Urine Trouble: Stroke Risk And Pee Problems

can not peeing cause stroke

Urinary incontinence is a common complication after a stroke, affecting up to 80% of survivors. A stroke occurs when there is a disruption in the blood supply to the brain, causing damage to brain tissue. This damage can affect the parts of the brain that control the bladder, leading to an overactive bladder.

During urination, nerves signal the bladder to contract and push urine into the urethra, while the urethral sphincters relax to let urine flow out. When not urinating, the bladder relaxes and the sphincter contracts to keep the urine in. After a stroke, the nerves controlling the bladder can be damaged, leading to issues such as frequent urination, inability to hold urine, and sudden urges to urinate.

Treatments for post-stroke bladder dysfunction include medication and physical therapy, such as pelvic floor exercises and bladder training. Pelvic floor exercises strengthen the muscles that support the bladder, improving bladder control. Bladder training involves sticking to a set schedule for bathroom trips to increase the volume of fluid the bladder can hold and reduce feelings of urgency. For more severe cases of urinary retention, a catheter may be prescribed to help draw urine out.

While bladder dysfunction can be a challenging complication after a stroke, there are effective treatments available, and seeking help from a healthcare provider is important to improve wellbeing and recovery.

Characteristics Values
Stroke type Ischemic stroke, Hemorrhagic stroke
Stroke occurrence in the US Every 40 seconds
Risk factors Diabetes, Heart disease, Obesity, High cholesterol
Bladder dysfunction types Retention, Frequency, Incontinence
Treatment for bladder dysfunction Medicine, Physical therapy, Catheter

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Urinary incontinence after a stroke: the inability to control urine, affecting up to 25% of stroke survivors within the first year

Urinary incontinence is a common complication after a stroke, affecting up to 40-60% of people admitted to the hospital. It can be caused by damage to the frontal lobe, the area responsible for controlling micturition. The more severe the stroke, the more likely it is to cause incontinence.

During the recovery process, individuals may experience urinary retention, also known as bladder retention, which is the inability to empty the bladder completely. This can be uncomfortable and cause serious health issues such as bladder infections.

There are effective treatments for bladder control problems, including medication, physical therapy, and the use of catheters. It is important to seek help from a healthcare provider to find the most suitable treatment option.

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Urinary retention, or bladder retention: the inability to completely empty the bladder, which can lead to UTIs and other serious health issues

Urinary retention, or bladder retention, is a condition where the bladder doesn't empty all the way or at all when you pee. It can be acute (sudden) or chronic (long-term). Acute urinary retention is a medical emergency and requires immediate medical attention.

Causes

Urinary retention can be caused by:

  • Blockages or obstructions, such as an enlarged prostate, bladder outlet obstruction, ureteral obstruction, cystocele, rectocele, or urethral stricture.
  • Medications, such as antihistamines, antispasmodics, opiates, tricyclic antidepressants, and certain blood pressure-lowering drugs.
  • Nerve issues or damage, which can be caused by multiple sclerosis, trauma to the spine or pelvis, pressure on the spinal cord, or pelvic surgery.
  • Infections or inflammation, such as prostatitis, urinary tract infections, sexually transmitted infections, urethritis, cystitis, or balanitis.

Symptoms

The symptoms of urinary retention can vary depending on whether it is acute or chronic. Acute urinary retention may cause an inability to urinate, lower abdominal pain or discomfort, and a feeling of fullness in the bladder. Chronic urinary retention may lead to difficulty starting to pee, a weak or uncontrollable urine stream, frequent urination, nocturia, and leakage.

Treatment

Treatment for urinary retention depends on the underlying cause and can include:

  • Draining the bladder using a catheter.
  • Medication, such as alpha-blockers, 5-alpha reductase inhibitors, antibiotics, or a combination of drugs.
  • Surgery, such as laser therapy, prostatic urethral lift, transurethral water vapor therapy, urethral dilation, or removal of obstructions or tumours.
  • Vaginal pessary, a device that supports the bladder.
  • Physical therapy, including pelvic floor exercises and bladder training.

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Treatments for bladder retention: medication, physical therapy, catheter use, and botulinum toxin injections

Urinary retention, or bladder retention, is a condition in which a person is unable to empty their bladder partially or completely. This can cause discomfort, leaking, and even bladder infections. Bladder retention can be acute (sudden) or chronic (developed over time). Treatments for bladder retention include medication, physical therapy, catheter use, and botulinum toxin injections.

Medication

Medications can help ease the symptoms of bladder retention. 5-alpha reductase inhibitors such as finasteride or dutasteride can shrink the size of the prostate. Alpha-blockers like terazosin or tamsulosin help relax the muscles in the bladder neck and the prostate, making it easier to urinate. A combination of a 5-alpha reductase inhibitor and an alpha-blocker may be more effective than either drug alone. Antibiotics may also be prescribed if bladder retention is caused by a urinary tract infection or prostate inflammation. Additionally, doctors may adjust or reduce the dosage of medications that cause bladder retention as a side effect.

Physical Therapy

Physical therapy, specifically pelvic floor physical therapy, can help strengthen the pelvic floor muscles responsible for starting and stopping urine flow. A trained physical therapist will assess the patient's pelvic floor and help them identify and utilise the proper muscles through a set of exercises tailored to their needs. These may include Kegel exercises, which focus on tightening and holding the muscles that control urine flow, as well as exercises targeting the glutes and posture. Pelvic floor physical therapy can help improve bladder control and reduce symptoms such as leakage and urgency.

Catheter Use

Urinary catheterisation is a common procedure used to treat bladder retention. Catheters are tubes that are inserted through the urethra, with the tip advanced into the base of the bladder, to drain urine. Catheters can be used intermittently (short-term) or as indwelling (long-term) devices. While catheterisation is typically performed in a clinical setting, intermittent self-catheterisation can be useful for patients with chronic urinary retention and incomplete bladder evacuation.

Botulinum Toxin Injections

Botulinum toxin injections into the bladder can be used to treat neurogenic incontinence, which is caused by spinal cord injuries or neurological conditions. The toxin helps to reduce urinary incontinence frequencies and improve bladder compliance. It is administered in different doses and injection sites depending on the patient's needs.

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Pelvic floor exercises: strengthening the muscles that support the bladder to improve bladder control

While not being able to pee can be a symptom of a stroke, it is unclear whether not peeing can directly cause a stroke. However, what is clear is that urinary incontinence is a common issue post-stroke, affecting up to 25% of survivors within the first year, and 15% a year or more post-stroke.

Pelvic floor exercises can help improve bladder control and reduce leaks. The NHS recommends doing daily pelvic floor exercises, including short and long squeezes, to strengthen the muscles that support the bladder. To do these exercises, squeeze your pelvic floor muscles quickly without pulling in your tummy. Hold the squeeze for 2 seconds, breathing normally and relaxing, and aim to gradually increase the hold time to 10 seconds. You may have to do these exercises for a few months before seeing any benefits.

Pelvic floor exercises can be particularly effective when combined with other treatments, such as bladder training and weight loss, to improve bladder control and reduce leaks.

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Bladder training: retraining the bladder to hold more urine by gradually increasing the time between bathroom visits

While not peeing for extended periods of time is not directly linked to causing a stroke, urinary incontinence is a common issue post-stroke. Bladder training can help with this.

Bladder training is a form of behavioural therapy that can effectively treat urinary incontinence. The goal is to increase the amount of time between urination and the amount of urine the bladder can hold. It can also reduce leakage and the urgency associated with the problem.

Step 1: Keep a Diary

Start by keeping a diary of your bathroom visits. Note down the times you go to the bathroom, how much urine you pass, and how much you drink throughout the day. This will help you and your doctor determine the right intervals for your schedule.

Step 2: Establish a Voiding Schedule

Based on your diary, work with your doctor to establish a fixed voiding schedule. This means going to the bathroom at specific times, whether or not you feel the urge to urinate. Start by gradually increasing the time between bathroom visits by 15-30 minute increments until you can comfortably wait for 3-4 hours.

Step 3: Use Urge Suppression Techniques

When you feel the urge to urinate before the scheduled time, try "urge suppression" techniques such as relaxation and Kegel exercises. Focus on relaxing all your muscles, and if possible, sit down until the sensation passes. If you can't suppress the urge, wait 5 minutes and then slowly make your way to the bathroom.

Step 4: Gradually Increase Intervals

As you become more successful, gradually increase the time between bathroom visits. Try to extend the interval by 15 minutes each week. You will be the best judge of how quickly you can advance. Continue increasing the time until you reach a voiding interval of 3-4 hours.

Step 5: Be Patient and Persistent

Bladder retraining can take 6-12 weeks to be successful. Don't be discouraged by setbacks, as it's normal to have good and bad days. Continue practising, and you will start to notice more and more good days.

Remember to work closely with your doctor throughout this process, as they can help monitor your progress and make any necessary adjustments.

Frequently asked questions

No, not peeing does not cause a stroke. However, a stroke can cause issues with urination, such as urinary retention, frequency, and incontinence.

Urinary retention is the inability to completely empty your bladder or the inability to urinate when you want to.

Urinary frequency is the need to pass urine more often than usual.

Urinary incontinence is the inability to control your bladder, which may result in leaking urine.

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