The nature and depth of knowledge concerning urinary incontinence (UI) after stroke, its impact on individuals and rehabilitation, and effectiveness of treatment is limited. The purposes of the studies reported here were to (a) explore stroke patients' perceptions of UI after stroke, (b) compare characteristics of stroke patients who gain continence with those who remain incontinent, and (c) determine the relationships between cognition, functional status, and UI post stroke.
Characteristics of incontinent stroke patients who regained continence by discharge from an acute rehabilitation program were compared with those who remained incontinent. Of the 90 cases meeting the inclusion criteria on admission to the program, 45 were continent by discharge. Compared to those who regained continence, subjects who remained incontinent at discharge took longer to be transferred to the rehabilitation program after the onset of stroke, had lower admission Functional Independence Measure (FIM) total scores and discharge FIM total scores, had more episodes of UI the first 24 hours after admission, and did not make as great an increase in functional scores during rehabilitation. When the time from stroke was controlled, a subsample of those who remained incontinent scored lower only on the FIM Social Cognition Subscale 14-18 days post stroke, while 27-30 days post-stroke Sphincter Control and Self-Care Subscale scores were lower for those remaining, incontinent. UI was not associated with discharge destination, but did predict total FIM score at discharge and the change in FIM scores from admission to discharge.
Incontinent stroke rehabilitation patients were interviewed to elicit their perceptions of the impact of incontinence. Five patients' responses were analyzed. The results support physical, social, and psychological dimensions of the impact of incontinence. Over one-half of the subjects indicated UI affected their daily routine. Although negative terms were used to describe the experience of being incontinent, many responses tended to minimize the consequences of incontinence. The findings suggest the duration, type, and severity of incontinence may influence the perceptions and responses of stroke rehabilitation patients
Clinical trials to compare the effect of behavioral treatment modalities on the course of UI after stroke and its impact on outcomes are indicated.
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