Managing Bathroom Habits After A Stroke

Hemiparesis is a common after-effect of a stroke, causing weakness on one side of the body. This can make everyday activities such as eating, dressing, and walking difficult. It can also impact a stroke patient's ability to go to the bathroom, as they may experience a loss of bladder control and difficulty moving quickly enough to reach the toilet in time. To address these challenges, modifications can be made to the bathroom, such as installing grab bars, raised toilet seats, and shower chairs, to improve safety and independence. Additionally, patients can seek help from an occupational therapist for training in personal care strategies.

Bladder and bowel incontinence

After a stroke, bladder and bowel incontinence can occur as a result of weak bladder muscles and nerve damage. This can lead to two types of bladder problems: incontinence and an inability to urinate. Incontinence is the inability to control your bladder, which may result in leaking urine without realizing it or wetting the bed. The latter problem is when you feel the urge to urinate but cannot, or when you cannot completely empty your bladder, which can lead to urinary tract infections (UTIs) or bladder stones.

Bladder Incontinence

To regain control of your bladder, you can try bladder retraining, which helps you hold your urine for longer. This involves gradually increasing the time between bathroom visits, starting with urinating every 2-3 hours. You can also try Kegel exercises to strengthen your pelvic floor muscles and prevent incontinence. Staying hydrated is important, but limit your fluid intake in the evening to avoid getting up at night. It is also important to check with your doctor to ensure that none of your medications are causing bladder problems.

Inability to Urinate

If you are unable to urinate, there are drugs that may help when you feel like you cannot go. Your doctor can advise on alternative medications if your current ones are causing bladder problems.

Bowel Incontinence

Weak muscles and nerve damage from a stroke can also cause bowel incontinence, which is less common than bladder incontinence. This is when you cannot control your bowel movements and may experience leaking. To help manage this, ensure you are drinking enough fluids and eating high-fiber foods like vegetables, fruits, beans, and whole grains. Staying active also helps to keep things moving in your colon. Bowel retraining can also be beneficial, which involves trying to poop at the same time each day without straining.

General Tips

• Talk to your doctor if you are having trouble going to the bathroom. They can recommend ways to relieve bladder and bowel problems.
• Make sure to wear clothes that can be easily removed when you need to use the bathroom, such as sweatpants instead of jeans with a zipper.
• Consider making modifications to your bathroom, such as installing grab bars and a raised toilet seat, to improve safety and stability.
• Use pads or adult diapers to stay clean and prevent accidents.

Loss of balance and coordination

Hemiparesis is a common after-effect of a stroke, causing weakness on one side of the body. This can make it difficult to perform everyday activities such as eating, dressing, and walking. Loss of balance and coordination are common symptoms of hemiparesis.

Balance and coordination issues can make it challenging for stroke patients with hemiparesis to perform basic tasks, including using the bathroom. The loss of balance and coordination can increase the risk of falling, which is already elevated due to the weakness on one side of the body. To prevent falls, it is recommended that patients use assistive devices such as canes or walkers and avoid relying on furniture for support.

To improve balance and coordination, patients can undergo rehabilitation and physical therapy. This may include modified constraint-induced therapy (mCIT), which forces the use of the weakened parts of the body to improve nerve function. Electrical stimulation and cortical stimulation are also used to improve muscle function and nerve signalling. Mental imagery, or visualising the movement of the affected body parts, can also help to activate the nerves and muscles.

Additionally, patients can make lifestyle changes to improve balance and coordination. Staying active and performing exercises to strengthen leg muscles and improve balance can be beneficial. Wearing flat, wide-toed shoes can also help with balance and reduce the risk of tripping.

By combining medical treatments and lifestyle changes, stroke patients with hemiparesis can improve their balance and coordination, making it easier to perform daily tasks, including using the bathroom safely and effectively.

Numbness or weakness in the tongue

Hemiparesis is a common after-effect of a stroke, causing weakness on one side of the body. This can make it difficult to perform everyday activities such as eating, dressing, and walking. The side of the body affected by hemiparesis depends on which side of the brain the stroke occurred. For example, an injury to the left side of the brain can result in right-sided weakness, as the left side controls language and speaking.

Now, let's focus on the topic of numbness or weakness in the tongue:

The tongue can be affected by numbness or tingling for various reasons, including:

• Nerve damage during a dental procedure, particularly when removing a wisdom tooth.
• Allergic reactions to certain foods, drinks, or medications.
• Canker sores, which are small mouth ulcers that can cause pain, numbness, or a tingling sensation.
• Burning the tongue on hot food or drink, resulting in a tingling sensation during healing.
• Vitamin B12 deficiency, which can also cause a sore, red tongue and other symptoms such as fatigue and weight loss.
• Low blood sugar or hypoglycemia, which is common in people with diabetes.

If you are experiencing numbness or weakness in the tongue, it is important to seek medical advice, especially if the feeling lasts for an extended period, spreads to other areas such as the lips and jaw, or if there is no apparent cause for the loss of sensation.

Managing Bathroom Activities

Hemiparesis can make it challenging for stroke patients to perform basic activities, including using the bathroom. Here are some strategies to help manage bathroom activities:

• Bladder retraining: Try to hold urine for longer periods, gradually increasing the time between bathroom visits.
• Kegel exercises: Strengthen the pelvic floor muscles to improve bladder control.
• Drink plenty of water: This dilutes the urine and makes it less irritating to the bladder. Avoid caffeine, alcohol, and soda, which can irritate the bladder.
• Medications: Consult your doctor about medications that may help with bladder control.
• Bowel management: Eat high-fiber foods, stay active, and try to establish a regular bowel routine.
• Bathroom modifications: Install grab bars, raise the toilet seat, and consider using pads or adult diapers for added protection.

Occupational therapy

Hemiparesis is a common effect of stroke, causing weakness on one side of the body and limiting movement. This can make it difficult to perform everyday activities, such as eating, dressing, and walking. Occupational therapy can help stroke patients with hemiparesis to improve their motor control and hand function, and maximize their ability to undertake personal self-care tasks and domestic tasks.

• Maintaining or improving soft tissue properties of the upper limb, such as stretching, splinting, or electrical stimulation to reduce spasticity.
• Preventing contractures or dependent edema through education, positioning, and compression.
• Retraining motor, sensory, visual, perceptual, and cognitive skills within the context of functional activities.
• Minimizing secondary complications, such as contractures or hand edema.
• Providing education and support to the patient and caregivers.
• Adapting tasks or the environment to improve the patient's level of independence, such as recommending assistive equipment or home modifications.
• Training caregivers to use assistive equipment or modifications safely.
• Referral to outpatient or community occupational therapy, if needed.
• Return to driving and return to work services, including off-road and on-road driving assessments and workplace assessments.

Bathroom modifications

The bathroom can be a particularly hazardous place for stroke patients, with wet and slippery surfaces increasing the risk of falling. Here are some modifications that can be made to the bathroom to make it safer and more accessible for stroke patients with hemiparesis:

• Grab bars: Install grab bars or handrails near the toilet, in the shower, and/or near the bathtub. These provide extra support and stability when getting on or off the toilet, or when getting in or out of the tub or shower.
• Non-slip bath mats: Place non-skid bath mats with suction cups outside the shower or bathtub to provide better grip and stability, reducing the risk of slipping.
• Tub transfer bench: Consider adding a tub transfer bench, which extends from inside the tub to the outside. This allows the patient to sit and slide into the tub without having to step over a high edge. The patient can then use a handheld showerhead while seated.
• Shower chair: A shower chair with rubber tips on each leg can provide a stable and safe place to sit while showering.
• Raised toilet seat: Install a raised toilet seat, which can make it easier for patients with weak legs to sit down and get up. Some models also come with armrests for additional support.
• Bedside commode: A bedside commode allows the patient to use the toilet without having to walk to the bathroom. It can be placed over the toilet once the patient is more mobile.
• Shower hose: A shower hose, or handheld showerhead, can be useful for those with limited movement who need to bathe or shower while seated. It is also helpful for caregivers assisting the patient.
• Doorknob extenders: Consider replacing traditional doorknobs with doorknob extenders or handles, which are easier to operate and do not require twisting.
• Lighting: Install red or orange night lights to illuminate the path to the bathroom at night. This helps to guide stroke patients without disrupting their internal clock or making it difficult to fall back asleep.
• Rugs: Remove unnecessary rugs or use non-slip adhesives/rubber pads to secure them in place. Rugs can be tripping hazards, especially for those with reduced mobility.
• Clear walkways: Keep walkways clear of clutter, such as furniture, toys, and cords, to reduce the risk of tripping.

Frequently asked questions