3. Practical advice and tips for carers > Continence problems

Continence problems

1) Introduction

Continence is a learned ability to control our bladder and bowel functions.

About half of all stroke patients will experience some temporary bladder incontinence and 15% may go on to have further problems which require longer term treatment and management. A much smaller proportion of patients will have bowel incontinence which will require treatment or management.

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Continence problems can be caused for a variety of reasons.

  • Functional – not being able to get to the toilet or being unable to manage clothing one handed.If the person has a communication problem they may not be able to let others know when they need to go. Usually as the person improves in other areas of their stroke such as their walking, balance or dressing this functional incontinence problem improves
  • Night time – the person may be unaware when they are passing urine in their sleep.
  • Urgency – changes in the bladder may mean the person feels the urge to pass urine suddenly.
  • Frequency – the person may feel they have to pass urine more often.
  • Overflow - if the person cannot feel when the bladder is full, it may leak under pressure.
  • Damaged area in the brain – messages are sent from the brain to control when to urinate. If these messages are blocked or missing the person may be incontinent.
  • Muscles in the bladder and pelvis - these muscles may be weaker after a stroke.
  • Perception or cognition – if the person has difficulty seeing and recognising the environment or is having difficulty working out or thinking through problems they could have difficulty locating the nearest bathroom.

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Continence problems can be caused for a variety of reasons.

  • Functional – not being able to get to the toilet or being unable to manage clothing one handed. If the person has a communication problem they may not be able to let others know when they need to go. Usually as the person improves in other areas of their stroke such as their walking, balance or dressing this functional incontinence problem improves.
  • Night time – the person may be unaware when they are passing urine in their sleep.
  • Urgency – changes in the bladder may mean the person feels the urge to pass urine suddenly.
  • Frequency – the person may feel they have to pass urine more often.
  • Overflow – if the person cannot feel when the bladder is full, it may leak under pressure.
  • Damaged area in the brain – messages are sent from the brain to control when to urinate. If these messages are blocked or missing the person may be incontinent.
  • Muscles in the bladder and pelvis – these muscles may be weaker after a stroke.
  • Perception or cognition – if the person has difficulty seeing and recognising the environment or is having difficulty working out or thinking through problems they could have difficulty locating the nearest bathroom.