Document Detail

Causes of urinary incontinence after acute hemispheric stroke.
MedLine Citation:
PMID:  8446973     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: We prospectively studied bladder function in stroke patients to determine the mechanisms responsible for poststroke urinary incontinence. METHODS: Fifty-one patients with recent unilateral ischemic hemispheric stroke admitted to a neurorehabilitation unit were enrolled. The presence of urinary incontinence was correlated with infarct location, neurological deficits, and functional status. Urodynamic studies were performed on all incontinent patients. RESULTS: Nineteen patients (37%) were incontinent. Incontinence was associated with large infarcts, aphasia, cognitive impairment, and functional disability (p < 0.05) but not with age, sex, side of stroke, or time from stroke to entry in the study. Urodynamic studies, performed on all 19 incontinent patients, revealed bladder hyperreflexia in 37%, normal studies in 37%, bladder hyporeflexia in 21%, and detrusor-sphincter dyssynergia in 5%. All of the patients with normal urodynamic studies were aphasic, demented, or severely functionally impaired. All of the patients with hyporeflexic bladders had underlying diabetes or were taking anticholinergic medications. Forty-six percent of incontinent patients treated with scheduled voiding alone were continent at discharge compared with 17% of patients treated pharmacologically. CONCLUSIONS: There are three major mechanisms responsible for poststroke urinary incontinence: 1) disruption of the neuromicturition pathways, resulting in bladder hyperreflexia and urgency incontinence; 2) incontinence due to stroke-related cognitive and language deficits, with normal bladder function; and 3) concurrent neuropathy or medication use, resulting in bladder hyporeflexia and overflow incontinence. Urodynamic studies are of benefit in establishing the cause of incontinence. Scheduled voiding is a useful first-line treatment in many cases of incontinence.
D A Gelber; D C Good; L J Laven; S J Verhulst
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  24     ISSN:  0039-2499     ISO Abbreviation:  Stroke     Publication Date:  1993 Mar 
Date Detail:
Created Date:  1993-04-02     Completed Date:  1993-04-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  378-82     Citation Subset:  IM    
Division of Neurology, Southern Illinois University School of Medicine, Springfield 62794-9230.
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MeSH Terms
Cerebrovascular Disorders / complications*
Cognition Disorders / complications
Diabetes Complications
Neural Pathways / physiopathology*
Parasympatholytics / adverse effects
Prospective Studies
Urinary Bladder / physiopathology*
Urinary Incontinence / etiology*
Reg. No./Substance:

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