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Stroke Smart Magazine

July/August 2007

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Caring for a Survivor With Incontinence

By Pete Lewis

Incontinence, or the inability to control urination, can be embarrassing and distressing for stroke survivors.

We control our bladders through a series of muscles. The bladder itself is a muscle. These muscles are controlled by nerve signals, some that we consciously send, and some that our brains send without us even knowing. When a stroke disrupts these signals, patients may have problems controlling their bladders.

About half of stroke survivors have bladder-control problems immediately after their strokes, said Dr. Rich Zorowitz of the Department of Physical Medicine and Rehabilitation at Johns Hopkins University and head of the Rehabilitation and Recovery Advisory Board for National Stroke Association. The good news is only about 15 percent of patients still have a problem one year later.

“As their general motor skills recover, bladder control returns,” Zorowitz said.

However, anyone with bladder-control problems should consult a doctor. Too many of us assume urinary problems are a natural part of aging or something we must endure. The condition often goes unreported because patients are embarrassed to discuss it. As a caregiver, you may need to be the one to open a dialogue between the patient and healthcare provider. While bladder problems can be embarrassing for the patient, doctors and nurses are used to dealing with incontinence issues.

Incontinence often can be managed by modifying diet and urinary habits. A common technique is timed voiding, in which the patient uses the bathroom on a regular schedule, maybe every two hours. Avoiding caffeine, alcohol, artificial sweeteners and limiting all liquids in the evening can help.

Your doctor also may prescribe medicine or, in some cases, suggest surgery.

The first step in treating any bladder dysfunction should be a medical evaluation. Simple tests can determine if the problem is caused by an infection. Other tests will establish if the bladder is contracting and emptying properly.

“Once we've identified the cause of the problem, if you follow through with therapy, you have a good chance of controlling the problem,” Zorowitz said.


Open the dialogue. Your loved one may be embarrassed, so the onus may rest with you.

Discuss the problem with a doctor. Don't assume that incontinence is a natural part of aging or something you “ have to live with.”

Don't neglect skin care. Absorbent products, specialized ointments, soaps and powders can help prevent skin irritation. While some products are available in drug stores and supermarkets, stores that specialize in home health care products offer a better selection and a more knowledgeable staff.

Suggest that the patient avoid tight and restrictive clothing.

Remove anything that may block the path to the bathroom.

Install safety devices such as handrails or elevated toilet seats.



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