Treatment of urinary incontinence after stroke in adults

Thomas LH, Cross S, Barrett J, French B, Leathley M, Sutton CJ, Watkins C

Published Online:

January 21, 2009

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 advisors 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.

Abstract (click to read)

Background:

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

Objectives:

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

Search strategy:

We searched the Cochrane Incontinence and Stroke Groups specialised registers (searched 15 March 2007 and 5 March 2007 respectively), CINAHL (January 1982 to January 2007), national and international trial databases for unpublished data, and the reference lists of relevant articles.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:

Twelve trials with a total of 724 participants were included in the review. Participants were from a mixture of settings, age groups and phases of stroke recovery.

Behavioural interventions
Three trials assessed behavioural interventions, such as timed voiding and pelvic floor muscle training. All had small sample sizes and confidence intervals were wide.

Specialised professional input interventions
Two trials assessed variants of professional input interventions. Results tended to favour the intervention groups: in a small trial in early rehabilitation, fewer people had incontinence at discharge from hospital after structured assessment and management than in a control group (1/21 vs. 10/13; RR 0.06, 95% CI 0.01 to 0.43); in the second trial, assessment and management by Continence Nurse Advisors was associated with fewer participants having urinary symptoms (48/89 vs. 38/54; RR 0.77, 95% CI 0.59 to 0.99) and statistically significantly more being satisfied with care.

Complementary therapy interventions
Three small trials all reported fewer participants with incontinence after acupuncture therapy (overall RR 0.44; 95% 0.23 to 0.86), but there were particular concerns about study quality.

Pharmacotherapy and hormonal interventions
There were three small trials that included groups allocated meclofenoxate, oxybutinin or oestrogen. There were no apparent differences other than in the trial of meclofenoxate where fewer participants had urinary symptoms in the active group than in the control group (9/40 vs. 27/40; RR 0.33, 95% CI 0.18 to 0.62).

Authors' conclusions:

Data from the available trials are insufficient to guide continence care of adults after stroke. However, there was suggestive evidence that professional input through structured assessment and management of care and specialist continence nursing may reduce urinary incontinence and related symptoms after stroke. Better quality evidence is required of the range of interventions that have been suggested for continence care after stroke.

This record should be cited as:

Thomas LH, Cross S, Barrett J, French B, Leathley M, Sutton CJ, Watkins C. Treatment of urinary incontinence after stroke in adults. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004462. DOI: 10.1002/14651858.CD004462.pub3

Assessed as up to date:

November 14, 2007

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Primary Review Group:

Incontinence Group

Health topics:

Gynaecology > Urinary incontinence > Complementary & alternative therapy

Gynaecology > Urinary incontinence > Dietary treatment

Gynaecology > Urinary incontinence > Drug treatment

Gynaecology > Urinary incontinence > Education

Gynaecology > Urinary incontinence > Mechanical treatment