Stroke Impact: Bladder And Bowel Function Decline

why does bladder and bowel function decrease in stroke patients

Bladder and bowel function can decrease in stroke patients due to a combination of physical and neurological factors. The stroke itself can cause damage to the part of the brain that controls the bladder and bowel, resulting in incontinence. This can also be caused by the brain having difficulty communicating with the body. In addition, patients may experience mobility issues, making it difficult to reach the toilet in time. This can be further exacerbated by communication problems, making it hard to ask for help. The effects of medication, constipation, and bladder infections can also contribute to bladder and bowel control issues.

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Brain damage

A stroke occurs when the blood supply to the brain is cut off, which can be caused by a blockage or a bleed in the brain. This can lead to brain damage that affects bladder and bowel function.

Damage to Brain Cells

A stroke can damage the part of the brain that controls the bladder or bowel. If a person loses consciousness during a stroke, they may soil themselves without realising it. Urine retention can also occur soon after a stroke, causing difficulty in emptying the bladder. Reflex incontinence can also occur, where a person wets or soils themselves without realising it due to reduced consciousness or awareness.

Communication and Mobility Issues

Communication and mobility problems after a stroke can make it difficult for individuals to ask for help or get to the toilet in time, leading to bladder and bowel control issues. Weakened muscles and reduced mobility can also contribute to these challenges.

Impact on Bowel Function

Bowel function can be impacted by reduced mobility, leading to constipation. This can result in overflow incontinence if the bowel becomes impacted. Dietary changes, such as decreased food and water intake after a stroke, can also contribute to constipation.

Impact on Bladder Function

Weakened muscles and nerve damage after a stroke can affect bladder control. Nerves that sense when an individual needs to urinate may have trouble sending and receiving messages from the brain. This can lead to incontinence and difficulty reaching the toilet in time.

Treatments for Brain Damage Impact

Treatments for bladder and bowel control issues resulting from brain damage include dietary adjustments, bladder and bowel retraining, pelvic floor exercises, and treatments for constipation. Creating a daily routine, improving hygiene practices, and using appropriate products can also help manage these issues effectively.

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Communication and mobility issues

The extra exertion required to move around can also make it more difficult to maintain bladder or bowel control. A stroke survivor may not be able to eat or drink as much as usual, which can lead to constipation. Being less mobile than usual can also make a person more prone to constipation, as they are not moving their bowels as regularly. A full bowel can put pressure on the bladder, causing incontinence.

If a person had mild bladder or bowel problems before their stroke, these are likely to be made worse by long periods of sitting.

If a person is unable to communicate their need to use the toilet, staff in a care setting may offer them the toilet or a commode every two hours or so. A bottle or sheath urinal (for men) or a bedpan (for women) may be offered.

Practical Strategies

  • Make getting to the bathroom easier by clearing a path and installing a night light.
  • Use a raised toilet seat.
  • Use a commode (portable toilet) or urinal, especially at night.
  • Use continence products such as absorbent pads.

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Medication

There are several medications available that can help prevent spasms of the bladder muscle, which can help reduce urgency and frequency incontinence associated with a stroke. These medications are known as antimuscarinic or anticholinergic drugs, and include:

  • Darifenacin Hydrobromide
  • Fesoterodine Fumarate
  • Oxybutynin
  • Oxybutynin Transdermal Patch
  • Solifenacin Succinate
  • Tolterodine
  • Trospium Chloride

Antidiarrheal medications such as loperamide (Imodium) can also be purchased over the counter. These work by slowing gut transit, making stools firmer and less frequent. However, it is important not to use this type of medication if the patient has diarrhoea with blood and/or mucus, or a fever.

Injectable therapies are also available as a treatment, which bulk up the anal sphincter muscles or urethra to improve leakage. This involves injecting a gel into the necessary area to thicken the tissues and prevent soiling and improve control.

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Constipation

Causes

There are several factors that can contribute to constipation after a stroke:

  • Reduced mobility: Being less mobile after a stroke can make it harder for waste to move through the colon.
  • Dietary changes: A stroke survivor may not be able to eat or drink as much as they used to, leading to potential dehydration and a lack of fibre in the diet.
  • Medications: Certain medications, such as blood pressure medications, can cause constipation.

Treatments

There are several treatments and lifestyle changes that can help with constipation:

  • Dietary changes: Increasing fluid intake and consuming more high-fibre foods like vegetables, fruits, beans, and whole grains can help soften stools and improve bowel movements.
  • Stay active: Physical activity can help keep things moving in the colon.
  • Bowel retraining: Establishing a regular bowel movement routine and gradually increasing the time between bowel movements can help improve bowel control.
  • Laxatives: Over-the-counter laxatives can be used to relieve constipation quickly. Different types of laxatives include bulking laxatives, osmotic laxatives, and stimulant laxatives.
  • Enema or suppository: If laxatives don't help, an enema or a suppository called a bulking agent may be recommended by a doctor.

It is important to seek help from a healthcare professional if you or someone you know is experiencing constipation after a stroke. They can help identify the cause and recommend appropriate treatments or lifestyle changes.

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Urinary tract infections

UTIs can also be caused by using a catheter, which is often necessary for stroke patients who are unable to empty their bladder. A catheter is a fine tube inserted into the urethra or through a small hole in the stomach to drain urine into a bag. As bacteria can enter the bladder through the catheter, it is important to keep the area clean and change the bag regularly.

Symptoms of a UTI include:

  • Feeling the need to urinate, even with an empty bladder
  • Losing control of your bladder (urinary incontinence)
  • Pain or burning while urinating
  • Cloudy urine or urine with a strong smell
  • Fever or increased body temperature
  • A sudden change in behaviour

If you or someone you know is experiencing these symptoms, it is important to contact a doctor as soon as possible. UTIs can usually be treated with antibiotics, but if left untreated, they can lead to more serious complications.

To reduce the risk of developing a UTI, it is important to maintain good bladder health. This includes drinking enough fluids (6-8 cups per day), limiting caffeine, and practising bladder retraining techniques. It is also important to maintain good hygiene, especially when using a catheter, and to seek help if you are having bladder control issues.

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Frequently asked questions

A stroke occurs when the blood supply to the brain is cut off, which can be caused by a blockage or bleed in the brain. This can damage the part of the brain that controls the bladder or bowel. In addition, the stroke patient may experience weakness in the muscles that control the bladder and bowel, as well as nerve damage that affects their ability to sense when they need to go.

Urinary incontinence, urinary frequency, urge incontinence, functional incontinence, nocturnal incontinence, stress incontinence, and reflex incontinence are some of the bladder problems that can occur after a stroke.

Bowel problems such as constipation, diarrhoea, and faecal incontinence can occur after a stroke.

Treatments include dietary changes such as increasing fluid and fibre intake, bladder and bowel retraining, pelvic floor exercises, and medication.

Practical tips include establishing a daily routine, wearing easily removable clothing, maintaining good hygiene, and using absorbent products when going out.

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