Bladder dysfunction after a stroke

Urinary incontinence after stroke affects 40-60% of people following acute stroke which is 60,000 – 90,000 people in UK each year.

• 44% continue to report urinary incontinence at three months post stroke
• 38% report continued urinary incontinence at one year post stroke

There is no evidence of any differences in urinary incontinence between ischaemic stroke or haemorrhagic. They are both associated with bladder dysfunction.

Possible types of bladder dysfunction associated with strokes

• Neurogenic overactive bladder – this is the most common type of bladder dysfunction because of damage to the higher cerebral micturition centres, in the frontal lobes, parietal lobes and mid-brain

• In the very early days of acute stroke (usually the first 3-5 days) acute urinary retention is reported in up to 40%^[1].

  This is caused by detrusor hyporeflexia – a form of ‘bladder shock’. It may resolve quickly but we do not know as there is no research evidence yet.

Clinical practice note. Because management uses urethral catheters there is the danger that these may become ‘long-term’. If this happens there are many complications and the stroke survivor cannot regain continence with an indwelling catheter. Intermittent clean catheterisation is the best option in the acute period for up to six weeks after stroke.

• Overflow incontinence – bladder dysfunction may also be caused by detrusor-sphincter dyssynergia from stroke damage to the pontine micturition centre. As with retention, this can lead to overflow incontinence.
• Functional incontinence is common after stroke. Communication difficulties, physical disability and cognitive impairment makes it hard for people to indicate they need to use the toilet. Because of urgency many people are unable to reach a toilet in time.

Did you know? Many stroke survivors need help to use the toilet. If they receive the right help at the right time most stroke survivors can regain continence.

References

_{1. Cowey E, Smith LN, Booth J, Weir CJ. Urinary catheterisation in acute stroke: clinical realities. A mixed methods study. Clin Rehabil. 2012 May;26(5):470-9. [Cited 17 August 2018] Available from: https://doi.org/10.1177/0269215511426160}

Further reading

_{2. Brittain KR, Perry SI, Peet SM, Shaw C, Dallosso H, Assassa RP, et al. Prevalence and impact of urinary symptoms among community-dwelling stroke survivors. Stroke. 2000:31;886-891. [Cited 1 January 2020] Available from: https://www.ahajournals.org/doi/full/10.1161/01.str.31.4.886}

_{3. Pizzi A, Falsini C, Martini M, Rossetti, MA, Verdesca S, Tosto A. Urinary incontinence after ischemic stroke: Clinical and urodynamic studies. Neurourol. Urodynam. 2014;33:420-425. [Cited 17 August 2018] Available from: https://doi.org/10.1002/nau.22420}

_{4. Williams MP, Srikanth V, Bird M, Thrift AG. Urinary symptoms and natural history of urinary continence after first-ever stroke – a longitudinal population-based study. Age and Ageing 2012;41;371-376. [Cited 17 August 2018] Available from: https://doi.org/10.1093/ageing/afs009}