Stroke: urinary incontinence was associated with worsening stroke and increasing age

Clinical bottom line (level 1b)

  1. 40% of patients with a first stroke had incontinence, but this fell to 5% after 2 years.
  2. The incontinence following a stroke was more likely with
    • age > 75
    • a subarachnoid haemorrhage
    • dysphagia
    • visual field defect
    • motor weakness
    and less likely with a lacunar infarct.
Patel et al: Stroke 2001; 32 : 122-127
Expires November 2003

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: community, UK

235 patients (aged mean 71, 51% female) with a first acute stroke

Excluded if
  • incontinence before stroke
  • not followed for 2 years


Factors studied:
  • age, sex, stroke location, stroke risk factors, initial impairments
  • age > 75
  • subarachnoid haemorrhage
  • dysphagia
  • visual field defect
  • motor weakness
  • lacunar infarct



    Cox regression analysis was used to adjust for confounding factors

    100% followed for 2 years
    Outcomes studied:
  • incontinence lost bladder control or indwelling catheter in-situ
  • incontinence losing bladder control at least once a week or indwelling catheter in-situ
  • incontinence
  • incontinence

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    incontinence 7 days 95/235 40%
    (34% to 47%)    		 2
    (2 to 3)
    incontinence 3 months 34/235 14%
    (10% to 19%)    		 7
    (5 to 10)
    incontinence 12 months 23/235 10%
    (6.0% to 14%)    		 10
    (7 to 17)
    incontinence 24 months 12/235 5.1%
    (2.3% to 7.9%)    		 20
    (13 to 44)

    prognostic factor for
    incontinence     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    age > 75 7 days 95/235
    (40.4%)     		15.9
    (2.18 to 116)     		2
    (2 to 5)
    subarachnoid haemorrhage 7 days 95/235
    (40.4%)     		15.4
    (1.32 to 180)     		2
    (2 to 15)
    dysphagia 7 days 95/235
    (40.4%)     		4.03
    (1.85 to 8.73)     		3
    (2 to 7)
    visual field defect 7 days 95/235
    (40.4%)     		4.78
    (1.78 to 12.9)     		3
    (2 to 7)
    motor weakness 7 days 95/235
    (40.4%)     		5.41
    (1.39 to 21.1)     		3
    (2 to 13)
    lacunar infarct 7 days 95/235
    (40.4%)     		0.12
    (0.02 to 0.62)     		-3
    (-9 to -3)

    • Urinary incontinence was independently associated with death (OR: 4.43: 95% CI: 1.76 to 11.2)

    Citation

    1. Patel M, Coshall C, Rudd AG, et al: natural history and effects of 2-year outcomes of urinary incontinence after stroke. Stroke 2001; 32 : 122-127
    Search Terms: from ACP Journal Club other articles noted
    Contributor: Chris Ball, November 2001
    Reviewer:

    Clinical Question.
    Patient stroke
    Intervention or Exposure clinical features
    Outcome incontinence
    		•