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Stroke Smart Magazine


January/February 2009
FEATURE

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Rehabilitation & Recovery After Stroke
Bladder & Bowel Function

BY ADAM MCVEIGH

Problems with bladder and bowel function are common but distressing for stroke survivors. These issues occur when a stroke has damaged the part of the brain that controls waste removal or the brain signals for it. “Going to the bathroom” after suffering a stroke can be complicated by:

  • The triad of bladder dysfunction: Urinary frequency, urinating more frequently than usual; urgency, having a sudden need to urinate; and incontinence, being unable to control your urination.
  • Urinary retention: Trouble urinating or not completely emptying your bladder.
  • Constipation: Being unable to have a regular bowel movement.
  • Bowel incontinence: Being unable to control your release of stool. If any of these symptoms occur, you should address it with your doctor as soon as possible.


Urinary Incontinence

Soon after stroke, many survivors need to use a small flexible tube called a catheter to urinate. When they improve, the catheter is removed and they begin a regular urination pattern again. Most stroke survivors regain control of their bladders and urinate normally. Others continue to suffer from urinary incontinence and are unable to control their urination.

Treatments

Treatments vary depending on the cause of your problem. Your doctor might perform a bladder scan or catheterize you after you urinate to see how much urine is left in your bladder. You might be referred to a urologist, who will perform a test called urodynamics that helps to diagnose the type of bladder problem you have. Tips that can help:

  • Go to the bathroom at regular times to help train your bladder. Urinate every 2-3 hours – whether you feel the urge or not.
  • Get help from others as soon as you feel the urge to urinate. They might be able to get you to the bathroom in time.
  • Drink plenty of fluids during the day and limit them in the evening to reduce the number of times you have to go to the bathroom at night.
  • Limit caffeine and alcohol at night.
  • Ask your physical therapist to help you strengthen the muscles around your bladder. Pelvic floor muscle exercises, called kegel exercises, might help.
  • Make sure that you have privacy and plenty of time to sit on the toilet or commode chair.
  • Try pantyliners, waterproof underpants or disposable adult diapers. Carefully clean and lubricate the urinary area to avoid skin irritation. Be sure and contact your doctor to devise a treatment plan if you have any of these symptoms.


Urinary Retention

Also common among stroke survivors is urinary retention: when you do not completely empty your bladder. If untreated, it can lead to bladder stones, reflux (reverse flow of urine back to the kidneys) or a urinary tract infection (UTI). UTI symptoms include:

  • Urine with a bad smell, cloudiness, blood or sediment (solid deposits).
  • Burning when urinating or around a catheter.
  • Fever and chills.
  • Cramps in lower abdomen or side.
  • Pain in lower back.
  • Frequent urination or feeling like you have to go to the bathroom even though your bladder is empty.

Treatments

It is important to be sure and drink plenty of water to dilute your urine. If this doesn’t resolve the problem, special treatments might be needed for conditions that cause urine retention. In these cases, your doctor might prescribe a drug to enable you to urinate better. Inform your doctor of other drugs you are taking because they could be the cause of your urinary retention.

Ongoing Problems

Despite all attempts to correct them, you can still have problems.

  • Use a catheter, if needed. Ask your doctor which type is best for you.
  • Try pantyliners, waterproof underpants or disposable adult diapers.


Constipation and bowel incontinence

Constipation and bowel incontinence (involuntary release of stool) might result from:

  • Reduced fluid intake.
  • Diet.
  • Not moving around enough.
  • Side effects from prescription drugs.
  • Being unaware you need to use the toilet.
  • Weakness in the muscle that holds a bowel movement until you reach a bathroom.
  • Being unable or reluctant to ask for help.


Tips that can help

  • Make a schedule of bowel movements at established times as soon as possible. Opportunities to use the bathroom should be planned according to previous bowel habits.
  • Give yourself privacy.
  • The sitting position allows you to lean forward, aiding the process.
  • Be active during the day to stimulate the process of bowel movement.
  • Eat healthy foods to reduce constipation and improve bowel control.


Treatments

If problems persist, your doctor might suggest one of these drugs or treatments:

  • A stool softener or bulk agent, called a suppository. Shaped like a bullet, suppositories are inserted into the anus 30 minutes after a meal to stimulate a bowel movement. When using suppositories, you should drink more liquids than usual. Never use them for a long period of time.
  • Enema or shot of liquid put into the rectum through the anus. Do the enema at a set time every day (usually morning or evening) and adhere to your schedule. If enemas cause bleeding or abdominal pain, consult your doctor right away.
  • Oral laxatives might be helpful, but be aware that their action times can be unpredictable and they can cause incontinence in a person with poor bowel control. Be sure to work closely with your physician to address problems with constipation and bowel incontinence.


Resources

What Can help

  • Talk with your doctor about symptoms and treatments.
  • Be kind to yourself and remember that you are not alone. many people have these issues.
  • Get information on stroke recovery from national stroke Association. Visit www.stroke.org or call 800-STROKES (800-787-6537).
  • Contact your local stroke association.
  • Join a stroke support group.
  • speak honestly with your caregivers about these issues. Together you can work out the best solution.


 

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National Stroke Association’s mission is to reduce the incidence and impact of stroke by developing compelling education and programs focused on prevention, treatment, rehabilitation and support for all impacted by stroke.

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