A stroke can have life-changing effects on both the mind and body, most often affecting mobility and speech. However, it can also impact basic bodily functions, like bladder control. Around 50% of stroke survivors will experience incontinence or some loss of bowel control after the incident. This can be one of the most frustrating and sensitive challenges of recovery, but the long-term prognosis is optimistic. Post-stroke incontinence is often manageable with the proper treatment and the use of reliable incontinence supplies, and many individuals regain control of their bladder and bowel over time. Here, we'll discuss some essential things to know about stroke and UI, along with tips to help you during recovery.
In this article, you’ll learn:
- What a stroke is and how it affects brain function and your body.
- The main types of strokes, including ischemic, hemorrhagic, and transient ischemic attacks.
- How to recognize stroke warning signs using the FAST acronym (Face, Arm, Speech, Time).
- Why strokes can cause urinary incontinence and which areas of the brain control bladder function.
- The different types of incontinence that may occur after a stroke, such as urge, stress, overflow, and functional incontinence.
- How doctors diagnose post-stroke incontinence through medical history, physical exams, and tests like urinalysis or bladder scans.
- Treatment options for managing urinary incontinence during recovery, including bladder training, pelvic floor exercises, and adaptive equipment.
- The role of medications, therapy, and professional support in improving bladder control after a stroke.
- How emotional and social support can help patients and caregivers cope during the recovery process.
What is a Stroke?
A stroke occurs when blood flow to a part of the brain is suddenly interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die, which can lead to lasting neurological damage.
There are a few main types of stroke:
- Ischemic stroke: caused by a blood clot blocking an artery in the brain (the most common type).
- Transient ischemic attack: commonly known as a "mini stroke," which may be a warning sign for the onset of stroke in the future.
- Hemorrhagic stroke: caused by a blood vessel rupturing and bleeding into the brain (usually more severe).
Because different parts of the brain control various body functions, the effects of a stroke depend on where it occurs and how severe it is. The most common occurrences following a stroke include weakness or paralysis on one side of the body, speech or vision problems, difficulty swallowing, and more.
The key to reducing the effects of strokes is to act fast, which is why it's essential to familiarize yourself with the main warning signs, using the acronym FAST:
- F – Face drooping: One side of the face may droop or feel numb. Ask the person to smile; is the smile uneven?
- A – Arm weakness: One arm may feel weak or drift downward when both arms are raised.
- S – Speech difficulty: Speech may sound slurred, strange, or completely absent. The person might struggle to repeat a simple sentence.
- T – Time to call emergency services: If you observe any of these signs, don't wait. Call emergency help immediately.
How a Stroke Can Lead to Urinary Incontinence
When blood flow to the brain is interrupted, it can also result in problems with bladder and bowel control. A stroke can damage the part of your brain that controls your bladder and bowel movements, but the effects aren't typically long-lasting. The frontal lobe and brainstem play key roles in signaling when it’s appropriate to store or release urine. If these areas are affected, the brain may struggle to send or interpret signals correctly, leading to involuntary leakage or difficulty holding urine.
The type of incontinence and severity after a stroke can vary:
- Stress incontinence: a loss of urine after sneezing, coughing, or excess pressure put on the bladder.
- Urge incontinence: a sudden, intense need to urinate followed by leakage.
- Functional incontinence: the person recognizes the urge but can’t reach the bathroom in time due to mobility or coordination issues.
- Overflow incontinence: incomplete bladder emptying causes frequent dribbling.
- Reflex incontinence: passing urine without realising it.
- Nocturnal enuresis: involuntary loss of urine at night (wetting the bed).
The good news is that post-stroke urinary incontinence often improves with stroke rehabilitation, bladder training, pelvic floor exercises, and medical treatment. Early intervention and ongoing support can make a big difference in recovery and quality of life.
However, according to research, there are still a lot of gaps in knowledge regarding the relationship between stroke and incontinence, especially regarding fecal incontinence. Working with your doctor is the best way to understand your unique circumstances better and determine the best course of treatment.
Diagnosing Incontinence After a Stroke
Diagnosing UI after a stroke involves several steps to determine the underlying cause and identify the most effective treatment. Because bladder control issues can stem from both neurological changes and physical limitations, healthcare providers take a comprehensive approach that includes:
Medical History and Symptom Review
Your healthcare provider will start by discussing your symptoms, family health history, personal medical history, and any medications you’re taking. They’ll ask about:
- Frequency and urgency of urination
- Leakage episodes and triggers
- Fluid intake and bowel habits
This helps identify patterns and rule out other causes, such as infection or medication side effects. If you experience non-urological-related problems after a stroke, it's important to mention these during this time.
Physical and Neurological Examination
A general physical exam evaluates muscle tone, reflexes, and mobility. This is an integral part of determining the best treatment and management, as it can help identify the type of incontinence you're experiencing. A neurological assessment can also help determine whether brain or nerve damage is interfering with bladder control.
Diagnostic Tests
Next, diagnostic tests may be performed. This will help rule out other possible causes and determine the type and severity of UI. Some of the most common tests include:
- A urinalysis and laboratory tests to check for things like urinary tract infections (UTIs) or other conditions that can worsen incontinence or mimic its symptoms.
- Bladder function tests (urodynamic studies) are used to measure how well the bladder stores and empties urine.
- Post-void residual measurement using an ultrasound or a catheter to see how much urine remains in the bladder after urination.
- Images or specialized testing (if needed) to further evaluate neurological function.
How to Manage Incontinence During Stroke Recovery
Luckily, treating urinary incontinence after a stroke is possible, and many people go on to regain continence. In the Copenhagen stroke study, almost 50% of individuals had UI or fecal incontinence immediately after a stroke, but this proportion declined to 20% UI and 10% FI after six months. However, recovery can be affected by other underlying causes or risk factors, so it's best to work with your doctor for both diagnosis and treatment. Some of the most effective options for managing symptoms of incontinence include the following:
Establish a Bladder Routine
Timed voiding can help retrain the bladder and reduce accidents. It involves scheduling bathroom breaks at specific times throughout the day, and trying to urinate regardless of whether you feel the need to go or not. This can help avoid urgency issues and train your bladder to urinate at regular intervals. As you continue with this management, you'll gradually increase the time between bathroom visits, which helps strengthen bladder control and restore normal patterns.
Practice Pelvic Floor Exercises
Pelvic floor muscle training, such as Kegel exercises, strengthens the muscles that support bladder control. These are easy to do and can be done at any time or any place. Simply try to squeeze the muscles that you would use to stop the flow of urine for three seconds, then relax for 10-20 seconds and repeat 10 times, gradually increasing the amount of time you hold the squeeze.
Some people may struggle to isolate the pelvic floor muscles, especially if Kegels have never been done before. In these cases, you can work with a physical therapist or continence specialist who can guide you through proper techniques, even if you experience limited mobility.
Use Adaptive Equipment and Incontinence Products
Regardless of the type of urinary incontinence experienced after a stroke, there are plenty of high-quality incontinence products and helpful tools to reduce the impact of leaks. Things such as absorbent pads, protective underwear, liners, adult briefs, and bed or chair protectors can all provide comfort and confidence during recovery. Your doctor can recommend products that will best fit your needs.
Explore Medication or Other Treatments
If lifestyle changes aren’t enough, doctors may prescribe medications that help calm bladder spasms or improve control. In some cases, medical devices or minimally invasive treatments may also be considered. These can include things such as electrical stimulation, but more research is needed to determine their long-term efficacy.
Seek Professional and Emotional Support
Recovering from a stroke can be challenging, and it can take a lot of patience. Sometimes, progress isn't linear, and this can significantly affect your mental health. However, it's important to stay consistent and seek professional and emotional support when needed. Working with a team of physical and occupational therapists, urologists, and continence nurses can help you get the guidance you need to overcome physical challenges. At the same time, support groups are great options to help with the emotional side of things.
Urinary incontinence after a stroke is a common and often distressing challenge, but recognizing the symptoms early and exploring a range of treatment options can make a significant difference in quality of life. For stroke survivors and caregivers looking for reliable solutions, Byram Healthcare offers a wide range of bladder management products, incontinence products, and resources designed to support independence and comfort. Contact Byram Healthcare today to learn more about options that can help you or your loved one manage urinary incontinence with confidence.
