Incontinence
after stroke
Summary
•Poor control of your bladder
or bowel is sometimes called
incontinence.
•Stroke can affect bladder and
bowel control in many ways.
•Difficulty with bladder and bowel
control is common after stroke.
•Your stroke team or health
professional can suggest different
ways or products to help if you
have trouble with incontinence.
What is the link between
incontinence and stroke?
How well you control your bladder and bowels
is called ‘continence’. Poor control (called
‘incontinence’) can be caused by a number of
changes after a stroke. Changes that may affect
continence include:
• muscle weakness.
• changed sensation or feeling.
• difficulty ‘holding on’.
• difficulty dressing and undressing.
• difficulty getting to the toilet.
• changes in eating and drinking habits affect
your digestion.
Fact Sheet
Call StrokeLine 1800 STROKE (787 653)
• changes to communication and thinking
skills.
• changes to vision.
• some medications can also cause problems
with bowel or bladder control.
The type of changes you may have with your
continence after a stroke will depend on
several things. These include where and what
type of stroke you had, your age and if you are
male or female. If you had difficulties with your
bladder control before your stroke, the stroke
may make them worse.
There are many incontinence problems that
can occur. The most common are:
• Frequency. Needing to go to the toilet very
often.
• Functional incontinence. Trouble getting
to the toilet on time or at all. Physical or
communication difficulties after a stroke can
make it harder to get to the toilet on time.
Sometimes clothing can be hard to get
undone or toilets may not be close by.
• Urge incontinence. A sudden and
uncontrollable need to pass urine. This may
result in urinating in your clothing.
• Urinary retention. Not being able to fully
empty the bladder or holding an increasing
amount of urine in the bladder.
• Nocturnal incontinence. Needing to go to the
toilet several times during the night.
• Faecal incontinence. Passing faeces in your
clothing.
• Constipation and diarrhoea.
Fact Sheet | Incontinence after stroke
Incontinence after stroke
Incontinence is common after stroke. It can be
frustrating, embarrassing and distressing. This is because difficulties with bladder and
bowel control can affect your work, social
activities, relationships and sexual activities.
It is important to seek assistance with your
incontinence as there are a range of treatments
and strategies to help.
Who can help me?
There are a number of health professionals who
can help you improve your continence. You
should be involved in developing a continence
management plan for your stay in the hospital
and for when you leave the hospital. The
following health professionals may be part of the
team that helps develop this plan:
• Doctor or GP. May change any medications
that could be making your incontinence worse.
• Nurse. Helps you with toileting while you are in
hospital.
• Continence Nurse Advisor. Can recommend
toileting aids and equipment, teach you
good bladder and bowel habits and provide
exercises and strategies to help.
• Urologist. A doctor who specialises in
problems of the urinary system.
• Occupational therapist. Can help you find the
right toilet aids and equipment and ensure your
clothing is easy to undo.
• Physiotherapist. Can help with your walking
and how to get to the toilet or on and off a
commode. They can also give you exercises to
strengthen your pelvic floor muscles. These are
the muscles you use when ‘holding on’ before
going to the toilet.
• Dietitian. May recommend foods and the right
amount of fluid to help you with your bladder
and bowel movements.
• Speech pathologist. Can help with ways to
communicate when you need to go to the
toilet.
How does my health
professional assess my
continence?
Incontinence can be prevented, treated, better
managed or cured.
If left untreated your difficulties may become
worse. They can also cause other problems.
The first step is a full assessment by health
professionals. For some people incontinence can
be difficult to talk about. However it is important
that you get the best help you can.
Your health professionals will ask you about how
well you were able to control your bladder and
bowels before the stroke (any leakage or other
issues). They will also ask about how well you
are able to control it now. They will look at things
like what you eat and drink, your medications,
how much you exercise and how well you move
around. Some tests may need to be done. These include:
• Bladder scan. A quick and easy ultrasound
(picture) of your bladder. This looks at how well
your bladder is emptying and if it is painless.
• Urine tests. You may need to pass urine into a
small jar. This will be sent off for tests to check
if there is an infection.
• Rectal examination. A doctor feels inside your
rectum for any abnormalities.
• Bladder and bowel diary. Keeping a diary of
how much you drink, how much fluid you pass
and how often.
After your assessment you should work with your
health professionals to develop a management
plan for how to improve or manage your
incontinence. If your problems with incontinence
do not get better then your doctor may
organise more tests, or refer you to one or more
continence specialists.
What products can help?
Some products can be used to make going to
the toilet safer and easier. They include raised
toilet seats, rails on the wall next to the toilet,
commode chairs and portable urinal bottles. Your
occupational therapist, nurse or continence nurse
can help you with these.
There are a number of products available to help
you stay dry, secure and comfortable.
These include:
• disposable or reusable pads.
• pants.
• liners.
• absorbent underclothing.
• mattress protectors.
• water resistant doona covers and bed sheets.
You can buy some of these products at your
local supermarket, chemist or specialist retailer.
For more significant problems, you may need to
go to (or phone) a medical supply company.
Phone the National Continence Helpline (1800 33 00 66) to find out where your nearest
medical supply company is. This helpline can
also tell you about the Continence Aids Payment
Scheme, a program for people who have
permanent and severe problems with bladder or
bowel control. The scheme helps by paying for
some of the cost of these aids.
What else can I do?
• Work with your treating team to develop a
continence management plan for your stay in
hospital and for any help you need when you
leave hospital.
• Before you leave hospital make sure you:
1.receive some education about managing
your incontinence.
2.learn how to access any continence aids you
need.
3.find out whether you need any follow
up appointments regarding your
incontinence.
• Let your family know you are having
difficulties. They may be able to help
you when needed. It can be difficult
talking about bladder problems because
it is a personal, sensitive and possibly
embarrassing issue. However it is
important that you share the problem. This
means you get all the help you can.
• Have a good diet with lots of fruit and
vegetables. A dietitian can help you get the
right balance of fibre and fluid in your diet.
If you increase the fibre in your diet make
sure you increase the fluid that you drink
too. See the Diet after stroke fact sheet for
more information.
• Drink up to 8-10 cups of fluid a day (water
is best). This can help stop bladder irritation
and make it easier to pass faeces. How
much you need to drink will increase with
hotter weather and more exercise. Check
with your doctor about the appropriate
amount of fluid for you.
• Try to reduce your intake of drinks that
make you need to go to the toilet more
often. These might include, coffee, tea,
chocolate drinks, cola drinks, alcoholic
drinks and high sugar/high caffeine ‘sports’
drinks.
• Get as much exercise as you can. A
physiotherapist can help you with an
exercise program that suits your needs.
It’s a good idea to check with your doctor
before beginning an exercise program. See
the Movement and exercise after stroke fact
sheet for more information.
• Wear clothing that can be undone quickly.
Swap buttons for velcro fasteners or wear
pants with elastic waistbands.
• Set up your toilet and/or bathroom so you
can get in quickly and safely. Use non-slip
mats.
Fact Sheet | Incontinence after stroke
For more information:
Talk to your stroke team or general practioner.
Continence Foundation Australia
StrokeLine 1800 STROKE (787 653) www.strokefoundation.com.au
The national peak body for continence
management, promotion and advocacy.
www.continence.org.au
National Continence Helpline 1800 33 00 66
Continence Nurse Advisors provide information
about bowel and bladder products, and local
continence clinics across Australia.
Bladder and Bowel website
Australian Government, Department of Health and
Ageing provides information and advice on the
prevention and management of bladder control
and bowel problems.
www.bladderbowel.gov.au
National Stroke Foundation
National Office
Level 7, 461 Bourke Street
Melbourne VIC 3000
Phone: +61 3 9670 1000
Email: [email protected]
www.strokefoundation.com.au
We have offices in Brisbane, Sydney, Hobart and Perth.
Toilet maps from the National Continence
Helpline or www.toiletmap.gov.au
To help you plan outings without worrying that you
will not be able to find a toilet when you need one.
Continence Foundation of Australia
National Continence Helpline 1800 33 00 66 Email: [email protected] www.continence.org.au
Call StrokeLine 1800 STROKE (787 653)
Proudly supported by Allergan Australia P/L.
For a complete list of fact sheets, visit our online
library at www.strokefoundation.com.au
© National Stroke Foundation. This fact sheet was developed by the
National Stroke Foundation together with Continence Foundation of
Australia. FS010_May2012
Printed on 100% post-consumer recycled paper.
Fact Sheet | Incontinence after stroke