CVA/Stroke

Incontinence problems after a stroke are extremely common; it is estimated that about half of all people admitted to hospital after a stroke will experience some form of bladder or bowel control problem. However, many of these problems are not long term and can resolve over time.

Bladder problems

There are numerous types of bladder continence problems that can occur as a result of stroke.
These include:

  • Frequency - needing to pass urine often
  • Urge incontinence - when someone suddenly feels an urgent, uncontrollable need to go to the toilet but leak before they get there
  • Nocturnal Enuresis - wetting the bed while asleep
  • Functional incontinence - due to the physical effects of a stroke, someone may not be able to get to the toilet in time, or may have difficulty unfastening their clothes in time to use the toilet
  • Reflex incontinence - this is also called neurogenic incontinence and means passing urine without realising you have done so. This happens when the part of the brain controlling the bladder is affected by the stroke. For most people this lasts only a few months and improves as recovery happens in the brain.
  • Overflow incontinence - happens when the bladder doesn't empty properly and so it leaks

Why problems develop

There are several reasons why individuals may develop incontinence problems following a stroke. For example;

  • If the person is not fully aware of their surroundings, they may be unaware of the need to use the toilet and may wet or soil themselves without realising.
  • The stroke may have damaged the part of the brain that controls the bladder and/or the bowel.
  • Someone with mobility difficulties might experience continence difficulties. They may rely on help getting to or using the toilet and might wet themselves before they reach the toilet.
  • Someone with communication problems may not be able to tell anyone when they need to go to the toilet.

Getting help

An assessment by a doctor or nurse is essential in finding the nature and cause of a person's continence problem and in devising an effective treatment programme.

You may be referred to a specialist or your local continence advisor. Continence advisors are specialist nurses, trained to help with continence problems and they can develop a plan specially tailored for the individual's circumstances.

A Physiotherapists can provide training and exercises to improve walking and transferring from a bed or chair to a commode or toilet.

Treatment

Once the cause of the continence problem has been determined, suitable treatment will be offered. This may include:

  • Bladder retraining helps you to begin to hold more urine for longer periods of time. It is possible to train your bladder to do this by gradually increasing the time between each visit to the toilet
  • Pelvic floor muscle exercises or pelvic floor muscle rehabilitation can, if done correctly, help you improve your bladder and bowel control and resolve or improve leakage
  • Medication can help reduce urine production, and decrease urgency and frequency
  • In severe cases of incontinence a catheter may be used. This involves using a tube to drain urine from the bladder.

Continence products, such as pads, pants and bed & chair covers, are available to help people manage their incontinence. Please visit our Products section which contains information and stockist listings which you may find helpful.

How you can help yourself

It is important to drink at least 1.5-2 litres (6-8 glasses) of fluid each day. Drinking enough is essential to keep the bladder healthy. The bladder will work at its best when you drink the right amount of fluid. When you are not drinking enough, the bladder gets used to holding smaller amounts of urine and can become sensitive - especially if your urine becomes more concentrated as then it is more likely to irritate your bladder.

Increasing the amount that you drink may sound counter-intuitive. Indeed, in the short term it may well seem to make your problems worse, but this will only be temporary. In the longer term your bladder will learn to hold more urine, will become less sensitive and irritable, and will be less likely to harbour infections.

Try to cut down on drinks which contain caffeine such as tea, coffee, cola and alcoholic drinks as they may irritate the bladder and cause urgency and frequency.

If you have a frequency or urgency bladder problem, performing the pelvic floor exercises can help to manage the symptoms more effectively.  To find out more about the pelvic floor muscles exercises please go to our Pelvic Floor Muscle Exercises section.

Further help available

This information has been provided in association with the Stroke Association. For more information and support about Stroke please visit the Stroke Association's website. www.stroke.org.uk/

You can also contact them via their helpline number on Tel: 0303 3033 100

If you are concerned about your problem and it is starting to affect your day to day life make an appointment to see your doctor, continence nurse or specialist physiotherapist. A continence nurse and specialist physiotherapist are healthcare professionals who specialise in bladder and bowel problems.

You can also call our specialist helpline on 0845 345 0165 (24 hour answerphone) for medical advice, or call our office on 01536 533255 to find out where your nearest NHS continence service is.

 

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