The patient

Desire for treatment – Can be affected by previous experiences, personal values, motivation, expectations, mental/cognitive status, financial status, environment and physical status.

Age -Staff/patient/family may believe bladder and bowel problems are a normal part of ageing. Shaw C, Rajabali S, Tannenbaum C, Wagg A. (2019). Is the belief that urinary incontinence is normal for ageing related to older Canadian women’s experience of urinary incontinence? International Urogynecology Journal. 30: 2157–2160 https://doi.org/10.1007/s00192-019-03906-z

Physical ability – Frailty and pre-existing physical disability can impact on the person’s abilities to locate, reach and use the toilet. Assistance may be required.

Type of stroke – Severe urinary incontinence is more common in TACS but bladder and bowel symptoms can be associated with any type of stroke.

Co-morbidities – Many conditions are associated with bladder and bowel symptoms following stroke e.g.

• Diabetes mellitus – increases urine production and can decrease sensation – urgency is common.
• Heart disease – can cause fluid retention and impaired renal function. Drug treatment increases urine output – frequency is common.
• Arthritis – associated impaired mobility and dexterity can lead to functional incontinence.
• Cognitive impairment in those with dementia may cause functional incontinence.

Significant past medical/ surgical/ obstetric/ genitourinary history – Any condition that may affect functioning of kidneys and urine production, pelvic floor, genitourinary tract, bowel function and lower bowel. Multiple births/large babies may damage pelvic floor and cause stress UI.

Medication – Any drug and/or its side-effects that increases urine production, sedates, impairs cognition, affects bowel function, sensation and muscle tone e.g. hypnotics, diuretics, anticholinergics, antispasmodics, analgesics, antihistamines, anti-psychotics.

Mental status – Pre-existing mental illness, especially depression can impact on motivation towards treatment and functional constipation. Mental health drug side-effects may cause constipation.

Cognitive status – Pre-existing dementias and learning disabilities can affect ability to take on new information or relearn activities. Dementia has a global impact on cognition influencing the person’s ability to locate and use the toilet and lead to functional constipation.