Category: Advancing Modules

Select the crosses for more information on the areas responsible for controlling the bladder.

Instructions for navigating the diagram- once you have read the text click on the side arrow to return the main diagram.

• The muscles of the bladder, urethra and pelvic floor are controlled by the central nervous system
• There are 3 main sites of control. The prefrontal area of cortex, micturition centre in pons, sacral micturition centre (S2-S4)
• During bladder filling detrusor (smooth muscle) is relaxed, to allow it to stretch as it fills and the external urethral sphincter (striated muscle) is contracted to keep it shut
• Bladder filling excites sensory receptors in the detrusor muscle which trigger the urge to empty the bladder
• The decision on whether to empty the bladder or not is made in the right prefrontal cortex
• The message is sent via the pontine centre to the sacral micturition centre
• If voiding is allowed, detrusor contracts as the external urethral sphincter and pelvic floor muscles relax – urinary voiding takes place

• Urinary incontinence is defined as ‘the complaint of any involuntary loss of urine’ ⁽¹⁾
• Urinary incontinence commonly occurs after stroke ^{(2, 3, 4)}. The prevalence in acute stroke ranges from between 30 and 79% and is nearly 20% in long term stroke survivors ⁽⁵⁾
• With correct identification of type of urinary incontinence and appropriate rehabilitation and treatment approximately 70% can be cured, or their symptoms greatly improved ⁽⁶⁾
• Faecal incontinence is involuntary loss of solid or liquid stool ⁽⁷⁾
• Bowel dysfunction and faecal incontinence commonly occur after stroke ⁽⁸⁾
• 5% of stroke survivors have major faecal incontinence ⁽⁸⁾
• To maintain continence requires normal function of the bladder and bowel and normal function of the rectum, anus, pelvic floor muscles and nervous system and awareness of the need to empty the bladder and/or bowel.

References can be found at the end of this section of the module.

On completion of this module you will:

• Understand the effects of stroke on a person’s bladder and bowel function
• Know how to assess bladder function and identify different types of post- stroke bladder dysfunction
• Know how to assess bowel function and identify types and causes of post-stroke difficulties
• Know how to develop and implement evidence-based bladder and bowel rehabilitation plans

The patient scenarios / cases will cover the following 4 main bladder and bowel issues following stroke:

• Urgency urinary incontinence
• Urinary retention
• Faecal impaction with overflow diarrhoea
• Functional incontinence