Urinary Incontinence
Introduction
Urinary incontinence (UI) is the loss of control of urine, or the inability to hold urine in until a bathroom can be reached. Unfortunately, UI following a stroke is common. The prevalence ranges from 37% to 79% in the days and weeks following the stroke. While many individuals with stroke will regain control of their bladder, one-third will remain incontinent at one year post-stroke.
There are multiple etiologies for UI post-stroke. UI may result from infarction or cerebral edema affecting central micturition pathways. Alternatively, impairments of consciousness; cognitive or language difficulties and motor and sensory loss, can also affect toileting, despite normal bladder function. Frequent coughing in individuals who experience dysphagia post-stroke may also exacerbate UI. In addition, certain medications; depression; constipation; pre-morbid conditions such as peripheral neuropathies from diabetes; pre-existing UI and environmental factors that impede toileting - or a combination of these - will increase the likelihood of UI post-stroke.
In most cases, UI can be treated successfully. Management of UI takes many forms including behavioural, pharmacological, surgical and supportive devices. The present review focuses on the behavioural management, the first line treatment for UI secondary to bladder dysfunction. Specific behavioural intervention for UI include:
Authors*: Chantal Dumoulin, PhD PT; Nicol Korner-Bitensky, PhD
| 1a (Strong) | Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings |
| 1b(Moderate) | 1 RCT of high quality (PEDro ≥ 6) |
| 2a (Limited) | At least 1 fair quality RCT (PEDro = 4-5) |
| 2b (Limited) | At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) |
| 3(Consensus) | Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results |
| 4 (Conflicting) | Conflicting evidence of 2 or more equally well-designed studies |
| 5 (No evidence) | No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) |
A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.
A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.
| 1a (Strong) | Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings |
| 1b(Moderate) | 1 RCT of high quality (PEDro ≥ 6) |
| 2a (Limited) | At least 1 fair quality RCT (PEDro = 4-5) |
| 2b (Limited) | At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) |
| 3(Consensus) | Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results |
| 4 (Conflicting) | Conflicting evidence of 2 or more equally well-designed studies |
| 5 (No evidence) | No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) |
| 1a (Strong) | Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings |
| 1b(Moderate) | 1 RCT of high quality (PEDro ≥ 6) |
| 2a (Limited) | At least 1 fair quality RCT (PEDro = 4-5) |
| 2b (Limited) | At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) |
| 3(Consensus) | Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results |
| 4 (Conflicting) | Conflicting evidence of 2 or more equally well-designed studies |
| 5 (No evidence) | No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) |
*high quality = PEDro score 6-10
*fair quality = PEDro score 4-5
*poor quality = PEDro score ≤ 3
The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/
A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.
| 1a (Strong) | Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings |
| 1b(Moderate) | 1 RCT of high quality (PEDro ≥ 6) |
| 2a (Limited) | At least 1 fair quality RCT (PEDro = 4-5) |
| 2b (Limited) | At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) |
| 3(Consensus) | Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results |
| 4 (Conflicting) | Conflicting evidence of 2 or more equally well-designed studies |
| 5 (No evidence) | No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) |
*high quality = PEDro score 6-10
*fair quality = PEDro score 4-5
*poor quality = PEDro score ≤ 3
The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/
A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.
Patients longer than 6 months post-stroke are identified as in chronic stage of recovery.
| 1a (Strong) | Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings |
| 1b(Moderate) | 1 RCT of high quality (PEDro ≥ 6) |
| 2a (Limited) | At least 1 fair quality RCT (PEDro = 4-5) |
| 2b (Limited) | At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) |
| 3(Consensus) | Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results |
| 4 (Conflicting) | Conflicting evidence of 2 or more equally well-designed studies |
| 5 (No evidence) | No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) |
A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.
*high quality = PEDro score 6-10
*fair quality = PEDro score 4-5
*poor quality = PEDro score ≤ 3
The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/
| 1a (Strong) | Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings |
| 1b(Moderate) | 1 RCT of high quality (PEDro ≥ 6) |
| 2a (Limited) | At least 1 fair quality RCT (PEDro = 4-5) |
| 2b (Limited) | At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) |
| 3(Consensus) | Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results |
| 4 (Conflicting) | Conflicting evidence of 2 or more equally well-designed studies |
| 5 (No evidence) | No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) |