Surviving a stroke or cerebrovascular accident (CVA) is a profound and life-altering experience, usually accompanied by a host of physical and emotional challenges. According to a Centers for Disease Control and Prevention (CDC) fact sheet, around 800,000 people in the US suffer a CVA every year. Another CDC study shows, as expected, that CVA risk increases substantially with age. In the 18 to 44 age group, the prevalence is less than 1%, rising to 3.8% in the 45 to 64 age group and almost 8% for over 65s.  

The prevalence of urinary incontinence is also skewed substantially towards older people, particularly women over 50. Depending on definitions, incontinence is estimated to affect up to 50% of women up to the age of 65 and even more of those over 65. In men, the pattern is similar, albeit with a much lower overall incidence. 

Although there is, thankfully, a relatively low likelihood of a person suffering a CVA while also experiencing incontinence, this probability increases exponentially in those over 65. And, of course, the stroke could actually trigger incontinence. This article discusses this troublesome duo, the compounded consequences of their co-existence, and strategies for overcoming or managing them. 

Understanding the Link Between Stroke and Incontinence

A CVA disrupts the flow of blood to the brain and, in most cases, causes a degree of brain damage. This may impair the brain's ability to control various bodily functions, including bladder control, resulting in incontinence. The type and severity of incontinence depend on the location and extent of brain damage caused by the stroke.

Types of Incontinence Common After a Stroke

1. Urge Incontinence
    This is the most prevalent form of incontinence among stroke survivors, characterized by a sudden and uncontrollable need to urinate. It occurs due to damage to the brain regions responsible for bladder signaling, leading to overactive bladder muscles.
2. Functional Incontinence
    Functional incontinence happens when physical or cognitive impairments, such as paralysis or memory loss, prevent timely access to a bathroom.
3. Overflow Incontinence
    This type occurs when the bladder fails to empty completely, leading to frequent dribbling or leakage. Stroke-induced nerve damage can impair the bladder's ability to contract fully.

The Compounded Impact of Stroke and Incontinence

Recovering from a CVA is, for some, an extremely challenging journey. However, when incontinence manifests as a consequence of a CVA, or if a person is already suffering from incontinence, the road to recovery becomes so much tougher.

1. Physical Challenges

The vast majority of stroke survivors will experience some impairment of mobility, such as paralysis, weakened muscles or balance disturbances. This may make it difficult to reach a bathroom in time, aggravating incontinence issues. In addition, bladder dysfunction can increase the risk of urinary tract infections (UTIs), which are twice as common in stroke patients with incontinence than in those without 

2. Emotional and Psychological Strain

The combination of incontinence and stroke-related disabilities can be deeply distressing. Estimates of the incidence of depression or anxiety among stroke survivors with incontinence vary significantly due to differences in study methodology, but a range of 30–50% is commonly reported. This is driven by feelings of embarrassment or the loss of independence or control over their bodies.

3. Social Isolation

The stigma associated with incontinence often discourages survivors from participating in social activities, compounding the isolation many feel after a CVA. Fear of accidents or the inability to find accessible facilities can also limit outings and interactions.

4. Financial Burden

Incontinence management adds to the already significant cost of stroke rehabilitation. Expenses for absorbent pads, medications, and frequent medical consultations can become overwhelming, especially for families facing ongoing therapy or care costs.

Treatment Options 

While there are significant similarities in therapy strategies for stroke and incontinence, the overall incontinence treatment regimen still requires a multidisciplinary approach, addressing both neurological recovery and bladder health.

1. Medical Interventions

• Medications
  • Anticholinergics are commonly prescribed to treat overactive bladder by calming the bladder muscles. However, they should be used with extreme caution in stroke patients, as they can cause various adverse side effects, including an increased risk of stroke.
  • Alpha-blockers help relax the bladder neck and improve urine flow, particularly in cases of overflow incontinence. They can also aid in stroke recovery, but there are potential downsides to look out for. 
• Neuromodulation
   Techniques like sacral nerve stimulation involve implanting a device that sends electrical impulses to nerves controlling the bladder, improving function. Certain neuromodulation techniques can reduce spasticity and improve nerve and motor function.  

2. Physical and Occupational Therapy

• Pelvic Floor Rehabilitation
   Targeted exercises such as Kegels strengthen the muscle structure supporting the bladder, reducing the severity of incontinence. Strengthening the core also helps stroke victims improve balance and stability. Biofeedback devices can enhance the effectiveness of these exercises.
• Mobility Training
   Occupational therapists can work with stroke survivors to improve mobility, making it easier to access bathrooms in time. Strategies include using assistive devices like walkers or grab bars.

3. Behavioral and Lifestyle Changes

• Bladder Training
   Scheduled voiding and progressively increasing the time between urination can help retrain the bladder.
• Dietary Adjustments
   Avoiding bladder irritants such as caffeine, alcohol, and spicy foods can reduce urgency. Adequate hydration is essential to prevent concentrated urine, which can irritate the bladder.
• Managing Constipation
   Constipation can aggravate incontinence by increasing pressure on the bladder. A high-fiber diet combined with hydration can alleviate this issue.

Coping Strategies

Recovering from a stroke and dealing with incontinence at the same time is a challenge that requires grit and determination. It’s a battle that few people will be able to fight without support. 

• Seek Professional Support
  Web-based support groups like the American Stroke Association provide comprehensive information about strokes, links to caregiver support resources, financial support and more. Community groups offer opportunities to share experiences and to engage socially to ward off feelings of isolation and the risk of mental health issues.
• Use Adaptive Aids
   Thanks to modern technology, the market offers numerous assistive devices and products to help make life more manageable for people recovering from a CVA or experiencing incontinence. The downside is that with all the options available, selecting the right products can be daunting.

At LL Medico, we have been in the senior care products market for 30 years. Our experience has allowed us to build up a comprehensive range of the best-quality products at competitive prices. We’ll gladly discuss your needs in adult diapers, mobility aids and other home and bath safety and comfort devices. Call us today at (855) 422-4556 or email support@llmedico.com. From 9 am to 5 pm EST, Monday to Friday, you can also chat with us online.       

Conclusion

Living with incontinence in the aftermath of a CVA presents a unique set of compounded challenges. It’s important to remember that, with the appropriate recuperative and management strategies, you can overcome this adversity. As Maya Angelou famously said, "You may not control all the events that happen to you, but you can decide not to be reduced by them."  While health challenges may sometimes shape your journey, they need not define your destination.