Post-Stroke Urinary Incontinence

So, you’ve had a stroke. In the aftermath, you may have found that one side of your body has become rebellious against your desires, making everyday tasks seem infinitely harder than they ever were in the past.  But, if that weren’t frustrating enough, you could also be experiencing some bladder-related issues. Maybe you have trouble holding in your urine when you laugh, cough, or sneeze (stress incontinence) or you are simply unable to control the urge to urinate when it comes on (urge incontinence).  If you have these issues, you are not alone.  The prevalence of urinary incontinence one week after a stroke has been estimated at 54%, with 32% of people still experiencing problems over a year out2.

The good news is that urinary incontinence after a stroke is treatable, and taking action even a few years afterward to address it has been proven to improve outcomes4.  If you are experiencing the symptoms of stress incontinence as described above (i.e. urinating while coughing) or a mixture of stress and urge incontinence, there are exercises that your physical therapist can teach you to help you fix these problems.  Two different studies have been published specifically showing that strengthening the muscles of your pelvic floor (think: Kegels) after a stroke significantly improves urinary symptoms, including frequency of urination, urine leakage, pelvic floor muscle strength, and overall quality of life5,6.

In addition, if you are experiencing the symptoms associated with urge incontinence (i.e. as soon as the urge to urinate hits you, it cannot be suppressed), there are ways your pelvic floor physical therapist can help with this as well.  Two separate studies published in 2014 showed that using transcutaneous electrical nerve stimulation (TENS) with people who experienced urge incontinence after a stroke significantly improved in urinary urgency, nocturia (waking up at night to urinate), frequency of urination, and overall quality of life1,3.  This process simply involves very low voltage electrical impulses to be transmitted via electrodes placed on the skin.  This is a non-invasive, convenient, outpatient treatment that is only performed for 30 minutes per day as few as 2 times per week, and has been proven to be effective even up to 3 years after a stroke.

Urinary incontinence is a prevalent side effect of a stroke, but all too often it goes untreated.  However, with the help of a skilled physical therapist, you can significantly improve your symptoms.  Contact us today to set up an evaluation with one of our specialized physical therapists.

Lila Abbate PT, DPT, OCS, WCS

Justine Payne, PT, DPT

References:

1.Guo Z, LiuY, Hu G, Liue H, Xu Y. Transcutaneous electrical nerve stimulation in the treatment of patients with poststroke urinary incontinence. Clinical Interventions in Aging, 2014;9:851-856.

2. Kolominsky-Rabas PL, Hilz MJ, Neundoerfer B, et al. Impact of urinary incontinence after stroke: Results from a prospective population-based stroke register. Neurourol Urodyn 2003; 22: 322–7.

3. Monteiro ES, Coin de Carvalho LB, Fukujima MM, Lora MI, Fernandes do Prado G. Electrical Stimulation of the Posterior Tibialis Nerve Improves Symptoms of Poststroke Neurogenic Overactive Bladder in Men: A Randomized Controlled Trial. Urology, 2014;84(3): 509-14.

4. Rotar M, Blagus R, Jeromel M, Skrbec M, Trsinar B, Vodusek DB. Stroke Patients Who Regain Urinary Continence in the First Week after Acute First-Ever Stroke have Better Prognosis than Patients with Persistent Lower Urinary Tract Dysfunction. Neurourology and Urodynamics,2011; 30:1315-8.

5. Shin DC, Shin SH, Lee MM, Lee KJ, Song CH.  Pelvic floor muscle training for urinary incontinence in female stroke patients: A randomized, controlled and blinded trial.  Clin Rehabil, 2015 [Epub ahead of print].

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