Incontinence After a Stroke

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After a stroke, the loss of control over urination is one of the more embarrassing and disheartening effects. But, if you suffer from bladder control problem after a stroke, you do not need to feel alone. Patient records show that between 50-70% of stroke survivors experience some degree of trouble with urine control.

Loss of urine control can produce leaking, a sense of urgency (you have to go RIGHT NOW) and embarrassing accidents that produce skin irritation, a bad smell or even an obvious wetness.

This can impair your sense of confidence in social situations, at work and wherever there are other people around.

But rest assured, you don't have to put up with loss of bladder control after a stroke. Some stroke survivors experience improvement within a few weeks after a stroke, but the majority of people who experience loss of bladder control after a stroke need some form of medical treatment. There are a number of effective options for the management of urination problems.

Lifestyle Adjustments

Simple lifestyle adjustments may be enough to handle minor leaks if they occur only rarely. Lifestyle changes include wearing absorbent pads and maintaining a consistent schedule for drinking fluids and going to the restroom. Avoiding caffeinated beverages such as coffee, caffeinated tea, and soft drinks is important because caffeine is a diuretic, which means that it triggers urination. Chocolate also contains caffeine and therefore desserts that contain chocolate can cause urgency or sudden leaking.

Rehabilitation and Bladder Training

Rehabilitation and physical therapy after a stroke may include bladder-training maneuvers. However, bladder training for stroke patients has not advanced as well as other types of therapy, such as physical therapy for speech, swallowing and walking. A recent research experiment in England included 413 patients from 12 different stroke hospitals.

The outcome of the experiment demonstrated that bladder training appears promising in controlling leaks and preventing infections.

Medication

However, if involuntary urination is a bigger problem that cannot be managed by lifestyle changes and bladder training, you may need medical intervention. Prescription medications can help reduce urine production and can help with muscle control. Your doctor might prescribe medication for you if it would help with your particular bladder control problem. On a similar note, some medications may trigger a lack of bladder control- and they may cause you to experience leaking if you take any of these medications after you have had a stroke. You might need to have your medications adjusted if you are taking something that could worsen your bladder control problem. Check with your pharmacist to see if any of your medications cause incontinence (loss of bladder control) or diuresis (large volume of urine).

Procedures for Bladder Control Problems

Other treatments include a procedure called transcutaneous electrical nerve stimulation (TENS), which is a type of electrical therapy applied to the spine.

A recent evaluation of 60 stroke patients in China found this method to be safe and effective in reducing incontinence. Injection of botulinum toxin, Botulinum Toxin, has been used for muscle stiffness after a stroke and has been recently approved for treatment of incontinence as well.

Stroke and Urine Control

Urinary control requires a sophisticated interaction between the brain, the spinal cord, and the nerves. The whole interaction allows us to hold urine so that we can avoid urinating at the wrong time, while waiting for a suitable time and place to empty the bladder. The control also allows people to begin the process of urination when the right time and place arrives and to continue until the bladder is empty.

An injury to the brain, such as a stroke, can interfere with the coordinated process that allows a stroke survivor to postpone urination and then eventually start and stop. There are several types of stroke and a number of different types of stroke can produce lack of bladder control. More severe strokes are more likely to cause bladder control problems. If you have a loss of control of bladder emptying, resulting in leaks, or an inability to empty your bladder, you should definitely discuss your bladder problems with your doctor. You have a variety of options and your individual pattern of urinary dysfunction will help define the best option for you. Your doctor can determine whether you need lifestyle adjustments, medication or a procedure to help you control your urination and regain your confidence again.

It is important to keep in mind that sometimes strokes can cause an inability to urinate, called bladder retention. Occasionally, medications used to prevent the loss of bladder control can cause bladder retention. Find out more about bladder retention after a stroke.

Sources

Prevalence and risk factors of urinary incontinence for post-stroke inpatients in Southern China, Cai W, Wang J, Wang L, Wang J, Guo L, Neurourology and Urodynamics, December 2013

Urinary incontinence after ischemic stroke: clinical and urodynamic studies, Pizzi A, Falsini C, Martini M, Rossetti MA, Verdesca S, Tosto A, Neurourology and Urodynamics, April 2014

The incidence and etiology of overactive bladder in patients after cerebrovascular accident, McKenzie P, Badlani GH, Cureent Urology Reports, July 2012

Identifying continence options after stroke (ICONS): a cluster randomised controlled feasibility trial, Thomas LH, Watkins CL, Sutton CJ, Forshaw D, Leathley MJ, French B, Burton CR, Cheater F, Roe B, Britt D, Booth J, McColl E; ICONS Project Team and the ICONS Patient, Public and Carer Involvement Groups, Trials, December 2014

Transcutaneous electrical nerve stimulation in the treatment of patients with poststroke urinary incontinence, Guo ZF, Liu Y, Hu GH, Liu H, Xu YF, Clinical Interventions in Aging, May 2014

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