Incontinence After Stroke: The Symptom No One Wants to Talk About

There are some parts of stroke recovery we talk about openly: learning to walk again, regaining movement in an arm or hand, improving speech, dealing with fatigue.

And then there are the things nobody really wants to talk about.

Like peeing your pants.

I’m going to get personal because this is something I deal with, too. Years after my strokes, bladder control is still an issue for me. It’s not something I’ve been eager to announce, but that’s why we need to talk about it. Other women are quietly dealing with the same thing and wondering whether it has anything to do with their stroke.

Urinary incontinence can be embarrassing, frustrating and sometimes humiliating. It can make you worry about leaving home, sitting through a meeting, exercising, traveling or making it to the bathroom in time.

Why Can a Stroke Affect Bladder Control?

We don’t think much about the brain’s role in going to the bathroom until something goes wrong. The brain, spinal cord, nerves and muscles work together to control the bladder. Your brain receives signals that the bladder is filling and helps determine when it is appropriate to empty it. A stroke can disrupt those pathways.

The American Stroke Association explains that survivors may experience urinary frequency, urgency, loss of control and difficulty completely emptying the bladder.

Sometimes the problem isn’t solely bladder control. A survivor may know she needs to go but be unable to walk quickly enough. Weakness, paralysis, balance problems, cognitive changes, communication difficulty or struggling with clothing can all contribute to accidents.

What Can Incontinence After Stroke Look Like?

It’s not always simply “losing control of your bladder.” Post-stroke problems can include:

• Suddenly needing to urinate right now
• Leaking before reaching the bathroom
• Urinating much more frequently
• Waking repeatedly at night to urinate
• Bedwetting
• Difficulty recognizing when the bladder is full
• Difficulty completely emptying the bladder
• Leakage when coughing, sneezing, laughing or exercising
• Difficulty physically getting to or using the toilet

You can have more than one type of bladder problem. Stroke can also affect bowel function.

Women May Have Another Layer to Deal With

Women can experience bladder-control problems for reasons unrelated to stroke. Pregnancy and childbirth can weaken pelvic-floor muscles. Hormonal changes during and after menopause can affect urinary and pelvic tissues. Aging can play a role too.

That means you shouldn’t automatically assume every bladder problem is a permanent stroke effect. Urinary tract infections, diabetes, constipation, pelvic-floor dysfunction, medications and other conditions can cause or worsen symptoms. That’s one reason to speak with your provider, even if you’d rather not.

Please Tell Your Doctor

I know. Talking about peeing your pants isn’t a conversation most of us are excited to have. But your doctor has heard it before, and there may be things that help.

Your provider may check whether you completely empty your bladder, test for infection, review medications or investigate other causes.

A bladder diary may help. For a few days, track:

• When and how much you drink
• When you use the bathroom
• When sudden urgency happens
• When leakage occurs
• What you were doing
• Whether you reached the bathroom

Patterns can provide useful information for you and your healthcare team.

What Can Help With Incontinence After Stroke?

There is no single treatment for everyone because the best approach depends on the cause. Your healthcare or rehabilitation team may suggest several strategies.

1. Scheduled Bathroom Trips

Using the bathroom at regular intervals instead of waiting until your bladder is screaming may prevent accidents. Going before you feel desperate can make a major difference when urgency or mobility is a problem.

2. Bladder Training

Some people benefit from gradually changing bathroom habits and increasing time between trips. This isn’t right for every bladder problem, so get professional guidance rather than forcing yourself to “hold it.”

3. Pelvic-Floor Therapy

Pelvic-floor muscle training can help some types of urinary incontinence—and it is much more than doing a bunch of Kegels. A pelvic-floor physical therapist can assess your muscles and identify exercises or treatments that fit your needs.

4. Make Getting to the Bathroom Easier

Sometimes the bladder gives enough warning, but your post-stroke body can’t move as quickly as it once did. An occupational or physical therapist may help with:

• Easier-to-remove clothing
• Grab bars
• Raised toilet seats
• Bedside commodes
• Mobility aids
• Clearing obstacles between your bed or chair and bathroom

There’s no prize for making toileting harder than it needs to be. Use tools that help you stay safe and independent. Our stroke recovery at home guide has more safety ideas.

5. Talk About Your Medications

Some medications affect bladder or bowel function. Never stop a prescribed medication on your own. Ask whether anything you take could contribute and whether alternatives or other strategies are appropriate.

6. Don’t Stop Drinking Water

When you’re worried about an accident, drinking less can seem obvious. But intentionally dehydrating yourself isn’t the answer. Too little fluid creates other problems, and concentrated urine may irritate the bladder.

Fluid needs depend on your conditions and medications, so ask your provider what is right for you. You may notice that drinks such as caffeine worsen urgency or frequency.

What About Bowel Incontinence?

This deserves discussion too. Survivors can experience constipation, bowel urgency or bowel incontinence. Reduced mobility, diet changes, inadequate fluid, medications, neurological changes and difficulty reaching the toilet can contribute.

Constipation can be especially common and shouldn’t be ignored. Tell your healthcare provider if bowel control changed after your stroke. There may be ways to improve it.

Does Incontinence Get Better After Stroke?

It can. Bladder problems are particularly common early after stroke, and many survivors improve as they recover. But not everyone does. Some survivors, like me, still experience bladder-control problems years later.

Improvement depends on the brain area affected, stroke severity, mobility, cognition, other health conditions and the cause of the incontinence. Don’t simply assume, “I had a stroke, so I have to live with this.” Even years later, it’s worth bringing up.

Pads and Protective Underwear Are Tools, Not Defeat

If you need a pad, protective underwear, a change of clothes in your bag or a bedside commode, use it. That’s not giving up. That’s adapting.

We use canes when walking is difficult, glasses when we can’t see clearly and pill organizers when memory is challenging. Managing bladder problems shouldn’t carry more shame.

Do whatever helps you feel comfortable enough to leave home, travel, work, exercise or spend time with people you love.

When Should You Seek Medical Care?

Discuss new or worsening bladder symptoms with a healthcare professional, especially if you have:

• Pain or burning when urinating
• Blood in your urine
• Fever or chills
• Difficulty urinating
• An inability to empty your bladder
• New or severe pelvic or abdominal pain
• Significant bowel changes
• Severe constipation

Sudden new neurological symptoms can be an emergency. New facial drooping, arm or leg weakness, speech difficulty, vision changes, severe balance problems or other possible stroke signs should never be dismissed as another strange post-stroke symptom. Call 911 immediately in the United States, even if symptoms improve, and do not drive yourself.

One More Thing, Sister

Stroke has a remarkable ability to take things we once did without a second thought and make them complicated: walking, talking, eating, sleeping, thinking—and yes, even going to the bathroom.

Years after my strokes, I’m still dealing with some of this. I’m sharing that because I don’t want another woman sitting at home thinking she’s the only one. She’s not.

We need to talk about the uncomfortable parts of stroke recovery too. The embarrassing parts. The things we whisper about or Google when nobody else is around.

Talk to your healthcare provider. Ask whether treatments or strategies may help. Use whatever products or adaptations make life easier.

Trusted Resources and Further Reading