Stroke's Impact: Digestive System Disruption And Recovery

A stroke can have a significant impact on the digestive system, causing what is known as bowel and bladder problems. These issues can range from incontinence, which is the loss of control of the bladder and bowel, to constipation and diarrhoea. In addition to these issues, a stroke can also lead to difficulties in getting to the bathroom on time or with removing clothes quickly enough. While many people recover from these problems soon after a stroke, others may experience long-term issues. The underlying causes of these problems can be the stroke itself, medication side effects, constipation, or bladder infections.

Bowel and bladder problems

Bowel problems can also occur after a stroke, including constipation, diarrhoea, and bowel incontinence, or loss of control of the muscles around the lower bowel. Strategies for dealing with bladder and bowel problems include making it easier to get to the bathroom, having a daily routine, and increasing the amount of fibre and fluids in the diet. Pelvic floor exercises can also help improve bladder and bowel control.

Incontinence

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

• Urinary incontinence: This is the loss of bladder control, which may include the sudden and uncontrollable need to pass urine.
• Urinary frequency: The need to use the toilet more often than usual.
• Urinary retention: Inability to fully empty the bladder.
• Nocturnal incontinence: Needing to use the toilet multiple times during the night.
• Faecal incontinence: Loss of control of the muscles around the lower bowel, resulting in bowel leakage.
• Functional incontinence: Difficulty getting to the toilet or undressing in time.

Treatments and management strategies are available to help those experiencing incontinence after a stroke:

• Bladder and bowel training: This involves scheduling bathroom breaks at specific times to avoid accidents and gradually increasing the time between breaks.
• Behavioural and physical therapies: These can help with managing incontinence and improving bladder and bowel control.
• Pelvic floor muscle training: Strengthening the pelvic floor muscles through Kegel exercises can lead to better bladder control.
• Medication: Stool softeners or laxatives can help with faecal incontinence, while other medications can be prescribed for urinary incontinence.
• Dietary changes: Increasing fibre and fluid intake can help with constipation, but reducing certain drinks and spicy foods that can irritate the bladder may also be recommended.
• Continence products: Pads, liners, absorbent underwear, and other products can help keep the skin healthy and dry.
• Home modifications: Making the bathroom more accessible, such as installing a raised toilet seat or using a commode chair, can make it easier to reach the toilet in time.

Constipation and diarrhoea

Managing Constipation

To manage constipation, it is recommended to:

• Increase fluid intake: Aim for 6 to 8 cups per day to prevent dehydration and soften stools.
• Consume a high-fibre diet: Include whole grains and legumes, vegetables, fruits, beans, and other high-fibre foods.
• Stay active: Physical activity stimulates your bowels and helps regulate bowel movements.
• Consider medication: Consult your doctor about medications that may be causing constipation. They can suggest alternatives or recommend laxatives or stool softeners.
• Practise bowel retraining: Try to have bowel movements at the same time each day, preferably after meals when the natural reflex stimulates the bowels.

Managing Diarrhoea

To manage diarrhoea, it is advised to:

• Monitor your diet: Ensure you are consuming enough fluids and high-fibre foods.
• Stay active: Physical activity aids in regulating bowel movements.
• Consult your doctor: Discuss any medications that may be contributing to diarrhoea and explore alternative options.
• Practise bowel retraining: Establish a routine by having bowel movements at similar times each day.

It is important to remember that everyone's experience with stroke is unique, and the impact on the digestive system can vary. Seeking professional advice from your healthcare team is crucial to understanding the specific causes and developing an appropriate management plan for constipation and diarrhoea.

Intestinal microbiota changes

The intestinal microbiota has been shown to play a role in stroke patients. Recent studies have provided evidence that selective bacterial translocation from the host gut microbiota to peripheral tissues, such as the lungs, plays a key role in the development of post-stroke infections.

In a study on mice, the microbial communities within the mucosa of the gastrointestinal tract (GIT) were found to be significantly different between sham-operated and post-stroke mice 24 hours following surgery. The stroke-induced shift in mucosal microbiota composition was characterised by an increased abundance of Akkermansia muciniphila and an excessive abundance of clostridial species.

In cerebral ischemic stroke patients, the gut microbiota has been found to have more short-chain fatty acids, including Odoribacter, Akkermansia, Ruminococcaceae_UCG_005, and Victivallis. The levels of certain gut bacteria were also correlated with the severity and outcome of cerebral ischemic stroke. For example, the genus Christensenellaceae_R-7_group was positively correlated with the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores, while the genus Enterobacter was negatively correlated with these measures.

In addition, the gut microbiota may also be involved in regulating key aspects of post-stroke management, including body temperature, blood glucose, blood pressure, oxygen, and hydration. For instance, the dysbiosis of gut microbiota induced by stroke has been found to increase pro-inflammatory cytokines, which can lead to an unfavourable outcome. On the other hand, antibiotic-induced dysbiosis of the gut microbiota has been shown to promote anti-inflammatory cytokines, thereby improving stroke outcome.

Furthermore, the metabolic products of gut microbiota, such as short-chain fatty acids (SCFAs), may also play a role in post-stroke recovery. SCFAs can stimulate the production of anti-inflammatory cytokines and improve neurological outcomes.

Overall, the intestinal microbiota is significantly altered following a stroke, and these changes may have implications for stroke recovery and prognosis.

Increased inflammation

The Firmicutes-to-Bacteroidetes ratio is a key indicator of gut health. A balanced ratio of these bacteria is essential for maintaining a healthy gut and preventing inflammation. However, following a stroke, this ratio can be disrupted, leading to an increased risk of inflammation in the body.

In a study conducted by Allison Brichacek and Candice Brown, they found that the Firmicutes-to-Bacteroidetes ratio in mice who had experienced a stroke was significantly higher than in healthy mice. Specifically, it was almost six times higher at the 14-day mark and more than three times higher after 28 days. This imbalance has been linked to an increased risk of inflammation, as well as other health issues such as obesity and diabetes.

The exact mechanism behind this link is not yet fully understood, but it is believed that the altered gut microbiota can impact the body's immune response, leading to a state of chronic low-grade inflammation. This inflammation can have far-reaching effects on the body, contributing to various diseases and conditions, including cardiovascular disease, Alzheimer's, and cancer.

Additionally, the intestinal tissue of mice that had experienced a stroke showed signs of disorganization and reduced space between the villi, which are essential for nutrient absorption. This could further compromise the body's ability to recover after a stroke, as proper nutrient absorption is crucial for maintaining overall health and promoting healing.

Treating the gut may become an important aspect of stroke recovery. By targeting the gut microbiota and restoring a healthy balance, it may be possible to reduce inflammation and improve health outcomes for stroke patients. This could involve the use of probiotics or other interventions to promote the growth of beneficial bacteria and reduce the risk of inflammation.

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