Skip to main content

Advertisement

Log in

Managing of Lower Urinary Tract Dysfunction Following Stroke

  • Overactive Bladder and Lower Urinary Tract Symptoms (U Lee and S Adelstein, Section Editors)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This comprehensive up-to-date review will synthesise relevant available literature on the topic of post-stroke lower urinary tract dysfunction (LUTD). Topics include epidemiology of LUTD, LUTD as a prognostic indicator for stroke recovery, urinary incontinence and retention, correlations between brain lesion localisation and LUTD, causes of LUTD, medical complications due to LUTD, diagnostics and contemporary management of LUTD in stroke patients.

Recent Findings

LUTD frequently occurs after a stroke and is associated with poor overall functional outcome, increased institutionalisation and mortality rates. The predominant symptoms are urinary frequency, urgency and urge incontinence. In the urodynamic findings, detrusor overactivity is predominant and detrusor underactivity is somewhat less prevalent. LUTD is correlated with the size and site of the brain lesion, and the presence of cognitive, motor, sensory, vision impairment and aphasia. There are multiple aetiologies for LUTD and the treatment usually includes continence aids, behavioural, pharmacological and surgical measures. A variety of behavioural therapeutic interventions is described in the literature, including bladder training and pelvic floor muscle training, but the evidence of the effectiveness is still sparse.

Summary

LUTD after a stroke remains under-recognised, poorly addressed and there is still a lack of clinical practice guidelines available in the literature. At the moment, a structured clinical assessment and the use of a multimodal treatment approach that includes a systematic voiding programme with the participation of all team members is recommended. In the future, additional evidence-based research should be performed to evaluate the effectiveness of various therapeutic approaches.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. de Groat WC, Griffiths D, Yoshimura N. Neural control of the lower urinary tract. Compr Physiol. 2015;5:327–96.

    PubMed  PubMed Central  Google Scholar 

  2. Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci. 2008;9:453–66.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Gross JC. Bladder dysfunction after stroke. Urol Nurs. 1992;12:55–63.

    PubMed  CAS  Google Scholar 

  4. Ween JE, Alexander MP, D'Esposito M, Roberts M. Incontinence after stroke in a rehabilitation setting: outcome associations and predictive factors. Neurology. 1996;47:659–63.

    Article  PubMed  CAS  Google Scholar 

  5. van Kuijk AA, van der Linde H, van Limbeek J. Urinary incontinence in stroke patients after admission to a postacute inpatient rehabilitation program. Arch Phys Med Rehabil. 2001;82:1407–11.

    Article  PubMed  Google Scholar 

  6. Kolominsky-Rabas PL, Hilz MJ, Neundoerfer B, Heuschmann PU. Impact of urinary incontinence after stroke: results from a prospective population-based stroke register. Neurourol Urodyn. 2003;22:322–7.

    Article  PubMed  Google Scholar 

  7. Kong KH, Young S. Incidence and outcome of poststroke urinary retention: a prospective study. Arch Phys Med Rehabil. 2000;81:1464–7.

    Article  PubMed  CAS  Google Scholar 

  8. Patel M, Coshall C, Rudd AG, Wolfe CDA. Natural history and effects on 2-years outcomes of urinary incontinence after stroke. Stroke. 2001;32:122–7.

    Article  PubMed  CAS  Google Scholar 

  9. Borrie MJ, Campbell AJ, Caradoc-Davies TH, et al. Urinary incontinence after stroke: a prospective study. Age Ageing. 1986;15:177–81.

    Article  PubMed  CAS  Google Scholar 

  10. Marinkovic SP, Badlani G. Voiding and sexual dysfunction after cerebrovascular accidents. J Urol. 2001;165:359–70.

    Article  PubMed  CAS  Google Scholar 

  11. •• John G, Bardini C, Mégevand P, et al. Urinary incontinence as a predictor of death after new-onset stroke: a meta-analysis. Eur J Neurol. 2016;23:1548–55. This meta-analysis study showed that urinary incontinence indicates high risk of death after a new-onset stroke.

    Article  PubMed  CAS  Google Scholar 

  12. Nakayama H, Jørgensen HS, Pedersen PM, et al. Prevalence and risk factors of incontinence after stroke. The Copenhagen stroke study. Stroke. 1997;28:58–62.

    Article  PubMed  CAS  Google Scholar 

  13. •• John G, Primmaz S, Crichton S, et al. Urinary incontinence and indwelling urinary catheters as predictors of death after new-onset stroke: a report of the south London stroke register. J Stroke Cerebrovasc Dis. 2018;27:118–24. This prospective observation study observed that urinary incontinence and urinary catheters within the first week after the stroke were associated with 1-year mortality.

    Article  PubMed  Google Scholar 

  14. Taub NA, Wolfe CD, Richardson E, Burney PG. Predicting the disability of first-time stroke sufferers at 1 year. 12-month follow-up of a population-based cohort in southeast England. Stroke. 1994;25:352–7.

    Article  PubMed  CAS  Google Scholar 

  15. •• Son SB, Chung SY, Kang S, et al. Relation of urinary retention and functional recovery in stroke patients during rehabilitation program. Ann Rehabil Med. 2017;41:204–10. This study investigated significant relationship between urinary retention and poor functional status in post-stroke patients.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Divani AA, Vazquez G, Barrett AM, Asadollahi M, Luft AR. Risk factors associated with injury attributable to falling among elderly population with history of stroke. Stroke. 2009;40:3286–92.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Dumoulin C, Korner-Bitensky N, Tannenbaum C. Urinary incontinence after stroke: does rehabilitation make a difference? A systematic review of the effectiveness of behavioral therapy. Top Stroke Rehabil. 2005;12:66–76.

    Article  PubMed  Google Scholar 

  18. Mehdi Z, Birns J, Bhalla A. Post-stroke urinary incontinence. Int J Clin Pract. 2013;67:1128–37.

    Article  PubMed  CAS  Google Scholar 

  19. Brittain KR, Peet SM, Castleden CM. Stroke and incontinence. Stroke. 1998;29:524–8.

    Article  PubMed  CAS  Google Scholar 

  20. Tibaek S, Gard G, Klarskov P, Iversen HK, Dehlendorff C, Jensen R. Prevalence of lower urinary tract symptoms (LUTS) in stroke patients: a cross-sectional, clinical survey. Neurourol Urodyn. 2008;27:763–71.

    Article  PubMed  Google Scholar 

  21. Kohler M, Mayer H, Kesselring J, Saxer S. (Can) not talk about it—urinary incontinence from the point of view of stroke survivors: a qualitative study. Scand J Caring Sci. 2018;32:371–9.

    Article  PubMed  Google Scholar 

  22. Brady MC, Jamieson K, Bugge C, Hagen S, McClurg D, Chalmers C, et al. Caring for continence in stroke care settings: a qualitative study of patients’ and staff perspectives on the implementation of a new continence care intervention. Clin Rehabil. 2016;30:481–94.

    Article  PubMed  CAS  Google Scholar 

  23. Shy M, Fung S, Boone TB, Karmonik C, Fletcher SG, Khavari R. Functional magnetic resonance imaging during urodynamic testing identifies brain structures initiating micturition. J Urol. 2014;192:1149–54.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Zhang H, Reitz A, Kollias S, Summers P, Curt A, Schurch B. An fMRI study of the role of suprapontine brain structures in the voluntary voiding control induced by pelvic floor contraction. Neuroimage. 2005;24:174–80.

    Article  PubMed  Google Scholar 

  25. Feder M, Heller L, Tadmor R, Snir D, Solzi P, Ring H. Urinary continence after stroke: association with cystometric profile and computerised tomography findings. Eur Neurol. 1987;27:101–5.

    Article  PubMed  CAS  Google Scholar 

  26. Linsenmeyer TA. Post-CVA voiding dysfunctions: clinical insights and literature review. NeuroRehabilitation. 2012;30:1–7.

    PubMed  Google Scholar 

  27. Han KS, Heo SH, Lee SJ, Jeon SH, Yoo KH. Comparison of urodynamics between ischemic and hemorrhagic stroke patients; can we suggest the category of urinary dysfunction in patients with cerebrovascular accident according to type of stroke? Neurourol Urodyn. 2010;29:387–90.

    PubMed  Google Scholar 

  28. Sakakibara R, Hattori T, Yasuda K, Yamanishi T. Micturitional disturbance after acute hemispheric stroke: analysis of the lesion site by CT and MRI. J Neurol Sci. 1996;137:47–56.

    Article  PubMed  CAS  Google Scholar 

  29. Burney TL, Senapati M, Desai S, et al. Acute cerebrovascular accident and lower urinary tract dysfunction: a prospective correlation of the site of brain injury with urodynamic findings. J Urol. 1996;156:1748–50.

    Article  PubMed  CAS  Google Scholar 

  30. Shukla R, Giri P, Bhandari A, et al. Pontine stroke and bladder dysfunction. BMJ Case Rep. 2014;2014

  31. Sung SM, Shin JY, Cho KY, Kang TH, Cho HJ. Bladder storage disorder due to detrusor overactivity in a patient with acute medial medullary infarction. J Neurol Sci. 2015;357:307–9.

    Article  PubMed  Google Scholar 

  32. • Chou YC, Jiang YH, Harnod T, et al. Characteristics of neurogenic voiding dysfunction in cerebellar stroke: a cross-sectional, retrospective video urodynamic study. Cerebellum. 2013;12:601–6. This study reports video urodynamic findings of 15 patients with cerebellar stroke.

    Article  PubMed  Google Scholar 

  33. Khan Z, Hertanu J, Yang WC, Melman A, Leiter E. Predictive correlation of urodynamic dysfunction and brain injury after cerebrovascular accident. J Urol. 1981;126:86–8.

    Article  PubMed  CAS  Google Scholar 

  34. Gupta A, Taly AB, Srivastava A, et al. Urodynamics post stroke in patients with urinary incontinence: is there correlation between bladder type and site of lesion? Ann Indian Acad Neurol. 2009;12:104–7.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Gelber DA, Good DC, Laven LJ, Verhulst SJ. Causes of urinary incontinence after acute hemispheric stroke. Stroke. 1993;24:378–82.

    Article  PubMed  CAS  Google Scholar 

  36. Leandro TA, Araujo TL, Cavalcante TF, Lopes MV, Oliveira TM, Lopes AC. Nursing diagnoses of urinary incontinence in patients with stroke. Rev Esc Enferm USP. 2015;49:924–32.

    Article  PubMed  Google Scholar 

  37. Natsume O. Detrusor contractility and overactive bladder in patients with cerebrovascular accident. Int J Urol. 2008;15:505–10.

    Article  PubMed  Google Scholar 

  38. Pettersen R, Haig Y, Nakstad PH, Wyller TB. Subtypes of urinary incontinence after stroke: relation to size and location of cerebrovascular damage. Age Ageing. 2008;37:324–7.

    Article  PubMed  Google Scholar 

  39. Barrett JA. Bladder and bowel problems after a stroke. Rev Clin Gerontol. 2002;12:253–67.

    Article  Google Scholar 

  40. Olsen-Vetland P. Urinary continence after a cerebrovascular accident. Nurs Stand. 2003;17:37–41.

    Article  PubMed  Google Scholar 

  41. Reding M, Winter S, Hochrein S, et al. Urinary incontinence after unilateral hemispheric stroke: a neurologic-epidemiologic perspective. J Neurol Rehabil. 1987;1:25–30.

    Google Scholar 

  42. Brittain KR, Perry SI, Peet SM, Shaw C, Dallosso H, Assassa RP, et al. Prevalence and impact of urinary symptoms among community-dwelling stroke survivors. Stroke. 2000;31:886–91.

    Article  PubMed  CAS  Google Scholar 

  43. •• Williams MP, Srikanth V, Bird M, et al. Urinary symptoms and natural history of urinary continence after first-ever stroke—a longitudinal population-based study. Age Ageing. 2012;41:371–6. This population-based study identified the prevalence of urinary symptoms, the natural history and factors associated with urinary incontinence after a stroke.

    Article  PubMed  Google Scholar 

  44. Coleman Gross J. Urinary incontinence after stroke evaluation and behavioral treatment. Top Geriatr Rehabil. 2003;19:60–83.

    Article  Google Scholar 

  45. Stott DJ, Falconer A, Miller H, Tilston JC, Langhorne P. Urinary tract infection after stroke. QJM. 2009;102:243–9.

    Article  PubMed  CAS  Google Scholar 

  46. Verhamme KM, Sturkenboom MC, Stricker BH, et al. Drug-induced urinary retention: incidence, management and prevention. Drug Saf. 2008;31:373–88.

    Article  PubMed  CAS  Google Scholar 

  47. Tsakiris P, Oelke M, Michel MC. Drug-induced urinary incontinence. Drugs Aging. 2008;25:541–9.

    Article  PubMed  CAS  Google Scholar 

  48. Thomas LH, Cross S, Barrett J, et al. Treatment of urinary incontinence after stroke in adults. Cochrane Database Syst Rev. 2008;1:CD004462.

    Google Scholar 

  49. Booth J, Kumlien S, Zang Y, Gustafsson B, Tolson D. Rehabilitation nurses practices in relation to urinary incontinence following stroke: a cross-cultural comparison. J Clin Nurs. 2009;18:1049–58.

    Article  PubMed  Google Scholar 

  50. Jordan LA, Mackey E, Coughlan K, Wyer M, Allnutt N, Middleton S. Continence management in acute stroke: a survey of current practices in Australia. J Adv Nurs. 2011;67:94–104.

    Article  PubMed  Google Scholar 

  51. Sayed W, Adhiyaman V, Chattopadhyay I. Urinary retention after stroke. Neurology. 2008;38:377–80.

    Google Scholar 

  52. Selius BA, Subedi R. Urinary retention in adults: diagnosis and initial management. Am Fam Physician. 2008;77:643–50.

    PubMed  Google Scholar 

  53. Lum SK, Marshall VR. Results of prostatectomy in patients following a cerebrovascular accident. Br J Urol. 1982;54:186–9.

    Article  PubMed  CAS  Google Scholar 

  54. Dumoulin C, Korner-Bitensky N, Tannenbaum C. Urinary incontinence after stroke: identification, assessment, and intervention by rehabilitation professionals in Canada. Stroke. 2007;38:2745–51.

    Article  PubMed  Google Scholar 

  55. Schnelle JF. Treatment of urinary incontinence in nursing home patients by prompted voiding. J Am Geriatr Soc. 1990;38:356–60.

    Article  PubMed  CAS  Google Scholar 

  56. Tibaek S, Gard G, Jensen R. Pelvic floor muscle training is effective in women with urinary incontinence after stroke: a randomised, controlled and blinded study. Neurourol Urodyn. 2005;24:348–57.

    Article  PubMed  Google Scholar 

  57. • Tibaek S, Gard G, Dehlendorff C, Iversen HK, Biering-Soerensen F, Jensen RI. Pelvic floor muscle training effective for men with poststroke lower urinary tract symptoms? A single-blinded randomized, controlled trial. Am J Mens Health. 2017;11:1460–71. This study evaluated the positive effect of pelvic floor muscle training in men with poststroke lower urinary tract symptoms.

    Article  PubMed  Google Scholar 

  58. Wikander B, Ekelund P, Milsom I. An evaluation of multidisciplinary intervention governed by functional independence measure (FIMSM) in incontinent stroke patients. Scand J Rehabil Med. 1998;30:15–21.

    Article  PubMed  CAS  Google Scholar 

  59. McKenzie P, Badlani GH. The incidence and etiology of overactive bladder in patients after cerebrovascular accident. Curr Urol Rep. 2012;13:402–6.

    Article  PubMed  Google Scholar 

  60. Liu Y, Liu L, Wang X. Electroacupuncture at points Baliao and Huiyang (BL35) for post-stroke detrusor overactivity. Neural Regen Res. 2013;8:1663–72.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nataša Bizovičar.

Ethics declarations

Conflict of Interest

Nataša Bizovičar declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Overactive Bladder and Lower Urinary Tract Symptoms

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bizovičar, N. Managing of Lower Urinary Tract Dysfunction Following Stroke. Curr Bladder Dysfunct Rep 13, 125–131 (2018). https://doi.org/10.1007/s11884-018-0472-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-018-0472-5

Keywords

Navigation