Stroke

Every other stroke victim suffers from a breakdown of bladder control. Neurourological assessment and treatment are essential in the acute phase following the stroke, during rehabilitation and also in the event of dysfunction later on.

A stroke involves a disturbance of the blood supply to a certain area of the brain. There are two possible causes: a decreased blood supply or intracranial haemorrhage. In the case of a decreased blood supply to part of the brain, in most instances a blood vessel in the brain is obstructed as a result of arteriosclerosis. The consequence is that the area of the brain supplied by the affected blood vessel is damaged; in the worst case scenario, the nerve cells in this area die off. In the case of intracranial haemorrhage, a blood vessel ruptures in the brain and the escaping blood accumulates in the nerve tissue. In this instance, too, nerve cells are damaged or even lost. In both forms of stroke, the intracranial pressure can increase, threatening to cause even more damage to the nerve cells in the brain. Each year, around 12,000 people in Switzerland suffer a stroke. More than half of victims incur lasting damage, with 20% ending up severely to very severely handicapped.

A permanent handicap generally also results in a functional disorder of the urinary tract or incontinence. The development depends on the extent and localisation of the area of the brain affected. An impairment of the frontal lobe and an interruption of the nerve tracts to the brain stem are considered the most frequent cause urinary incontinence after a stroke. Damage on one side of these regions tends to lead to temporary incontinence, while damage on both sides generally results in permanent incontinence. Urinary incontinence after a stroke is considered an important indicator of how the disease will progress and whether the victim will later be dependent on outside help. Fortunately, in many patients the bladder recovers. Three months after the event, some 50% of stroke victims still complain of urological difficulties, mostly urge incontinence or a problem with emptying the bladder. Six months after the event, no less than 20 to 30% are still affected by incontinence if they have not received any treatment. Neurourological assessment and treatment are essential in the acute phase after a stroke, during rehabilitation and also in the event of dysfunction later on.