Urinary Incontinence After Stroke: A Prospective Study

Abstract

During one year 151 patients with 154 strokes were studied prospectively to determine the occurrence and outcome of urinary incontinence after a stroke. Seventeen per cent had pre-existing urinary incontinence. At 1, 4 and 12 weeks, 60%, 42% and 29% of the survivors, respectively, were not continent. Cystometry was performed in those with moderate or severe urinary incontinence persisting 4 weeks after the stroke. Detrusor instability was present in 85% of those who had been continent prior to their stroke. Factors associated with urinary incontinence at 4 weeks were moderate or severe motor deficit, impaired mobility and mental impairment (P less than 0.001). Two-thirds of patients with mild urinary incontinence at 4 weeks regained continence by 12 weeks.

New-Onset Fecal Incontinence After Stroke

“…A partial explanation may lie in shared risk factors for persistent UI; studies show that similar mobility difficulty and impaired function are primary associations rather than stroke-specific factors. 2,[31][32][33][34] In fact, urodynamic studies in incontinent stroke survivors show a similar diagnostic profile to that of incontinent patients without stroke, 32 with detrusor dysfunction predominating. 33 The few data available on anorectal function after stroke suggests that likewise there may be no specific pathophysiology underlying FI in stroke survivors.…”

“…2,[31][32][33][34] In fact, urodynamic studies in incontinent stroke survivors show a similar diagnostic profile to that of incontinent patients without stroke, 32 with detrusor dysfunction predominating. 33 The few data available on anorectal function after stroke suggests that likewise there may be no specific pathophysiology underlying FI in stroke survivors. 24 The prevalence is not dissimilar either; new-onset UI affects 40% of patients immediately after stroke, with 19% still incontinent at 3 months and 15% at 2 years.…”

Stroke and Incontinence

“…27 Brocklehurst et al 27 found in their study that 6 additional survivors at a 3-year follow-up became incontinent of urine, 4 of whom subsequently died. Only 1 37 of 12 reports that specifically sought a link between stroke or brain injury and incontinence investigated the prevalence of premorbid incontinence. 4 -6,27,33,35,38 -42 This article suggests that 17% of 151 stroke survivors may have had incontinence before their stroke.…”

“…4 -6,27,33,35,38 -42 This article suggests that 17% of 151 stroke survivors may have had incontinence before their stroke. 37 The presence of premorbid incontinence is clearly important because it affects the apparent prevalence of incontinence due to stroke and because survivors who have premorbid incontinence may be very different from those who become incontinent after the stroke, with different morbidity and mortality. The rela- tionship between stroke and incontinence may not only be in one direction.…”

“…11 Dysphasia, 37 aphasia, 38 and impaired cognitive and functional ability are all correlated with urinary incontinence, but so too are nonurological complications of stroke such as fecal impaction, drug therapy, or increased solute load. Any drug with ␣-adrenoreceptor blocking action will worsen the urethral sphincter weakness, whereas anticholinergic drugs may precipitate retention.…”