Interventions for treating urinary incontinence after stroke in adults

Area of Science:

• Neurology
• Urology
• Rehabilitation Medicine

Background:

• Urinary incontinence is a common complication following stroke, affecting a significant percentage of patients.
• A substantial proportion of stroke survivors continue to experience incontinence upon hospital discharge and even after one year.
• This review is an update of previous analyses examining interventions for post-stroke urinary incontinence.

Purpose of the Study:

• To evaluate the effectiveness of various interventions for treating urinary incontinence in adult stroke survivors.
• The focus is on individuals at least one month post-stroke.

Main Methods:

• A systematic review of randomized or quasi-randomized controlled trials was conducted.
• Searches were performed across major databases including Cochrane Incontinence and Cochrane Stroke registers.
• Data extraction, risk of bias assessment, and GRADE methodology were independently applied by two reviewers.

Main Results:

• Low-quality evidence suggests behavioral interventions may slightly reduce incontinence episodes but show little effect on quality of life.
• Moderate-quality evidence indicates structured continence nurse interventions likely have minimal impact on continence rates.
• Complementary therapies, such as acupuncture, showed low-quality evidence of increasing continence rates.
• Physical therapy, particularly transcutaneous electrical nerve stimulation (TENS), demonstrated low-quality evidence for reducing incontinence episodes and moderate-quality evidence for improving functional ability.

Conclusions:

• There is insufficient evidence to guide the continence care of adults in the post-stroke rehabilitative phase.
• The included trials were often small, heterogeneous, and prone to bias due to poor reporting and inadequate allocation concealment.
• Further large-scale, multicenter trials are necessary to establish robust evidence for effective interventions.