Urinary Incontinence After Stroke: Causes and Solutions

Urinary incontinence after a stroke?

Hello, Dr.
Hsu.
My mother is 67 years old and was recently hospitalized due to a minor stroke, where she was found to have hypertension.
She is currently on a long-term regimen of antihypertensive medication, and her physical and mental state is unchanged from before.
However, after her discharge, she has been experiencing frequent coughing fits that have led to urinary incontinence.

I have several questions:
1.
Is there a direct relationship between hypertension and urinary incontinence?
2.
I have heard that many antihypertensive medications contain diuretic components; could this be causing her urinary incontinence, or is there another reason?
3.
Are there any strategies for improving urinary incontinence in adults? What is the likelihood of recovery?
4.
Is frequent coughing a common symptom in the elderly? Are there any methods to improve this condition?
5.
Does urinary incontinence in adults serve as a warning sign or precursor for dementia in the elderly? If so, how can it be prevented?
I apologize that these questions are not purely urological, but I appreciate your attention to them.
Thank you! Wishing you peace and happiness.

Qiúzhù zhě, 40~49 year old female. Ask Date: 2002/09/16

Dr. Xu Wencang reply Urology

Hello, in response to your question regarding your mother's symptoms, she is experiencing stress urinary incontinence.
Normally, the bladder is supported by the pelvic fascia, but after childbirth, this fascia can become lax, causing the bladder to descend when straining, which prevents the sphincter from functioning properly and leads to urinary incontinence.
Another cause can be the loss of contraction ability of the pelvic floor muscles, which can also result in stress urinary incontinence.
Generally, antihypertensive medications do not worsen urinary incontinence, except for medications like Doxazosin, which are used to treat benign prostatic hyperplasia and can relax the sphincter, exacerbating incontinence.
Diuretics do not affect bladder function, but if the bladder's capacity to store urine increases, it can easily lead to coughing and result in urinary incontinence.

Treatment for stress urinary incontinence can be divided into three areas: first, pelvic floor muscle training, also known as Kegel exercises, which strengthen the pelvic muscles to support the bladder; second, pharmacological treatment, which increases the resistance of the sphincter and improves incontinence; and for severe cases, surgical intervention may be necessary.
Since your mother's urinary incontinence is not severe, improving her cough is also a potential treatment approach.
It would be advisable to consult a neurologist to check for any swallowing difficulties that may have arisen post-stroke.
Dementia can exacerbate urinary incontinence, but incontinence is not necessarily a precursor to dementia.
The scope of urinary disorders and incontinence is quite broad, and further examination may be required.

Reply Date: 2002/09/16

More Info

Urinary incontinence, particularly following a stroke, can be a complex issue influenced by various factors, including neurological impairment, medication side effects, and underlying health conditions. Let's address your questions systematically.

1. Is there a direct relationship between hypertension and urinary incontinence?
Hypertension itself does not directly cause urinary incontinence; however, the medications used to manage high blood pressure can have side effects that may contribute to urinary issues. Additionally, the physiological changes associated with aging and hypertension can affect bladder control. For instance, the vascular changes in the body due to long-standing hypertension can lead to changes in bladder function.

2. Do antihypertensive medications contribute to urinary incontinence?
Some antihypertensive medications, particularly diuretics, can lead to increased urine production and frequency, which may exacerbate urinary incontinence. Diuretics work by promoting the excretion of water and salts from the body, which can lead to more frequent urination. If your mother is on such medication, it may be beneficial to discuss with her healthcare provider whether adjustments can be made to her treatment plan to minimize this side effect.

3. Are there strategies for improving adult urinary incontinence? What is the likelihood of recovery?
Yes, there are several strategies to manage and potentially improve urinary incontinence in adults. These include:
- Pelvic floor exercises (Kegel exercises): Strengthening the pelvic floor muscles can help improve bladder control.

- Bladder training: This involves scheduling bathroom visits and gradually increasing the time between them to train the bladder to hold more urine.

- Lifestyle modifications: Reducing caffeine and alcohol intake, maintaining a healthy weight, and managing fluid intake can also help.

- Medications: There are medications available that can help manage symptoms of urinary incontinence.

- Physical therapy: A physical therapist specializing in pelvic health can provide tailored exercises and strategies.

The likelihood of improvement varies based on the underlying cause of the incontinence, the individual's overall health, and adherence to treatment strategies. Many individuals experience significant improvement with appropriate interventions.

4. Is frequent coughing and choking a common symptom in older adults? Are there ways to improve this?
Yes, frequent coughing and choking can be common in older adults, often due to age-related changes in swallowing and respiratory function. This can be exacerbated by conditions such as stroke, which may affect coordination and muscle control. To improve this, consider:
- Swallowing therapy: A speech-language pathologist can provide exercises and strategies to improve swallowing safety and efficiency.

- Diet modifications: Soft foods and thickened liquids may help reduce choking risks.

- Postural adjustments: Sitting upright while eating and drinking can help minimize choking incidents.

5. Is urinary incontinence a warning sign of dementia in older adults? How can it be prevented?
While urinary incontinence can be associated with cognitive decline and conditions such as dementia, it is not a definitive warning sign. It can occur due to various factors, including physical health issues, medication side effects, or neurological conditions. Preventative measures include:
- Regular health check-ups: Monitoring and managing chronic conditions like hypertension and diabetes can help maintain overall health.

- Cognitive engagement: Keeping the mind active through social interactions, puzzles, and learning can help reduce the risk of cognitive decline.

- Physical activity: Regular exercise can improve overall health and potentially reduce the risk of cognitive impairment.

In conclusion, urinary incontinence following a stroke can be multifactorial, and addressing it often requires a comprehensive approach involving medical management, lifestyle changes, and possibly rehabilitation. It is crucial to maintain open communication with healthcare providers to tailor a management plan that best suits your mother's needs.

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