Urinary Incontinence

Urinary incontinence (UI) is the loss of control of urine, or the inability to hold urine in until a bathroom can be reached. Unfortunately, UI following a stroke is common. The prevalence ranges from 37% to 79% in the days and weeks following the stroke. While many individuals with stroke will regain control of their bladder, one-third will remain incontinent at one year post-stroke.

There are multiple etiologies for UI post-stroke. UI may result from infarction or cerebral edema affecting central micturition pathways. Alternatively, impairments of consciousness; cognitive or language difficulties and motor and sensory loss, can also affect toileting, despite normal bladder function. Frequent coughing in individuals who experience dysphagia post-stroke may also exacerbate UI. In addition, certain medications; depression; constipation; pre-morbid conditions such as peripheral neuropathies from diabetes; pre-existing UI and environmental factors that impede toileting – or a combination of these – will increase the likelihood of UI post-stroke.

In most cases, UI can be treated successfully. Management of UI takes many forms including behavioural, pharmacological, surgical and supportive devices. The present review focuses on the behavioural management, the first line treatment for UI secondary to bladder dysfunction. Specific behavioural intervention for UI include:

1) Timed voiding: fixed time interval toileting assistance program determined by the person’s own habits;
2) Prompted voiding: teaches individuals to initiate their own toileting through requests for help in combination with positive reinforcement by a caregiver;
3) Bladder retraining with urge suppression: education about the mechanisms underlying incontinence and continence, scheduled voiding regimen and urgency control strategy;
4) Pelvic muscle exercises: program of repeated voluntary pelvic floor muscle contractions;
5) Bladder retraining with urge suppression in combination with pelvic floor muscle exercises;

6) Compensatory rehabilitation approaches to neurological impairment: rehabilitation approaches focused on optimization of the general function of an individual with stroke.
7) Transcutaneous electrical nerve stimulation (TENS): electrical stimulation to the pelvic floor region using electrodes.

Authors*: Tatiana Ogourtsova, MSc BSc OT; Nicol Korner-Bitensky, PhD
Editors: Annabel McDermott, OT; Annie Rochette PhD, OT
Expert reviewer: Chantal Dumoulin, PhD PT
Evidence reviewed as of before 21-02-2017

NOTE: *The authors have no direct financial interest in any tools, tests or interventions presented in StrokEngine.