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Toileting

Some stroke survivors may be dependent on others for help with toileting. In one large study, 12% of patients needed some help with toileting one year after a stroke. Inability to walk, transfer to the commode and undress may hamper independence in toileting.

Physiotherapists and occupational therapists can help by improving mobility, transfers and dressing. A home visit and assessment in the patients own home and bathroom are often crucial prior to discharge from hospital.

Solutions like bedside commodes, urinals, grab rails, toilet frames, raised seats may have to be provided to promote independence.

Urinary incontinence can occur in about half of all stroke patients admitted to hospital but in most cases, control is regained quickly.

About 15% remain incontinent at one year. The most common reasons for incontinence are bladder over activity as a result of the stroke, impaired sphincter control, immobility, difficulty communicating, drowsiness, constipation, urinary infections and pre-existing problems. Several methods are used to try and overcome this problem.

Assessments include testing the urine for infections, measuring bladder residual volumes after voiding and maintaining a micturition chart. Simple measures like treating infections, regulating fluid intake and avoiding diuretics (water tablets) are tried first.

Regular toileting, providing bedside commodes, 'bladder retraining' and occasionally drugs (anticholinergic drugs) are used to control incontinence. Aids and appliances useful in patients with urinary incontinence include absorbent pads, penile sheath and urinals. Long term urinary catheters are avoided if possible because of the risk of infection and other complications.

Occasionally, in patients who are at risk of pressure sores, those who have urinary retention and in those where all other measures have failed, catheters may be the only option.

Faecal incontinence after a stroke has been associated with ageing and stroke severity. Constipation can lead to overflow and faecal incontinence and can be treated with enemas and laxatives.

The development of diarrhoea can cause faecal incontinence and has to be dealt with by treatment of the diarrhoea. It is sometimes necessary to induce constipation by medication to control incontinence.