Urinary Problems in Stroke Patients

Some stroke patients may have urinary incontinence (incontinence). This is mostly a temporary issue. Urinary incontinence is present in 1/3 of patients in the early period after stroke, and 1 out of 4 at the end of the first year. If there is urinary incontinence in stroke patients, their diseases are more severe, their functional status is worse, their hospitalization and death risks are higher (1).

Urinary incontinence can occur due to many reasons. Stroke may have a direct effect, as well as infection, constipation, drug side effects, communication and movement difficulties may increase this problem.

How many types of urinary incontinence are there?

Urinary incontinence is not all the same. Frequent urge to urinate, urgent need to urinate, nocturnal urinary incontinence, functional incontinence (inability to reach the toilet), stress leaks (during coughing, sneezing, laughing), reflex incontinence (unintentional leakage), overflow leaks (leakage because the bladder is full) form of leakage). Since there are such different types, it is necessary to make a correct diagnosis with appropriate examinations and tests.

What tests can be useful in a patient with urinary incontinence?

A complete urinalysis (TIT) can be done to find out if there is an infection in a patient with urinary incontinence. To understand the type of incontinence, keeping a voiding diary with the amount and time of the ingested fluids, the time and amounts of voiding, and the leakages may be helpful. The voiding test (uroflowmetry) can show whether there is a stricture in the urinary tract. With post-voiding catheterization or ultrasonography, it can be understood whether there is urine in the bladder (residual urine). Bladder and kidneys can be visualized with urinary system ultrasound. The urodynamic examination shows the function of the muscles (sphincter) that open and close the bladder and urinary tract outlet in the most detailed way.

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How is urinary incontinence treated in stroke patients?

Emptying the bladder at regular intervals (every 2-3 hours), controlling the amount of fluid consumed, avoiding coffee and alcohol, and not drinking too much water after dinner are simple measures that can prevent urine leakage. With Kegel exercises, the muscles in the groin floor can be strengthened and urine leakage can be reduced. One of the causes of urinary incontinence may be that the patient has difficulty in reaching the toilet due to paralysis. When there is a feeling of urination, the patient may ask for help from relatives to go to the toilet.

In cases where leaks cannot be prevented, the patient may need to use cloths to keep the clothes and sheets clean. Depending on the type of urinary incontinence, drug therapy may be effective.

What causes inability to urinate? What’s the downside?

Sometimes, the person cannot urinate fully, that is, the bladder remains full despite trying to pee. This is called urinary retention, which is common in the first days after a stroke but resolves greatly later on. Urinary retention was found in 29% of patients admitted to the rehabilitation center in the first 4 weeks after stroke. It is more common in patients with aphasia, poor cognitive status, and diabetes (2). If the bladder cannot empty completely, intermittent catheterization (ICC) may be required. If there are obstacles to this, an indwelling catheter can be used.

Urinary retention predisposes to urinary tract infections, backflow of urine to the kidneys, and bladder stones. In the first days of life-threatening stroke, a Foley catheter is inserted to the patient, so that the accumulation of urine in the bladder is prevented and the fluids taken into the body and exiting the body can be calculated. If there is a complaint of urinary incontinence or inability in stroke patients, one should be alert for urinary tract infection.

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Symptoms of urinary tract infection:

Bad smell of urine, turbidity, blood clot or other solid content, burning during urination or around the catheter if any, fever and chills, pain in the lower abdomen and sides, low back pain, feeling of going to the toilet even though the bladder is empty, frequent urination.

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