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Urinary incontience after stroke

02 December 2019
Volume 24 · Issue 12


Normal bladder function is achieved by most in childhood. Stroke affects 15 million people worldwide every year, with incontinence affecting over half these individuals in the initial post-stroke phase. Statistically it has been shown that incontinence can increase the morbidity risk of stroke victims. The social taboo surrounding continence issues has been a challenge for many years with individuals experiencing shame and isolation. This article looks at the normal physiology associated with continence and stroke. It suggests possible treatment options during the post-stroke rehabilitation phase to encourage improved patient experience and professionals' confidence and knowledge base when treating this group of patients.

Continence is a skill we all expect to achieve in childhood. It is reliant on intact nerve pathways between the brain, spinal cord and bladder to send and receive appropriate messages resulting in effective and acceptable bladder emptying. Normal bladder filling and storage involves the bladder stretching to accommodate a reasonable volume of urine (it is generally accepted that a normal bladder capacity in an adult is 400–600 ml), and the detrusor muscle is at rest until the bladder capacity for the individual is reached. Thereafter, a series of nerve impulses communicate between the bladder and brain to start the emptying phase. During the filling and storage phase the urethra and sphincters must remain closed and the pelvic floor contracted to ensure no leakage occurs. This continues even when intra-abdominal pressure is raised during coughing, sneezing, laughing and physical activity. During the emptying phase, the detrusor contracts, the urethra and sphincters open and the pelvic floor relaxes; then, the intravesical pressure increases to effectively empty the bladder contents.

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