition, social context also influences emotion regulation in various ways. Having attachment figures, friends, parents, spouse, children, and significant others are valuable interpersonal resources for dealing with emotions, expectations about their accessibility, assistance, and sensitivity can significantly increase or impair the capacity to manage emotions.

Based on this, the interventions/steps that need to be taken in controlling emotions include:

