Bladder and bowel problems after stroke

Bladder and bowel problems

A stroke often causes problems with bladder and bowel control. These usually improve in the early weeks after the stroke, but around a third of stroke survivors may have longer-term difficulties.

It is vital you seek treatment, because most bladder and bowel problems can be improved.

Tell a healthcare professional you are having difficulties. Keeping it hidden could mean missing out on treatment and support. Regaining control can improve your wellbeing and your recovery.

A stroke can affect bladder and bowel control through:

• Damage to brain cells
• Mobility and communication problems
• Constipation
• Medication
• Being immobile

View our guide, 'Bladder and bowel problems after stroke' for more information.

Treatments

Once the cause of your bladder or bowel problem has been found, you will be offered advice and treatment. These can include:

Treating bladder problems

• Drinking plenty of fluids. Strong, concentrated urine irritates your bladder. This makes feelings of urgency worse, can cause leakage and also bladder infections.
• Caffeine can also stimulate urine production so you may be advised to reduce your caffeine intake.
• Bladder training reduces urgency and frequency by gradually teaching your bladder to hold more urine. This is done by making regular visits to the toilet, and gradually extending the time between visits until your bladder learns how to ‘hold on’.
• Pelvic floor exercises help strengthen muscles so that they provide support. This will help improve bladder control and improve or stop leakage of urine.
• Electrical stimulation devices, which can be inserted in either the vagina or the anus to stimulate and strengthen the muscles that control the bladder.
• Using medication to reduce feelings of urgency and frequency, or reduce the amount of urine your body makes.
• Weight loss (if you are overweight) often improves bladder control in the longer term.
• Stopping smoking: coughing makes bladder leakage worse. Stopping smoking can help.

Treating bowel problems

• Bowel retraining involves regular visits to the toilet. This is usually after meals, when the bowels are stimulated to move by a natural reflex. You also learn to delay bowel movements once on the toilet to improve your ability to ‘hold on’.
• Pelvic floor exercises can strengthen the muscles that control bowel movement.
• Dietary changes such as eating more fibre.
• Medication: mainly laxatives to treat chronic constipation and impacted stool, which is the most common cause of leaking faeces. If you have true diarrhoea, medication can help. It is important you seek help to find out what is causing your bowel problem.
• Drinking more fluids helps soften the stools.
• Enema or bowel irrigation may be used to clear the bowel if faecal impaction occurs.

Which professionals can help me?

Bladder and bowel problems can be treated by a range of professionals, including doctors, nurses and therapists. Continence problems can affect all aspects of your life and your health, so you may need different types of help with your individual needs. You should get help to live well with continence problems.

Individual assessment and treatment

Your medical and nursing team will assess and treat your bladder and bowel problems. They should help you to understand the causes of your problems, and support you to make lifestyle changes and perform exercises and training to manage your bladder and bowel.

Continence advisors are specialist nurses who are trained to treat bladder and bowel problems. They will fully assess your individual needs and develop a plan with you that is tailored to your personal circumstances. Your GP can advise you and provide a referral. Your local health centre, or one of the organisations listed in our guide 'Bladder and bowel problems after stroke' can also help you to find a continence clinic.

You may need to see a specialist consultant, such as a urologist, gastroenterologist, gynaecologist or geriatrician. A GP referral will be needed for this.

Living well with incontinence

While it does involve extra thought and effort, with good advice and preparation, bladder and bowel problems can be managed discreetly as part of everyday life.

Planning ahead when you go out

Practical measures like planning access to toilets when you are out, and having a change of clothing and hygiene kit with you (which might include plastic bags for disposal or laundry, soap and flannel, anti-bacterial wet wipes and disposable gloves) will help you manage in any situation.

Find a routine that works for you

A daily routine of regular visits to the toilet, staying hydrated during the day and reducing the amount you drink just before bed time, will help to avoid accidents. An alarm can be used to schedule a visit to the toilet during the night, or you may prefer to try a moisture alarm on your bed, which will sound when wetness is detected. This is designed to wake you up so that you can finish emptying your bladder in the toilet.

Practical tips and equipment

There are various continence products available, such as absorbent pants and pads. Your GP or continence adviser will be able to tell you what is provided free of charge through your local NHS and what you can buy.

At home

Specialised products are prescribed by continence advisors or GPs. They include catheters, anal plugs, urine drainage bags and appliances for men.

Absorbent products can be purchased from supermarkets, pharmacies and by mail order or online. If you buy products from a chemist or by mail order, they can give you a form to sign so you do not pay VAT.

Keeping skin healthy

The moisture, friction and bacteria due to urine and faeces can cause skin rashes and infection. Careful hygiene and skin care are needed to avoid the risk of skin damage such as redness and blistering (incontinence-associated dermatitis).

If your skin is badly affected, an ‘indwelling’ catheter, in which the bag is attached to the leg and worn under clothing, may be recommended, though this is generally used only as a last resort. In some cases a suprapubic catheter, where the catheter is inserted into the bladder through the abdomen, may prove a more convenient method of permanent drainage. Your continence adviser should be able to explain your options.

Self-help tips

• Know your own bladder and bowel patterns and try to stick to your routine. Don’t go to the toilet ‘just in case’. Go when you feel the need to go.
• Remember to follow all the bladder and bowel training tips and exercises your nurse or continence adviser has given you. It takes time for the effects to show and perseverance does give results.
• Drink plenty of fluids during the day. This will help to avoid infections of the bladder and constipation. Try to have 6–8 glasses of fluid each day, and more if you have a catheter.
• Cut down on drinks which contain caffeine such as tea, coffee and cola, and avoid fizzy drinks as they can irritate the bladder. Alcoholic drinks can cause dehydration.
• Eat a balanced diet with plenty of fruit and vegetables. They contain valuable fibre, which helps bowel movements. Keep as active as you can. This can help to reduce bladder leakage and will help stimulate your bowel to move regularly.
• Try not to use the toilet unless you need to, and empty your bladder fully when you go. Sometimes sitting for longer can help to empty your bladder, or you could try standing up and sitting down again. This can also help to avoid infections.
• Wear clothes that are quick to remove, such as trousers with Velcro fastenings or elasticated waistbands.
• Carry a Just Can’t Wait card or download the Just Can’t Wait app, available free from the Bladder & Bowel Community website. A RADAR key is also available from the website and can help you gain fast access to public toilets.
• Take care of your skin by using mild soap or specialised products and take care to clean and dry thoroughly.
• Dispose of wet or soiled products safely. Ensure that disposal bags are secure and leak-proof, and use a bin with a lid.

Information guide

• Download Bladder and bowel problems after stroke guide (PDF)

Where to get help and information from the Stroke Association

Helpline
Call us on 0303 3033 100,from a textphone 1800 0303 3033 100
Email: helpline@stroke.org.uk
Our Helpline offers information and support for anyone affected by stroke, including family, friends and carers.

Read our information
Call the Helpline to ask for printed copies of our guides.

Other sources of help and information

Age UK Incontinence
Phone: 0800 046 1501
This incontinence advice and product ordering service are run as a business in association with Age UK. Sample packs of a wide range of products are available to order.

Bladder and bowel community
Email: help@bladderandbowel.org
Get in touch for information, support and a free 'Just can't wait' toilet card including access to a UK-wide directory of NHS and private continence services.

British Red Cross
Phone: 0344 871 1111
Local branches offer a short-term loan of equipment such as commodes.

DLF (Disabled Living Foundation)
Helpline: 0300 999 0004
Provides free, impartial and authoritative advice about equipment and resources to help with all aspects of daily living.

ERIC (Education and Resources for Improving Childhood Continence)
Helpline: 0808 169 9949
A national charity supporting children and young people, families and health professionals on childhood continence – bedwetting, daytime wetting, soiling and constipation, and potty training.

RADAR NKS Key
Email: enquiries@disabilityrightsuk.org
Coordinates the National Key Scheme for wheelchair-accessible toilets, supplying keys and a directory of over 9,000 toilets fitted with a RADAR lock at nominal cost.

NHS
A full overview of urinary incontinence covering symptoms, causes, diagnoses, non-surgical treatment, surgery and procedures, incontinence products and 10 ways to stop leaks.

Apps from MyTherappy
App recommendations from the NHS for survivors and carers ranging from communication, eating and drinking, healthy lifestyle, vision and more.

Disclaimer: The Stroke Association provides the details of other organisations and apps for information only. Inclusion on My Stroke Guide does not constitute a recommendation or endorsement.