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

Many people soon recover from bladder or bowel problems after stroke. But if you have longer-term problems, there are treatments and support that can help you get on with daily life.

Initial care after stroke

If you have good bladder and bowel function but you cannot tell anyone when you need the toilet because of a communication difficulty, healthcare staff may offer you the toilet or commode every two hours or so. You could be offered a urinal, bedpan, or penile sheath (designed for men).

Until you can start to regain control of your bladder or bowel, you may be offered absorbent pads. These should be changed as soon as possible if they become soiled. Good hygiene and skin care are important to protect your skin from damage.

If your bladder is not emptying fully, then a catheter may be used to empty it. This involves inserting a fine tube into the urethra to drain urine from the bladder into a bag. This may need to be done several times to keep you comfortable and reduce the risk of developing a urinary tract infection (UTI).

Assessment

If you stay in hospital after your stroke, your healthcare team will carry out an assessment to find out the type of bladder or bowel difficulties you have and plan your treatment with you. They should help you to understand the causes of your problems. They should also support you to make lifestyle changes and carry out exercises and training to manage your bladder and bowel. The assessment may include:

• A history of any bladder and bowel problems you had before the stroke and your current medication.
• A diary recording what you drink and how much urine you pass over about three days.
• A urine test to rule out infections.
• A diary of your bowel movements.
• Other tests may include a physical examination, a bladder ultrasound scan, abdominal X-ray or specialist investigations to find out how the bladder and bowel are working.

If you still have continence problems after two weeks of treatment and support, you should be reassessed.

Treatments for bladder problems

Once the cause of your bladder problem has been found, you will be offered advice and treatment. This may include:

• Drinking enough fluids. Strong, concentrated urine irritates your bladder. This can make feelings of urgency worse and can cause leakage and bladder infections. Caffeine or alcohol can also stimulate urine production, so you may be advised to reduce your caffeine or alcohol intake.
• Bladder training reduces urgency and frequency by gradually teaching your bladder to hold more urine. This is done by making timed 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. You may be able to be referred to a specialist physiotherapist for help with these.
• Using medication to reduce feelings of urgency and frequency, or reduce the amount of urine your body makes.
• If you are overweight, losing some weight can often improve bladder control in the longer term.
• Stopping smoking. Coughing makes bladder leakage worse. Stopping smoking can help reduce coughing.
• Electrical stimulation devices, which can be inserted in either the vagina or the anus to stimulate and strengthen the muscles that control the bladder.
• A longer-term catheter or surgery may be considered for some persistent continence problems, if other treatments have not worked well or are unsuitable.

Treatments for bowel problems

Advice and treatment for bowel problems may include:

• Bowel retraining involves timed 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 enough fibre.
• Drinking more fluids can help soften stools.
• Medication: laxatives may be used to treat chronic constipation and impacted stool, which is the most common cause of leaking faeces (poo). If you have true diarrhoea, other medications can help. It’s important you seek help first to find out what is causing your bowel problem.
• Enema or bowel irrigation may be used to clear the bowel if faecal impaction occurs.

Which health professionals can help me?

Bladder and bowel problems can be treated by a range of healthcare professionals, including doctors, nurses and therapists. Incontinence can affect all aspects of your life and health, so you may need different types of help with your individual needs.

Getting treatment

Continence advisers are specialist nurses who are trained to treat bladder and bowel problems. They can fully assess your individual needs and develop a plan with you that fits your personal circumstances. After you’ve been discharged from hospital, your GP surgery can provide further advice on what services are available in your area. Some organisations listed in 'Other sources of help and information' can also help you find a continence clinic.

You may need to see a specialist consultant, such as a urologist, gastroenterologist, gynaecologist or geriatrician. Your GP surgery can refer you if appropriate.

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