Stroke

Continence problems after a stroke and cathererisation

Incontinence, the loss of control of the bladder or bowel, is extremely common after stroke. Whether this is caused by the stroke, or a consequence of poor continence care early after stroke, is unclear. Main instances of incontinence would be avoidable if there was comprehensive assessment of continence problems and early intervention to promote long term continence. Unfortunately, few clear guidelines exist, and many professionals do not know how to prevent incontinence. Nearly half of all people who have had a stroke experience some bladder incontinence in the weeks afterwards and a third will experience some loss of bowel control. Around 15% of people still have problems when they go home but can still get better afterwards (Stroke Association April 2012).

Many of the people we spoke to had difficulties with getting to the toilet when they were in hospital and had to use bed-pans, bottles or commodes which many found embarrassing or distressing (see 'Early care experiences'). 

Some of the people we talked to had a catheter - a tube to drain urine from the bladder - when they were in hospital or a care home after their stroke, although these days it is recommended that catheterisation should be avoided unless there are specific exceptional circumstances. One person who was in a care home after her stroke said that it was another nuisance because she had to learn how to attend to it every morning, although she got used to it and it was taken out after a while. A man whose catheter came out found it embarrassing when it was put in by a female doctor. 

Catherisation can increase the risk of urine infection which is very uncomfortable and can be life threatening. One person described the symptoms of urine infection after a catheter as needing to go to the toilet and feeling as if he were wetting himself which he felt was the lowest point of being in hospital. 

Another person who had an infection after a catheter was treated with antibiotics which gave her diarrhoea. She described this as worse than the stroke and it delayed her rehabilitation because it made her weak.

Another man's wife had noticed that his aggression was worse when he had a urine infection.

Overnight catheters could sometimes leak. One man explained that he occasionally lay on the tube which caused a leak. 

Around 1 in 7 people (15%) with a stroke are left with long-term continence problems (Stroke Association 2012). One of the people we spoke to was doubly incontinent after his stroke (having problems controlling urine and faeces) and was cared for at home by his wife. They explained that his bowel care was managed by medication to constipate him and a nurse who gave him an enema three times a week. They talked at length about the problem of infections with catheters, which they found did not occur when instead of having an internal catheter, he was able to use an externally worn sheath catheter (like a condom with a tube and drainage bag attached). 

One woman who cares for her mother after her stroke (who also has dementia) described that her mother's continence problems were the most upsetting aspect of her problems. Her mother uses continence pads which work well although she sometimes puts them the wrong way round.

For more information on catheters see our website on 'Living with a urinary catheter'. The Stroke Association also has a useful leaflet on Continence problems after stroke’ and so do Chest, Heart and Stroke Scotland.
 

Last reviewed June 2017.
Last updated June 2017.

 

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