Constipation Post-Stroke: What You Need To Know

Experiencing constipation after a stroke is common, with incidents ranging from 29% to 79%. This can be caused by weak muscles and nerve damage, or a change in diet and activity levels. It can also be a side effect of medication. Bowel complications after a stroke can negatively affect social functioning and quality of life, and even lead to death.

Constipation incidence in stroke patients

Constipation is a common occurrence in stroke patients, affecting their quality of life and social functioning. A systematic review and meta-analysis of eight studies revealed that the incidence of constipation in stroke patients was 48% (95% confidence interval [CI] = 33%–63%). The incidence varied across different types and stages of stroke, with hemorrhagic stroke patients experiencing a higher rate of constipation (66%) compared to those with ischemic stroke (51%). Additionally, the incidence during the rehabilitation stage (48%) was slightly higher than in the acute stage (45%).

Several factors contribute to constipation in stroke patients. Reduced physical mobility, decreased fluid and fibre intake, and dependence on others for toileting are common issues. The use of certain medications and the impact of the stroke on the brain-gut axis can also lead to constipation. The brain-gut axis, which involves the central nervous system, enteric nervous system, and autonomic nervous system, plays a crucial role in maintaining bowel function. Lesions in the cerebral cortex, basal ganglia, brain stem, cerebellum, and lower cranial nerves resulting from a stroke can disrupt this axis and cause constipation.

To manage constipation, stroke patients can make dietary changes, such as increasing fluid and fibre intake, and staying physically active. Bowel retraining techniques, such as establishing a daily routine, can also be beneficial. In some cases, medications or over-the-counter laxatives may be recommended by a doctor. It is important for stroke patients to seek medical advice and work with their healthcare team to find the most effective strategies for managing constipation.

Bowel complications

Bowel and bladder problems are common after a stroke, with constipation being a frequent issue. This can be caused by weak muscles and nerve damage, as well as reduced physical activity and changes in diet. The stroke itself can also affect bowel control, along with medication, constipation, and bladder infections. Incontinence, or loss of bowel control, is another possible complication, although it is less common than bladder incontinence.

Strategies for Dealing with Bowel Problems

There are several strategies that can help with bowel problems after a stroke:

• Dietary changes: Increasing fluid intake and consuming more high-fibre foods such as vegetables, fruits, beans, and whole grains can help with constipation.
• Physical activity: Staying active can help keep things moving in the colon.
• Bowel retraining: Establishing a regular schedule for bowel movements, such as trying to poop at the same time each day, can be beneficial. However, it is important not to strain.
• Medications: Certain medications may contribute to constipation, so it is important to discuss alternatives with your doctor. Stool softeners, laxatives, enemas, or suppositories may also be recommended.
• Practical tips: Making it easier to get to the bathroom, such as by clearing obstacles and installing a night light, can be helpful. Wearing clothes that are easy to remove when you need to go to the bathroom is also a practical solution.

Seeking Help

It is important to talk to your doctor or healthcare team if you are experiencing bowel problems after a stroke. They can help identify the cause and suggest appropriate strategies or treatments to improve your bowel function and overall quality of life.

Strategies to prevent constipation

Constipation is a common complication after a stroke, affecting 48% of patients and causing adverse outcomes, including disability and even death. Here are some strategies to prevent constipation in the event of a stroke:

Dietary Changes:

• Increase Fluid Intake: Ensure you are drinking enough liquids throughout the day. Fluids help to keep the colon hydrated and promote easier bowel movements.
• High-Fiber Diet: Consume high-fiber foods such as vegetables, fruits, beans, and whole grains. Fiber adds bulk to stools, softening them and making them easier to pass.

Physical Activity:

Stay Active: Physical activity helps stimulate bowel function. Moving your body regularly can help keep things moving in your colon as well.

Bowel Retraining:

Develop a Routine: Try to establish a routine by having a bowel movement at the same time each day. However, be careful not to strain, as this can lead to other complications.

Medication Review:

• Medicine Assessment: Ask your doctor to review your medications to ensure they are not causing constipation. There may be alternative medications available that do not have this side effect.
• Stool Softeners and Laxatives: If recommended by your doctor, try using stool softeners or laxatives to ease constipation.

Bathroom Accessibility:

• Clothing Choice: Choose clothing that can be easily removed when you need to use the bathroom. This can help reduce the urgency and stress associated with trying to get to the toilet in time.
• Bathroom Modifications: If you have difficulty moving around, consider making modifications to your bathroom, such as installing a raised toilet seat and grab bars along the walls. These changes can make it easier and safer to use the toilet.

How to get help

Constipation after a stroke is a common issue, but there are several ways to manage and treat it.

Firstly, it is important to talk to your doctor about any bladder or bowel problems you are experiencing. They can recommend treatments and give you advice on how to manage your symptoms. It is also important to talk to your doctor about any medications you are taking, as these could be causing or contributing to your constipation. Ask your doctor if any of your medications cause constipation and whether there are alternatives you can try.

To help prevent constipation, it is important to drink enough liquids—around six to eight cups per day—and to eat enough fibre. Whole grains, legumes, lentils, kidney beans, fruits, and vegetables are good sources of fibre. If you are still experiencing constipation after increasing your fluid and fibre intake, speak to your doctor about over-the-counter treatments such as stool softeners or laxatives.

Your doctor may also recommend bowel retraining, which involves going to the toilet at the same time each day. It is important not to strain, and to be careful not to wait too long before going to the toilet. Making changes to your bathroom, such as installing a raised toilet seat or grab bars, can also help.

If you are experiencing bladder problems, such as incontinence, there are several strategies you can try. These include bladder retraining, Kegel exercises, and drinking plenty of water. It is also important to avoid caffeine, alcohol, and soda, as these can irritate the bladder.

If you are having trouble getting to the bathroom in time, try to clear a path and remove any items that might block your way. Install a night light to help you see at night, and consider using a commode or urinal, especially at night. Choose clothing that is easy to remove, such as sweatpants, and consider using incontinence products to keep yourself dry and maintain healthy skin.

Your healthcare team can also provide support and suggest strategies to help you manage your symptoms. Physiotherapists can teach you pelvic floor exercises, occupational therapists can help make it easier for you to get to and use the toilet, and nurses can advise on skin care and provide tips for retraining. Dietitians can also help you plan meals that include high-fibre foods and plenty of liquids.

Impact on quality of life

Constipation after a stroke is a common occurrence, with incidents ranging from 29% to 79%. This complication can negatively impact a person's quality of life, limiting their social activities and independence. It is important to address and manage constipation effectively to minimise its impact on daily living.

Constipation can lead to discomfort and pain, affecting an individual's ability to perform daily tasks and participate in social activities. It can cause embarrassment and anxiety, particularly if it results in incontinence or the need to wear adult diapers. The condition may also limit mobility, as individuals may become hesitant to leave the house due to fear of not reaching a toilet in time. This can result in social isolation and a reduced quality of life.

The impact of constipation on quality of life is further exacerbated by the physical limitations that often accompany a stroke. Weakened muscles and nerve damage can make it difficult for individuals to move quickly or perform basic tasks, such as getting dressed or using the toilet. These challenges can contribute to a sense of frustration and loss of independence.

Additionally, constipation can lead to other health complications, including urinary tract infections and bladder stones. These secondary issues can further impact an individual's quality of life, requiring additional medical interventions and potentially prolonging the recovery process.

Effective management of constipation is crucial to minimise its impact on stroke survivors' quality of life. This includes dietary modifications, such as increasing fluid and fibre intake, as well as physical activity and bowel retraining techniques. Seeking medical advice is important to ensure proper evaluation and treatment, which can help improve bowel function and overall well-being.

By addressing constipation and implementing appropriate strategies, individuals can regain a sense of control and independence, improving their overall quality of life following a stroke. Support from healthcare professionals, such as physiotherapists, occupational therapists, and dietitians, can also play a vital role in helping individuals manage their bowel problems and adjust to their new circumstances.

Frequently asked questions