A stroke is a serious medical event that occurs when the brain does not receive normal blood flow. Damage to the brain from a stroke can cause symptoms throughout the body that may be temporary or permanent. Having a stroke can cause a multitude of symptoms, many that leave you relying on others for care. The loss of independence and recovery process can be difficult to navigate, especially when dealing with symptoms such as incontinence.
As a nurse, I have learned that working with stroke survivors takes patience and understanding. The recovery process can be difficult, and knowing how to support someone experiencing such sudden shifts in their ability to care for themselves can be hard. Understanding incontinence after a stroke and what treatment may look like can help the process feel a little easier.
What is a Stroke?
A stroke is a serious medical event that occurs when blood flow to the brain is disrupted or blocked. When blood flow to the brain is reduced by a blockage or a ruptured blood vessel, brain cells can begin to die. Cell death happens because they rely on oxygen from blood to stay alive. The extent of damage to the brain from a stroke depends on how severe the blockage is and how long it takes to restore normal blood flow. If a stroke is identified and treated early, the person has a better chance at a full recovery.
These are some, but not all, symptoms that can be experienced with a stroke:
- Difficulty speaking (called aphasia) or speech that becomes slurred
- Changes in vision
- Confusion
- Loss of consciousness
- Dizziness or a feeling of vertigo
- Severe headaches that come on quickly
- Not being able to move one side of the body
- Becoming unbalanced and uncoordinated
- Incontinence
Some symptoms from a stroke can become permanent, whereas others may improve over time as the brain heals and skills are re-learned through therapy and rehabilitation.
How Strokes Cause Incontinence
A stroke can cause incontinence in different ways. It can be due to damage to brain areas that control urination, muscle weakness or loss of sensation, or functional factors such as being unable to communicate the need to urinate, or physical deficits that make it impossible to get to the restroom. Incontinence after a stroke can be broken down into two different categories:
Functional Incontinence: With functional incontinence, a person recovering from a stroke may have normal bladder function but is unable to communicate for help or move their body independently to a restroom, resulting in incontinence. The person may also not recognize the need to urinate due to cognitive deficits related to the stroke.
Mixed Incontinence: Mixed incontinence is when someone experiences urge and stress incontinence. Urge incontinence is the sudden need to go with little to no warning, resulting in loss of bladder control. Stress incontinence occurs when someone coughs, laughs, sneezes, or engages in certain activities that cause urine to leak.
Additionally, some people recovering from stroke can also have problems with bladder spasms or urinary retention (when urine becomes trapped in the bladder and does not voluntarily empty).
How Incontinence is Managed After a Stroke
Incontinence can be temporary and resolves on its own as you recover from a stroke. It can also take some time to regain function of your body and bladder, so some people may experience long-term incontinence. Treatment will be different for each person, but these are some of the options that may be used:
- Medication: Different medications may be used to treat incontinence depending on the specific symptoms. Medications called anticholinergics are used to help with bladder spasms that can cause feelings of urgency. Alpha-blockers can be used to help with urinary retention (urine that does not drain out of the bladder on its own). Other medication types may also be used based on symptoms.
- Bladder and Bowel Training: This involves techniques to help retrain the bladder and bowel. Commonly, this includes timed voiding (scheduled bathroom trips), managing the urge to go (using breathing exercises and relaxation techniques), and pelvic floor therapy (to strengthen the muscles needed to control the bladder and bowel).
- Catheterization: Catheters are often used during hospitalization after a stroke to manage incontinence, but may be needed long-term for some people. Catheters are soft, flexible tubes placed in the bladder that drain urine to a collection bag outside of the body. There are different types of catheters, including indwelling (inserted through the urethra and stays in the bladder), straight or intermittent catheters (inserted to drain urine and then removed), and suprapubic (inserted through the abdomen into the bladder, bypassing the urethra and left in place).
- Rehabilitation or Therapy: Working with physical and occupational therapists is a key part of stroke recovery. Regaining mobility and, in some cases, re-learning how to care for yourself are a big part of managing incontinence. Being able to walk, sit, and coordinate movements are all needed to use the restroom.
- Incontinence Products: Incontinence products are used to manage urine leakage and are commonly used. Products come in varying sizes, styles, and absorbency levels. They may be used short-term or long-term and are an easier way to manage incontinence while recovering from a stroke or for long-term use.
Emotional Impact of Incontinence
Incontinence can take a mental toll on people, which can be made worse when also dealing with a loss of independence and physical challenges of recovery after a stroke. Incontinence can cause people to avoid activities and socially isolate due to embarrassment about leaks or the worry of not being able to get to a bathroom in time. Social isolation has been linked to an increased risk for depression, decline in cognition, falls, and a poor quality of life.
It is important to address not only incontinence itself but also the emotional impact. From a nursing perspective, this means discussing incontinence symptoms and how they are being managed, and ensuring the person can participate in activities they enjoy and also feel comfortable leaving their house. This can mean problem-solving leaks, using higher-absorbency incontinence products when away from home, and making a plan for when urine loss occurs (such as keeping extra clothes, wipes, and a plastic bag for soiled clothing on hand).
If you or someone you care for is experiencing social isolation, signs of depression, or other mental health concerns, consult with a medical provider to receive more support and referrals to a behavioral health specialist when needed.
Recovery Includes More Than What You Can See
Experiencing a stroke can significantly impact your life; it can impact more than just the obvious physical changes people see on the outside. Dealing with incontinence is often not obvious to others, yet it can take a large physical and emotional toll. There are many options for the short- and long-term treatment and management of incontinence after a stroke. If incontinence continues to impact daily life, reach out to your healthcare provider for more support and guidance.
