Did you know that 28-79% of stroke survivors experience urinary incontinence? While different types of bladder and bowel dysfunction can occur post-stroke, incontinence specifically means that you have poor control of your bladder, your bowels, or both.
Just as you may experience weakness or nerve issues in your arm, hand, leg, or foot after a stroke, you may develop the same issues with the muscles and nerves of your pelvic floor that support bladder and bowel functions.
When there is an interruption in the way nerves communicate with the brain and spinal cord, this is called neurogenic bladder and bowel. Neurogenic bladder and bowel result in those systems either being overactive or underactive.
Types of Bladder Dysfunction
When we are continent, that means that our brain, pelvic floor muscles, sensors, and sphincters are all working as they should. We make it to the bathroom on time and don’t leak. We can empty our bladder and bowels when we feel the urge. When there’s an interruption in any of these systems, that’s when we see dysfunction.
Have you ever been doing something when all-of-sudden, out of nowhere, you’ve gotta go? Then because it happened so quickly, you have a hard time actually making it to the toilet?
That sudden need to go and subsequent inability to make it to the toilet is called urge incontinence. The ability to successfully communicate the need to empty your bladder is on the fritz. The messaging between your brain and bladder sensors may have been interrupted after your stroke. This can lead to bladder spasms which are involuntary contractions of the bladder muscles that make you feel like you need to go.
Think about a water balloon representing your bladder. It’s not tied shut. You’re just holding it lightly closed with your fingers. With urge incontinence, it’s like your balloon starts filling up to the point it’s almost overfilled. Your fingers don’t get the memo that the balloon is too full. On top of that, someone suddenly puts pressure on the balloon until water is forced out of the end you’re trying to keep closed.
Have you ever sneezed and accidentally leaked? Or perhaps you jumped on a trampoline with your kids/grandkids and experienced leakage.
Stress incontinence happens when the pelvic floor muscles are weakened. Think about that water balloon again. This time picture your balloon full but not over-filled. You’re again lightly holding the end pinched shut so that no water escapes.
Now, think about if someone tried to tickle you (the stress) while holding that balloon shut. You would likely release your grip on the ballon which would lead to leakage.
The pelvic floor muscles are like your fingers keeping the balloon shut. If those pelvic floor muscles are weak, then when they’re confronted with some type of physical stress, like a cough or sneeze, they won’t be able to hold the urine in.
It’s normal to get up and go to the bathroom once or twice a night. However, if you’re going significantly more than that, you may be dealing with nocturia or excessive nighttime urination. You may wake up from sleep with strong urges to use the bathroom.
This is more common just after having had a stroke and often, but not always, resolves with time.
Like with incontinence issues, sometimes your brain and bladder just aren’t able to communicate effectively. However, with urinary retention, you may have difficulty getting urine out due to an underactive bladder.
Think about that water balloon again. This time someone has tied a knot onto the end. There’s no other way to get the water out unless you insert something to provide an escape route.
In this example, the knot is the inability to release your bladder and urinate. An example of a real-life “escape route” would be to use a catheter.
Types of Bowel Dysfunction
Bowel dysfunction is somewhat less common than bladder dysfunction after stroke. Somewhere between 23-60% of stroke survivors experience constipation, and 9-15% experience bowel incontinence chronically.
Like with bladder incontinence, muscle weakness and nerve damage following a stroke can lead to the inability to control when you have a bowel movement. It can also cause leakage.
Bowel incontinence is something that may be more of an issue shortly after having a stroke, and that gets better with time. In the first two weeks following a stroke, bowel incontinence can range from 31-40%. However, as I mentioned above, the range of survivors experiencing chronic bowel incontinence is 9-15%.
Difficulty producing a bowel movement, or constipation, is usually not due to the stroke itself.
You may be drinking less liquid, be more sedentary, and be eating different foods than you’re used to after having a stroke. You may also be on varying medications that cause constipation as a side effect.
Bowel and bladder dysfunction can lead to some pretty serious complications if not watched for or treated. It’s important to recognize the signs and symptoms of complications in order to get help sooner rather than later, or avoid the issue in the first place.
Urinary Tract Infections (UTIs)
If you’ve ever had a UTI, you know that they’re no fun at all. In fact, they can be incredibly painful, uncomfortable, and embarrassing. A UTI happens when bacteria enter the urethra and cause an infection.
This can happen when fecal matter enters the urethra (wiping back-to-front or bowel incontinence) or by sitting for an extended time in your own urine. If you are experiencing incontinence, check your underwear or other incontinence aids (like pads) to make sure you’re changing them often to avoid this.
Signs and symptoms of a UTI include:
- Increased urgency to urinate
- Burning sensation when you’re able to urinate
- Blood in the urine (may pink in the toilet)
- Cloudy urine
- Running a temperature
- Really strong-smelling urine
- Inability to fully empty your bladder
- Cognitive and behavioral changes
You may be tempted to limit your liquid intake if experiencing incontinence. However, this can lead to a much more serious issue of dehydration. It’s incredibly important to keep yourself hydrated. Our body relies on water to perform necessary functions. If you become severely dehydrated, you may end up having to go to the hospital.
Signs and symptoms of dehydration include:
- Dry lips and mouth
- Brown or dark urine
- Feeling thirsty
- Feeling dizzy
Depending on the type of dysfunction you’re experiencing, there’s a range of treatment options. These sit on a spectrum from behavioral changes, environmental modifications, lifestyle changes, medications, device use, or surgery.
Bowel & Bladder Retraining
There are a few different strategies you can use under the umbrella of retraining strategies.
You can build awareness of bladder and bowel patterns by keeping a journal. Track what you eat or drink, when you eat or drink, the medications you’re taking, when you feel the urge to go to the bathroom, and if you made it in time. This can give you a better picture of anything that might make your bowel or bladder dysfunction worse. It also allows you to more objectively see what’s helping.
Pelvic Floor Therapy
Physical or occupational therapists specializing in pelvic floor health can help both men and women with bladder and bowel issues. They prescribe specific exercises depending on the type of incontinence you’re experiencing. Pelvic health therapists may also utilize tools like electrical stimulation or biofeedback to improve your incontinence.
Timed voiding is one technique that can be helpful for someone experiencing urge incontinence. Often what happens with urge incontinence is you will feel the need to go all of a sudden. By the time you feel the urge, it’s already too late, and you end up not being able to make it to the toilet.
Timed voiding works by scheduling the times you go to the bathroom. Try not to go to the bathroom outside of those times. By setting a voiding schedule, you can plan a time for both bladder (start around every 2 hours) and bowel (once in the morning). For timed bladder voiding, in particular, you can begin to slowly expand the time between bathroom visits when able to successfully hold urine for 2 hours.
Another behavioral retraining technique that may help is urge control. This technique is used to quiet bladder or bowel urges so that you don’t end up going to the bathroom once every 30 minutes.
Here are the basic steps to follow for urge control:
- Stop what you are doing and stand still. Sit down if you can. Remain still.
- Relax your body and take a few deep breaths.
- Squeeze your pelvic floor muscles gently and repeat as necessary to help quiet your bladder or bowel.
- Keep the rest of your body relaxed.
- Stay calm and concentrate on suppressing the urge feeling.
- When the urge subsides walk slowly to the bathroom.
- Stop and repeat the previous steps along the way as needed to stay in control.
This won’t be news to you but how we live our lives impacts our overall health. There are some simple lifestyle changes you can make to reduce the impact of bowel and bladder dysfunction on everyday life.
If you’re dealing with urinary incontinence and nocturia, try to reduce the amount of liquid you consume before bed. Stop drinking liquids around 2 hours before your bedtime.
If you’ve got an overactive bladder (urge incontinence), decrease or limit the amount of caffeine, alcohol, and other diuretic drinks/foods you include in your diet. Diuretics cause your body to flush out extra sodium and water through urination. So drinks and foods that cause you to urinate more frequently should be avoided.
If you’re struggling with bowel incontinence, make sure to include foods in your diet that have plenty of fiber to help harden your stools.
It’s common after a stroke to become more sedentary, especially if experiencing physical weakness and fatigue. You should consider some type of activity regimen when your doctor gives you the okay to start. If you’re having constipation issues, getting consistent physical activity can help keep your bowels regular.
Making environmental modifications is more of a compensatory treatment approach. By this, I mean these changes will not necessarily fix the underlying issue. They will, however, improve safety so that you’re not falling or tripping trying to rush to the bathroom. They can also improve your quality of life.
Ideas for environmental modifications:
- Clear clutter in walkways, especially to the bathroom.
- Put a night light in the hallway or bathroom so you can see where you’re going.
- Install grab bars around your toilet.
- Get a raised toilet seat that makes it easier to get off of.
- Always keep plenty of backup toilet paper close to the commode.
- If you’re unable to make it to the toilet, put a bedside commode where you spend most of your time.
Talk to your doctor about the medications you’re currently taking and if they may be causing bowel or bladder dysfunction. If so, your doctor may be able to recommend something different without those side effects.
You can also talk to your doctor about medications (over-the-counter or prescription) or treatments designed to treat issues like incontinence, urinary retention, and constipation. Don’t start taking anything new, even something over-the-counter, before talking to your doctor. This is important because you want to make sure the new medications won’t adversely interact with your current medications.
As I mentioned earlier, your medical team may recommend using a catheter if you’re experiencing chronic urinary retention that medication doesn’t help. In some cases, this may be the only way to empty your bladder. After a medical professional shows you the appropriate steps, it’s something that you can do yourself.
If other treatment options don’t work for you, surgery is usually the last resort. There are many different surgeries that can improve bladder or bowel incontinence and urinary retention if other options have failed. Surgical options are best discussed with your doctor or neurologist.
Bowel and bladder dysfunction after stroke can be super frustrating and can also be embarrassing to talk about. But know that you are not alone in your experience and that there’s a wide range of treatments that can help.