Prevention and treatment of urinary incontinence after stroke in adults

  • Review
  • Intervention

Authors

  • LH Thomas,

  • J Barrett,

  • S Cross,

  • B French,

  • M Leathley,

  • C Sutton,

  • C Watkins


Dr Lois Thomas, Senoir Lecturer in Research, Room 218 Greenbank Building, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK. lhthomas@uclan.ac.uk.

Abstract

Background

Urinary incontinence can affect 40-60% of people admitted to hospital after a stroke, with 25% still having problems on hospital discharge and around 15% remaining incontinent at one year.

Objectives

To determine the optimal methods for prevention and treatment of urinary incontinence after stroke in adults.

Search strategy

We searched the Cochrane Incontinence and Stroke Groups specialised registers (searched 15 December 2004 and 26 October 2004, respectively), CINAHL (January 1982 to November 2004), national and international trial databases for unpublished data, and the reference lists of relevant articles.

Selection criteria

Randomised or quasi-randomised controlled trials evaluating the effects of interventions designed to promote continence in people after stroke.

Data collection and analysis

Data extraction and quality assessment were undertaken by two reviewers working independently. Disagreements were resolved by a third reviewer.

Main results

Seven trials with a total of 399 participants were included in the review. Participants were from a mixture of settings, age groups and phases of stroke recovery. No two trials addressed the same comparison.

Four trials tested an intervention against usual care, including acupuncture, timed voiding, and two types of specialist professional intervention. One cross-over trial tested an intervention (oestrogen) against placebo. One trial tested a specific intervention (oxybutynin) against another intervention (timed voiding), and one trial tested a combined intervention (sensory-motor biofeedback plus timed voiding) against a single component intervention (timed voiding alone).

Reported data were insufficient to evaluate acupuncture or timed voiding versus usual care, oxybutynin versus timed voiding, or sensory motor biofeedback plus timed voiding versus usual care. Evidence from a single small trial suggested that structured assessment and management of care in early rehabilitation may reduce the number of people with incontinence at hospital discharge (1/21 versus 10/13; RR 0.06, 95% CI 0.01 to 0.43), and have other benefits. Evidence from another trial suggested that assessment and management of care by Continence Nurse Practitioners in a community setting may reduce the number of urinary symptoms (48/89 versus 38/54; RR 0.77, 95% CI 0.59 to 0.99), and increase satisfaction with care.

Authors' conclusions

There was suggestive evidence that specialist professional input through structured assessment and management of care and specialist continence nursing may reduce urinary incontinence after stroke. Data from trials of other physical, behavioural, complementary and anticholinergic drug interventions are insufficient to guide continence care of adults after stroke.

Plain language summary

Plain language summary

Assessment and treatment from specialised professionals appear promising to promote urinary continence in people after stroke.

Urinary incontinence is a common consequence of stroke and has many causes. In early stroke rehabilitation, structured assessment and management of care shows promise in reducing the number of people with urinary incontinence. In the later phases of stroke recovery the use of specialist practitioners may be helpful in reducing symptoms associated with urinary incontinence. Even late after stroke, interventions targeted at specific causes of incontinence may be helpful. Unfortunately, all the conclusions were limited by a lack of robust information.

Ancillary