Correlation between urinary incontinence and localization of brain lesion and severity of neurological lesion caused by a stroke

Abstract

Abstract. Urinary incontinence is one of the medical problems, which may develop as a result of a stroke, and, according to several authors, its occurrence frequency may reach up to 80%. Clinical symptoms of urinary incontinence are considered to be one of the symptoms, which, along with the severity of the stroke and the level of functional limitations, allows to develop reliable predictions and to make targeted use of resources. Aim of the study, materials and methods. The aim of the study is to explore whether post-stroke urinary incontinence correlates with localization of lesion and clinical symptoms. The study includes 180 patients after a stroke, who have received treatment at Riga Eastern Clinic University Hospital Stroke Unit. All had a comprehensive clinical and functional assessment and cerebral computed tomography (CT). The examination took place at the hospital a few days after the stroke had occurred. Results. There are 180 participants to the study. Symptoms of urinary incontinence were reported for 70.6% of study participants. In 64% of cases new incontinence problems had developed, while in 6.5% of cases the previous symptoms of urinary incontinence (prior to the stroke) had worsened. The most common types of urinary incontinence in the acute period were urge and mixed incontinence (functional and urge incontinence). Patients with low Barthel Index showed higher frequency of urinary incontinence. A comparison of patient groups with and without symptoms of urinary incontinence showed that patients older than 75 years showed more symptoms of urinary incontinence (p = 0.013), and the same can be said about patients with low indicators of Barthel (p = 0.001) and patients with cognitive disorders (p = 0.001). Severity of paresis, aphasia and sensory disorders show a reliable correlation with the type of urinary incontinence.Conclusion. Symptoms of post-stroke urinary incontinence are linked both to a person's age, and functional and cognitive disorders. Urinary incontinence develops more frequently among patients with anterior circulation of the brain and subcortical brain lesion. There is a reliable correlation between severity of neurological lesion and urinary incontinence. Key words: stroke, rehabilitation, urinary incontinenceUrinary incontinence is a serious health disorder that develops after a stroke and occurs within the first days or weeks after affection in between 37% and 79% of cases (Van Kuijk, Van der Linde, Van Limbeek, 2001).Urinary incontinence is not seen as a specific early symptom of the stroke with characteristic brain lesion localization, however several authors view it as an indicator of potential occurrence of death, disability and re-hospitalization. The most common mechanism of post-stroke urinary incontinence is an increase in activity of bladder wall muscle or detrusor (m.detrusor), yet a decrease in activity of detrusor may be observed and urodynamic testing may show indicators below the norm.Lesion of various brain structures, movement and speech or language disorders, ...