Post stroke urinary loss, incontinence and life satisfaction: when does post-stroke urinary loss become incontinence?

While urinary incontinence (UI) has been extensively studied after stroke, the threshold for when it becomes a social problem by affecting life satisfaction or social participation has not been established. The study goal was to establish this threshold, examine the impact of UI on life satisfaction and participation, and determine whether UI contributes independently to poor stroke outcome.

Retrospective analysis was performed on prospectively collected data from a cohort of consecutive admissions to the acute Neurology Stroke Service of a large metropolitan teaching hospital. Four hundred and sixty patients with ischemic stroke were prospectively evaluated for stroke severity, medical, and demographic factors. Telephone interviews were completed with 361 community-dwelling subjects 6 months after stroke onset.

The FIM bladder item was used to determine the frequency of urinary loss. All patients were continent before stroke onset, 16% reported UL at 6-month follow-up. ROC analysis suggested that UI once per month or more is associated with diminished quality of life and activity participation. Logistic regression found poor life satisfaction associated with ADL impairment, cognitive disability, low SF12 physical and mental health scores, and incontinence. Poor outcome was independent of stroke severity.

Urinary loss became incontinence when it occurred at least monthly. UI was associated with greater dependence in basic and instrumental ADL, decreased participation and low life satisfaction.