Post-stroke bladder trouble may harm outcome

By Will Boggs, MD

NEW YORK (Reuters Health) - After a stroke, people may be less aware of their bladder needs, leading to urinary incontinence, and this is associated with a poor outcome after stroke, researchers have found.

In a study 315 stroke patients, Dr. Renate Pettersen from University of Oslo, Norway and a colleague found that 65 developed urinary incontinence soon after the event. Twenty-seven of the 65 had classical urge urinary incontinence symptoms and signs.

Sixteen of the 65 patients with "new-onset" incontinence did not experience urge sensations and often they did not sense that their bladder was filling before leaking urine, the results indicate.

The remaining 22 patients were completely unaware of and denied having any leakage, despite repeated attempts on the part of nurses to point it out to them. This latter group had the highest risk of poor outcome 3 months after stroke, the researchers note.

"New-onset post-stroke urinary incontinence with impaired awareness is probably a marker for considerable brain damage," the investigators suggest.

They've now followed the stroke patients for up to one year, and "the main conclusion has not been changed," Pettersen said, "namely that urinary incontinence with impaired awareness remains a strong and independent risk factor for poor outcome."

SOURCE: Journal of the American Geriatrics Society December 2006.

J Am Geriatr Soc 2006;54:1878-1884.