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South LondonIStroke Register SLSR
 
Incontinence and stroke
Funded by:
Funded by: Stroke Association 1999-2000
Study team:
Dr Mehool Patel
Aims:
  • describe the natural history of incontinence following stroke
  • examine the effect of initial incontinence on mortality and two-year outcome in stroke survivors
  • determine the factors for recovery of post-stroke incontinence and whether regaining continence influences stroke outcomes
Setting:
Inner city London
Design:
Subjects registered in the SLSR in 1995 were followed up for two years. Patients were classified by continence status at 10 days. Incontinent patients were compared with continent ones to estimate effects of incontinence on outcomes. Subjects registered in the SLSR during 1995-1998 were recruited to determine factors for recovery and its effect on three-month outcomes.
Results:
Prevalence of urinary incontinence at 10 days, 3 months, 1 and 2 years post-stroke was 40%, 19%, 15% and 10% respectively. Multivariate analysis revealed that age over 75 (odds ratios [OR] 15.9;confidence intervals [CI] 2.2-116.2), dysphagia (OR 4.03;CI 1.85-8.73), motor weakness (OR 5.41;CI 1.38-21.1) and visual field defects (OR 4.78; CI 1.78-12.9) were all significantly associated with incontinence.
At 2 years, compared to the continent group, the incontinent group had higher case-fatality rates (67%v20%; p<0.001), greater institutionalisation rates (39%v16%; p=0.007), and worse disability (BI:[0-9]:39%v5%;p<0.001) (FAI:[0-15]:75%v37%;p=0.001).
Death or disability at 2 years was worse in subjects with post-stroke incontinence (OR 4.43;CI 1.76-11.2). 324 subjects over 4 years were recruited to determine reasons for recovery of incontinence. 3 months follow-up revealed 80/207 survivors had regained continence. Age was the only significant association with recovery of incontinence (p=0.002). At 3 months, compared to those who had regained continence, the incontinent group had higher institutionalisation rates (27[34%] v 9[7%], p<0.001) and worse disability.
Conclusion:
Incontinence remains a prevalent condition two years after stroke. Post-stroke incontinence adversely affects two-year stroke survival, disability and institutionalisation rates. Increasing age is associated with poor recovery of post-stroke incontinence. Recovery of incontinence is associated with better three-month outcome in stroke survivors.