Bladder Issues: A Surprising Stroke Risk Factor?

A stroke can cause damage to the brain, which may affect the parts of the brain that control the bladder, leading to an overactive bladder. This condition may resolve quickly or can last months or years. Urinary incontinence is common in people who experience a stroke, with researchers estimating that up to 80% of stroke survivors develop this condition. In addition to UI, a stroke can also lead to an overactive bladder, with up to 53% of people developing this condition after a stroke.

Can bladder issues cause a stroke?

Bladder issues are common after a stroke and can cause incontinence, which is the loss of bladder control. This happens when the muscles that control urine are weakened, and the nerves that sense when you need to go to the toilet have trouble sending and receiving messages from the brain.

A stroke involves a disruption in the blood supply to the brain, which can cause damage to the brain tissue. This damage may affect the parts of the brain that control the bladder, leading to an overactive bladder. A 2017 study suggests that up to 53% of people develop an overactive bladder after a stroke.

There are several types of bladder problems that can occur after a stroke:

• Urinary incontinence, which is the loss of control of the bladder.
• Urinary frequency, which is the need to use the toilet more often.
• Urge incontinence, which is the sudden urge to urinate.
• Functional incontinence, which refers to the difficulty in getting to the toilet in time or removing clothes quickly enough.
• Nocturnal incontinence, which is the need to use the toilet several times during the night or wetting the bed.
• Stress incontinence, which is the loss of bladder control due to pressure on the abdomen, such as after sneezing or exercising.

Bladder issues after a stroke can be treated and managed in several ways:

• Bladder retraining: This involves gradually teaching the bladder to hold more urine by making regular visits to the toilet and extending the time between visits.
• Pelvic floor exercises: These help strengthen the muscles that control the bladder and improve bladder control.
• Lifestyle changes: Limiting fluid intake at certain times of the day, avoiding bladder-irritating foods and drinks, and keeping a written record of bathroom trips to identify triggers.
• Medication: Doctors can prescribe drugs to help with the feeling of not being able to urinate.
• Physical therapy: This includes pelvic floor electrical stimulation and vaginal weight training.

In summary, bladder issues can be a common consequence of a stroke, affecting bladder control and causing overactive bladder symptoms. Treatment options and management strategies are available to help individuals regain bladder control and improve their quality of life.

What are the types of bladder issues after a stroke?

Bladder and bowel problems are common after a stroke, and many people soon recover without experiencing long-term issues. However, for those who do, there are treatments and support available to help manage daily life.

• Frequency: Needing to pass urine more often than usual.
• Urgency incontinence: Feeling a sudden, urgent, and uncontrollable need to pass urine, often with no time to get to the toilet.
• Nocturia: Waking from sleep with an urgent need to pass urine.
• Nocturnal enuresis: Wetting the bed while still asleep.
• Functional incontinence: Physical effects of the stroke, such as reduced mobility or communication difficulties, make it hard to reach the toilet or undress in time.
• Stress incontinence: Small dribbles of urine leak when coughing, sneezing, or laughing due to weak or damaged pelvic floor muscles.
• Reflex incontinence: Passing urine without realising it due to the stroke affecting the part of the brain that senses and controls bladder movement.
• Overflow incontinence: The bladder leaks because it is too full, which can happen when there is a loss of feeling in the bladder or difficulty fully emptying it.
• Urinary incontinence (UI): Inability to control bladder function, which is common in people who have experienced a stroke, affecting up to 80% of survivors.
• Overactive bladder: This condition can develop after a stroke, causing a sudden, strong urge to urinate, possibly leading to urine leakage. A study found that up to 53% of people develop an overactive bladder after a stroke.

It is important to seek help from a healthcare professional if you experience bladder issues after a stroke. They can help determine the cause and provide appropriate treatment and support to improve your wellbeing and recovery.

What are the treatments for bladder issues after a stroke?

Bladder and bowel problems are common after a stroke. Many people soon recover, but if you have longer-term problems, there are treatments and support that can help you get on with daily life. The most important thing you can do is seek help from your doctor or a member of your stroke team. They can help you find out the cause of your continence problems, and get the right treatment.

• Bladder training helps you work on holding it for longer periods of time. Try to pee every 2 or 3 hours. You may have to start out going more often and then gradually go longer between bathroom visits. Work on ignoring the urge to go right now. And go at your scheduled time even if you don’t think you have to.
• Pelvic floor exercises help strengthen the muscles so that they provide better support. This will help improve bladder control and improve or stop leakage of urine. Pelvic floor exercises, such as Kegel exercises, can strengthen the muscles in your pelvic floor and help prevent incontinence. Pelvic floor electrical stimulation devices can be inserted in either the vagina or the anus to stimulate and strengthen the muscles that control the bladder.
• Medication can reduce feelings of urgency and frequency, or reduce the amount of urine your body makes. Check with your doctor that none of your medicines cause bladder problems. Ask about drugs that may help when you feel like you can’t go.
• Weight loss (if you are overweight) often improves bladder control in the longer term.
• Stopping smoking can help with bladder leakage.
• Lifestyle changes may be recommended by your doctor to minimise the effects of an overactive bladder, such as limiting fluids at certain times of the day or evening.

What are the long-term effects of bladder issues after a stroke?

Bladder and bowel problems are common after a stroke, and many people soon recover. However, long-term bladder issues can have a significant impact on a person's life. Urinary incontinence is a known predictor of moderate to severe stroke, and 25% of stroke patients have urinary incontinence at discharge, with 15% still incontinent a year later.

The long-term effects of bladder issues after a stroke can include:

• Incontinence: This is the inability to control the bladder, which may result in leaking urine or wetting the bed at night.
• Urinary tract infections (UTIs): If urine is retained and the bladder is not emptied properly, it can lead to UTIs.
• Bladder stones: These can develop if the bladder is not emptied completely.
• Skin rashes and infections: Due to the moisture, friction, and bacteria from urine and faeces, the skin can become irritated and infected.
• Emotional and psychological impacts: The social stigma associated with incontinence can lead to a poor self-image, depression, and reduced participation in rehabilitation.
• Physical complications: The extra exertion required to manage bladder issues can affect mobility and increase the risk of falls.
• Disruption to daily life: Bladder issues can require planning access to toilets when out and about, carrying a change of clothing, and using absorbent pads or adult diapers.
• Increased care needs: Those with long-term bladder issues after a stroke may require additional support from caregivers, including help with toileting, cleaning, and managing incontinence products.
• Impact on caregivers: Caring for someone with long-term bladder issues can be physically and emotionally demanding, and caregivers may need support and advice to manage the additional responsibilities.

How can bladder issues be prevented after a stroke?

Bladder and bowel problems are common after a stroke, and many people soon recover. However, if you have long-term bladder issues, there are treatments and support that can help you get on with daily life.

• Seek help from your doctor or a member of your stroke team: They can help you find out the cause of your continence problems and get the right treatment.
• Regain control: Regaining control can improve your wellbeing and your recovery.
• Bladder training: This helps you work on holding it for longer periods. Try to pee every 2 to 3 hours. Gradually extend the time between visits until your bladder learns how to 'hold on'.
• Pelvic floor exercises: These help strengthen muscles so that they provide better support. This will help improve bladder control and stop leakage of urine.
• Drink plenty of water: Get plenty of water during the day. That makes your pee less irritating to your bladder.
• Avoid bladder-irritating drinks: Stay clear of caffeine, alcohol, and soda, since they can irritate the bladder as well. But limit how much you drink in the evening so you won't get up too much at night.
• Check your medication: Check with your doctor to see if any of your medicines cause bladder problems. Ask about drugs that may help when you feel like you can't go.
• Keep skin healthy: The moisture, friction, and bacteria from urine and faeces can cause skin rashes and infection. Careful hygiene and skin care are needed to avoid the risk of skin damage such as redness and blistering.
• Plan ahead: When you go out, plan access to toilets, and have a change of clothing and a hygiene kit with you.
• Find a routine that works for you: A daily routine of regular visits to the toilet, staying hydrated during the day, and reducing the amount you drink before bedtime will help to avoid accidents.
• Wear suitable clothing: Wear clothes that are quick to remove, such as trousers with Velcro fastenings or elasticated waistbands.

Frequently asked questions