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Stroke

Definition

Stroke, also called cerebrovascular accident) is caused by a blockage of blood flow (a clot), or a haemorrhage in the brain, resulting in a sudden death of brain cells due to a lack of oxygen (1)

This results in a sudden death of brain cells due to a lack of oxygen. So, a person can have an embolic stroke or a haemorrhagic stroke and both can result in different degrees of severity, symptoms and outcomes (2)

Statistics

  • One in four people globally will have a stroke (3)  
  • Stroke kills more women than breast cancer and more men than prostate cancer (4) 
  • Sudden Onset
  • More common over 65 years (75%) (5)
  • Can be mild, moderate or significant

Australia

  • Around 27,428 people have a stroke each year (4)
  • 445,00 are living with the effects of stroke (6)
  • Equaling one stroke occurring every 19 minutes

New Zealand

  • Around 9,000 people have a stroke each year 50,000 people live with the consequences of stroke (7)

Why does incontinence occur?

With a stroke, incontinence is mainly caused by a disruption in the messages from the brain to the bladder or bowel, due to an interruption to blood flow3

If a stroke affects the brainstem and the pons due to reduced blood supply and oxygen, then incontinence may or will occur.

Not all strokes will result in incontinence, it depends on the severity of the stroke and where in the brain the stroke occurs. Incontinence can sometimes resolve over time.

“Urinary incontinence following stroke will affect more than 1/3 of acute stroke patients” (8)

“Urinary incontinence will persist in up to 1/4 of cases at one year post event” (8)

Common symptoms as disease advances

  • Weakness to one side of the body (hemiplegia)
  • Altered swallow- dysphagia
  • Altered speech- dysphasia
  • Cognitive changes - can be significant at onset but can improve/resolve or if a severe stroke can remain the same
  • Impaired gait
  • Impaired balance 
  • Dyspraxia
  • Decreased dexterity (9)

Type Inco EARLY disease

Symptoms can include:
  • urinary frequency
  • urinary urgency
  • urinary retention is common at onset and an IDC can be required 
  • initially
  • faecal incontinence 
  • functional incontinence is present with moderate to severe strokes due to physical, cognitive changes (comprehension, problem solving, memory and judgement) and vision changes (1)

Type Inco MODERATE disease to ADVANCED

The degree of urinary or faecal incontinence post stroke will be determined by the severity of the stroke and an individual’s response to rehabilitation.

An indwelling catheter may be necessary for some at onset, and for some months afterwards. For others, the urinary and/or faecal incontinence may settle quickly but cognitive and/or physical changes may persist.

References:

3 GBD 2016 Lifetime Risk of Stroke Collaborators, Feigin VL et al. Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016. N Engl J Med. 2018; 379(25):2429-2437.
4 Deloitte Access Economics. 2020. No postcode untouched, Stroke in Australia 2020.
6 [ [4] Australian Institute of Health and Welfare 2018. Australia’s health 2018. Australia’s health series no. 16. AUS 221. Canberra: AIHW.
8 Post‐stroke urinary incontinence; Z. Mehdi, J. Birns, A. Bhalla; 8 July 2013; https://doi.org/10.1111/ijcp.12183