Understanding Incontinence After Stroke: Why It Occurs and How to Manage It

Incontinence after stroke alters your ability to control your bladder and bowel movements.

About half of all stroke patients admitted to the hospital experience incontinence, according to the Stroke Association.

If you’re a stroke survivor, the most important thing for you to know is that incontinence is not your fault. It’s a common secondary effect of stroke that can often be treated.

To help you understand incontinence after stroke, this article will discuss:

• What Is Incontinence After Stroke?
• Tips for Dealing with Incontinence After Stroke
• Treatment for Incontinence After Stroke
• Exercises to Improve Continence
• Incontinence After Stroke: Key Points

What Is Incontinence After Stroke?

Incontinence is the involuntary loss of urine from the bladder or feces or wind from the bowel, according to the Continence Foundation.

There are varying degrees of incontinence. Some may experience light leaking while others may have a complete loss of bowel and bladder control.

Incontinence after stroke occurs when a stroke affects the area of the brain that controls your bladder and bowels. Studies often suggest that damage to the frontal lobe results in bladder dysfunction after stroke. However, some studies suggest that damage to other areas of the brain such as the brainstem, temporal lobes, internal capsule, frontal cortex, or frontoparietal lobes also affect bladder control.

Factors that place individuals at an increased risk of incontinence after stroke include:

• High severity of stroke
• Increased age
• Diabetes
• Hypertension
• Comorbidity of other disabling diseases

In this study of 935 acute stroke patients, 47% of individuals had urinary incontinence upon admission. However, in a 6-month follow-up, only 19% reported urinary incontinence. Likewise, 40% had fecal incontinence upon admission while only 9% had it by the 6-month follow-up.

This demonstrates that incontinence after stroke can be treated and individuals may be able to regain bowel and bladder control.

In the following section, we’ll share some helpful tips for managing incontinence after stroke.

Tips for Dealing with Incontinence After Stroke

Because incontinence after stroke can significantly affect one’s quality of life, it’s essential to be prepared to prevent or handle accidents.

Based on feedback from other stroke survivors, here are some useful tips for dealing with the symptoms of incontinence:

• Add waterproof pads beneath bedsheets
• Protect furniture with plastic covers
• Keep an extra set of garments in all bathrooms
• Give yourself extra time to get to the bathroom
• Use undergarments that you don’t mind tossing out
• Keep an extra set of clothes in your car
• Have hand wipes and sanitizer nearby at all times

These tips help you deal with the unavoidable results of incontinence. Now let’s move onto some treatment options that can lessen these effects.

Treatment for Incontinence After Stroke

Sometimes, incontinence goes away on its own after a short amount of time. This is known as spontaneous recovery.

However, if it does not go away, treatments are available.

You can treat incontinence with or without exercise. Here are the different ways you can treat incontinence without exercise:

• Urgency control involves using deep breathing or complex mental tasks, like counting down from 100, to help you ignore your urgency to relieve yourself. Urgency control is the best treatment long-term because it can help rewire the brain and improve incontinence.
• Avoiding coffee and alcohol, which makes you produce more urine, can help prevent urinary incontinence.
• Taking medication can help reduce the amount of urine that your body produces and help reduce bowel movements to keep urges at bay and improve your control.
• Making dietary changes to reduce constipation can help as constipation worsens bowel incontinence. Adding stool softeners or laxatives while avoiding low fiber foods (like cheese) can also improve symptoms.
• Losing weight can help with incontinence as being overweight can affect your ability to control your bladder.
• Following a bowel and bladder program involves following a schedule to stimulate bowel and bladder movements rather than waiting until you have the urge to use the toilet.

With that being said, you should be working closely with your physician, rehab nurses, and occupational therapist to determine the best incontinence treatment plan for you.

In the following section, we’ll discuss exercises that can help improve bladder and bowel control after stroke.   

Exercises to Improve Continence

An effective way to regain control over your bowel and bladder muscles after stroke is to practice targeted exercises.

Whenever you repeatedly practice something, it activates neuroplasticity and rewires the brain. Neuroplasticity is how the brain heals itself after stroke, including healing the secondary effects of stroke like incontinence.

So if you want to improve incontinence long-term, try these exercises that can help treat incontinence.

• Bladder/bowel training involves gradually retraining your bladder and bowels to hold more for longer. Start by setting specific times to go to the restroom, and then each week increase the amount of time between each bathroom break. However, don’t wait more than a few hours between bathroom breaks if possible.
• Pelvic floor training (i.e., Kegel exercises) can help you strengthen the muscles that support your bladder, small intestine, and rectum. To do this exercise, squeeze the muscles that you use to stop urinating for 3 seconds, then relax for 10-20 seconds. Continue this for 10 reps while adding one second to each repetition.

These exercises will help increase the length of time between bathroom breaks and strengthen the muscles that control continence.

The more you practice the skill of controlling your bladder/bowel movements, the better you will get at it.

Incontinence After Stroke: Key Points

Incontinence is a common secondary effect of stroke that occurs due to damage to the areas of the brain that control the bowel and bladder muscles.

With the right support and management interventions, many individuals regain control over their bowel and bladder muscles, which significantly improves their quality of life.

We hope this article helped you better understand why incontinence occurs after stroke and how to treat it.