Henry Hoffman
Friday, November 30th, 2018
Last modified on August 26th, 2022

More than 15 million people suffer a stroke worldwide each year. Approximately half of all stroke survivors admitted to a medical facility will be affected by temporary bladder incontinence and one in three will struggle with bowel incontinence. Losing control of one’s bladder or bowel movements can be frustrating and embarrassing for survivors. Fortunately, there are many strategies to help survivors regain bladder and bowel control after suffering a stroke. It’s important to remember that every stroke is different and every recovery and rehabilitation model will be unique for each stroke survivor. In this case, it all starts with a greater understanding of the causes of incontinence.

Why Do Stroke Survivors Experience Incontinence?

There are many types of incontinence a survivor may experience following a stroke, with some survivors experiencing more than one. It’s important to remember that constipation, diarrhea, and urinary retention are all common following a stroke and may increase urge and functional incontinence issues. It is equally important to remember that there are many proven strategies to help individuals regain control and minimize accidents.

For some stroke survivors, incontinence may be a consequence of the damaged brain tissue suffered from a stroke event. This tissue damage can cause muscular spasms, loss of sphincter control, and other impairments. Those struggling with cognitive difficulties may not be able to properly or effectively communicate their need to use the restroom in time, causing delays and potential accidents. Motor impairments are common after a stroke, which can increase the amount of time an individual needs to reach the bathroom and adjust their clothing. The extra exertion required to move as a result of stroke motor impairment may lead to leaks and accidents.

Urinary urge incontinence involves an immediate urge to use the restroom and “is by far the most frequent long-term, chronic urologic complaint,” according to a report by The New York Times. This urgent need to use the restroom is typically caused by bladder contractions, which may result in the loss of bladder control and nighttime urges. The average adult will typically urinate about six to eight times a day, however, a stroke survivor may feel the need urinate more than usual.

Bowel incontinence is less common following a stroke than urinary incontinence. Diminished mobility often leads to increased constipation for stroke survivors which may result in control difficulties. A stroke survivor may not be able to eat or drink as much as usual and may be undernourished or dehydrated. This can also lead to constipation or bowel incontinence issues. Some individuals may struggle with fecal impaction in the rectum, causing constipation, and this condition can add pressure to the bladder, exacerbating urinary control issues.

Ways Stroke Survivors Can Manage Loss of Bladder Control

Research has shown that it may be easier to regain control of bowel movements than combat urinary incontinence. Again, motor impairments are common following a stroke and these deficits may interfere with an individual’s ability to make it to the restroom and also undress themselves in time. With these impairments in mind, wardrobe modifications such as switching to pants with an elastic waist band for convenience may be prudent. If an individual is dealing with more severe mobility issues, home modifications may be necessary to ensure the person can easily and quickly reach the restroom unhindered. Bedpans and portable urinals can also be strategically and discreetly placed in rooms to minimize accidents. Adult diapers are a solid backup plan, especially if the survivor has some room to go in the recovery journey before being able to manage using the bathroom independently.

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Making small changes to a person’s diet and feeding schedule can be helpful. For example, survivors struggling with bladder control at night may need to minimize fluid intake in the hours leading up to bedtime. Similarly, some food and drink exaggerate incontinence issues. Coffee and alcohol, for example, can compound frequency and urge issues and should probably be avoided. Establishing set times for bathroom breaks staggered throughout the day, or timed voiding, may also be beneficial. Once a comfortable routine has been established, the space between these scheduled breaks can be increased.

There are also exercises designed to strengthen the muscles of the pelvic floor, which can help survivors struggling with urinary stress incontinence and bowel incontinence. These exercises can be performed at home and many individuals notice improvements within a few weeks. The United States National Library of Medicine has compiled a helpful guide to a few of these exercises. If exercises and lifestyle adjustments have failed to address a survivor’s incontinence issues, their doctor may recommend the use of medications for constipation or incontinence.

Incontinence Is Usually Temporary and Always Manageable!

Thankfully, long-term incontinence is uncommon following a stroke and the latest research suggests that only about 15 percent of stroke patients will continue to experience incontinence issues one year after suffering a stroke. Nonetheless, even short-term incontinence can be upsetting and embarrassing for survivors. Here at Saebo, we are committed to stroke support and recovery for all survivors and their families. Saebo offers a wide range of products that combine cutting-edge technology with evidence-based rehabilitation techniques. Our offerings and network of Saebo-trained therapists can help you or a loved one to obtain all the necessary tools to maximize stroke recovery.

All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

— Update: 10-02-2023 — cohaitungchi.com found an additional article Coping With Incontinence Following A Stroke from the website www.bladderandbowel.org for the keyword loss of bowel control after stroke.

This month is Make May Purple for Stroke Awareness and we will be highlighting this devastating illness that affects over 1.2 million people and is the leading cause of disability in the UK.

What Is A Stroke?

A stroke is a brain attack and there are two main types of stroke:

• Ischaemic Stroke – this is caused by a blockage (such as a blood clot) to the brain’s blood supply. The lack of blood supply causes brain cells to become damaged
• Haemorrhagic Stroke – this is caused by a blood vessel bursting within or on the surface of the brain. These types of stroke are usually more severe

A TIA (Transient Ischaemic Attack) is also commonly known as a ‘mini stroke’. This has the same symptoms as a stroke but they tend to last for less than 24 hours after the blockage moves. These can indicate a warning sign that a full stroke may occur and should be treated as seriously and as quickly as a full stroke as it is difficult to differentiate between the two.

How Does A Stroke Affect You?

The effects of a stroke will depend on where the bleed or blockage is in the brain and how much damage this has caused to the brain. Some side effects of a stroke include:

• Weakness in the arms and/or legs
• Memory loss, speaking, reading, writing and understanding issues
• Issues with swallowing
• Loss of vision, headaches and fatigue
• Loss of bladder and/or bowel function
• Neuropathy – numbness and pins and needles in fingers and toes

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How Does A Stroke Affect The Bladder And Bowel?

A stroke can affect the bladder and bowel in many different ways. The part of the brain controlling the bladder and bowel may have been damaged causing the signals to misfire. If you have difficulty communicating, you may find it difficult to tell someone that you need the toilet. If you have trouble moving around then you may have difficulty reaching the toilet in time. If you are not aware of your surroundings then you may pass urine or faeces without realising.

Having a bladder or bowel problem following a stroke is very common. Around 50% of stroke survivors will go on to develop a bladder or bowel problem, so it is nothing to feel embarrassed about. The good news is that there are many treatments available to treat bladder and bowel conditions and many people will have recovered from their incontinence issues following a year after their stroke.

Some of bladder and bowel symptoms that are caused by a stroke include

• Urgency – a sudden or uncontrollable need to pass urine, often caused by spasms in the bladder
• Frequency – needing to pass urine frequently
• Nocturnal Enuresis – wetting the bed at night
• Urinary retention – an inability to pass urine
• Stress incontinence – when you pass urine through sneezing, coughing or by means of putting the bladder under pressure. Can be caused by weak pelvic floor or sphincter muscles
• Reflex incontinence – passing urine without realising. This is caused by the part of the brain that controls function being damaged
• Constipation – this is a common problem if you become inactive or immobile as it causes the bowel to slow down
• Overflow – which can be caused by constipation or faecal impaction where liquid stools flow uncontrollable around hard impacted stools that have lodged in the rectum

How Can I Treat My Bladder And Bowel Symptoms?

It is important to seek advice about any bladder and bowel issues that you are suffering from following a stroke so that it can be treated effectively. The first line of treatment will be to make sure you’re comfortable and looking at how diet and lifestyle changes may help. This may include seeking the right protection with pads or specialist underwear to keep your skin dry and stop it from getting sore from contact with urine or faeces. Reducing acidic or sugary foods and drinks, alcohol and caffeine can cause less irritation to the bladder and bowel. There are also lots of different medications that can be prescribed to treat your condition.

For specific information on treating you condition have a look at our bladder and bowel treatment pages.

How Can I Reduce My Chances Of Having A Stroke?

You can reduce your chances of having a stroke by making sure you eat a healthy, balanced diet and by being a healthy weight. Stop smoking, keep your blood pressure under control if you suffer from high blood pressure and reduce your alcohol consumption to the recommended daily allowance. If you have high cholesterol, look to reduce this by limiting your consumption of saturated fats. If you are diabetic, make sure that your blood sugar levels are as well controlled as possible.

You can find out more about strokes and the effects, plus support Make May Purple for Stroke by visiting the Stroke Association website, Facebook and Twitter pages.

Read more  Coping With Incontinence Following A Stroke

You can also find information about Stroke and incontinence on the Bladder and Bowel Community website.

— Update: 10-02-2023 — cohaitungchi.com found an additional article Stroke: Bowel Dysfunction in Patients Admitted for Rehabilitation§ from the website www.ncbi.nlm.nih.gov for the keyword loss of bowel control after stroke.

INTRODUCTION

Cerebrovascular accident (CVA) or stroke is considered to be the second leading cause of death in the world [1]. In Brazil, according to a survey conducted by the Ministry of Health in which data collected over a period of 16 years (between 1990 and 2006) were analyzed, stroke is the leading cause of death amongst cerebrovascular diseases and the seventh cause of hospitalizations [2]. The gastrointestinal tract can be affected after a stroke, with dysphagia and alterations in the intestinal rhythm being the most common manifestations [3]. Motor, cognitive, and communication alterations may ensue and thus impair the dynamics for defecation to occur at a socially acceptable place and time [4]. Nevertheless, the specific changes that take place in the gastrointestinal tract after a stroke, which is responsible for causing such alterations, still need further investigation [5].

The main alterations in intestinal rhythm are intestinal constipation and fecal incontinence, whose prevalence varies depending on the definitions used in the studies, staging of the lesion and type of study. The prevalence of intestinal constipation varies between 22.9 and 60% [3, 6-11], whereas that of fecal incontinence oscillates between 31 and 40% in the two weeks following stroke [12], and between 9 and 15% in its chronic phase [5].

The definition of intestinal constipation is not a simple one. It can be influenced by cultural factors, therefore one needs to take into consideration both subjective and objective aspects when diagnosing it [13]. Intestinal constipation may thus be defined as the elimination of hard and dry stools with a frequency lower than three bowel movements a week; unsatisfactory or unsuccessful evacuation; or as the general assessment of any difficulty completing the act of defecation, such as need for straining, manual handlings, or excessive time spent on the toilet [13, 14]. According to the most common definition, anyone showing two or more of those symptoms can be considered constipated [13].

Fecal incontinence is a condition that restricts one’s social interactions and can be characterized as the incapacity for keeping one’s physiological control at an appropriate time and place. It is estimated that between 0.5% and 5% of the general population have fecal incontinence [15, 16].

Under the neurological rehabilitation program kept by Hospital SARAH-Brasília, which integrates the SARAH Network of Rehabilitation Hospitals and provides free care to the Brazilian population, we observed reports provided both by patients and their caregivers describing difficulties related to evacuation and expectations of improved bowel function. When facing such problems, an interdisciplinary team must also advise patients and caregivers on measures that can alleviate symptoms and promote bowel retraining. Still, the literature on programs able to provide for better care of this specific population is scarce. A better understanding of these symptoms, as self-reported by patients and their caregivers, will allow for establishing bowel retraining strategies that have a positive impact on the patient’s expectations.

The current study thus aimed to assess the prevalence of diminished frequency of bowel movements, lumpy or hard stools, intestinal constipation, straining, incomplete evacuation, incontinence (bowel dysfunctions) before and after stroke as self-reported by patients (or reported by their caregivers) with brain injury resulting from it; to describe the type and frequency of such disorders, and the prevalence of laxatives use both before and after stroke.