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Meta-Analysis
. 2008 Jan 23;2008(1):CD004462.
doi: 10.1002/14651858.CD004462.pub3.

Treatment of urinary incontinence after stroke in adults

L H Thomas  1 , S Cross, J Barrett, B French, M Leathley, C J Sutton, C Watkins
Affiliations
Meta-Analysis

Treatment of urinary incontinence after stroke in adults

L H Thomas et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Urinary incontinence can affect 40-60% of people admitted to hospital after a stroke, with 25% still having problems on hospital discharge and 15% remaining incontinent at one year.

Objectives: To determine the optimal methods for treatment of urinary incontinence after stroke in adults.

Search strategy: We searched the Cochrane Incontinence and Stroke Groups specialised registers (searched 15 March 2007 and 5 March 2007 respectively), CINAHL (January 1982 to January 2007), national and international trial databases for unpublished data, and the reference lists of relevant articles.

Selection criteria: Randomised or quasi-randomised controlled trials evaluating the effects of interventions designed to promote continence in people after stroke.

Data collection and analysis: Data extraction and quality assessment were undertaken by two reviewers working independently. Disagreements were resolved by a third reviewer.

Main results: Twelve trials with a total of 724 participants were included in the review. Participants were from a mixture of settings, age groups and phases of stroke recovery. BEHAVIOURAL INTERVENTIONS: Three trials assessed behavioural interventions, such as timed voiding and pelvic floor muscle training. All had small sample sizes and confidence intervals were wide. SPECIALISED PROFESSIONAL INPUT INTERVENTIONS: Two trials assessed variants of professional input interventions. Results tended to favour the intervention groups: in a small trial in early rehabilitation, fewer people had incontinence at discharge from hospital after structured assessment and management than in a control group (1/21 vs. 10/13; RR 0.06, 95% CI 0.01 to 0.43); in the second trial, assessment and management by Continence Nurse Advisors was associated with fewer participants having urinary symptoms (48/89 vs. 38/54; RR 0.77, 95% CI 0.59 to 0.99) and statistically significantly more being satisfied with care. COMPLEMENTARY THERAPY INTERVENTIONS: Three small trials all reported fewer participants with incontinence after acupuncture therapy (overall RR 0.44; 95% 0.23 to 0.86), but there were particular concerns about study quality. PHARMACOTHERAPY AND HORMONAL INTERVENTIONS: There were three small trials that included groups allocated meclofenoxate, oxybutinin or oestrogen. There were no apparent differences other than in the trial of meclofenoxate where fewer participants had urinary symptoms in the active group than in the control group (9/40 vs. 27/40; RR 0.33, 95% CI 0.18 to 0.62).

Authors' conclusions: Data from the available trials are insufficient to guide continence care of adults after stroke. However, there was suggestive evidence that professional input through structured assessment and management of care and specialist continence nursing may reduce urinary incontinence and related symptoms after stroke. Better quality evidence is required of the range of interventions that have been suggested for continence care after stroke.

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Conflict of interest statement

None known.

Figures

Analysis 1.1
Analysis 1.1
Comparison 1 INTERVENTION VERSUS NO INTERVENTION/USUAL CARE, Outcome 1 Number of people with incontinence after treatment.
Analysis 1.2
Analysis 1.2
Comparison 1 INTERVENTION VERSUS NO INTERVENTION/USUAL CARE, Outcome 2 Severity of incontinence: mean number of incontinence episodes in 24 hours.
Analysis 1.3
Analysis 1.3
Comparison 1 INTERVENTION VERSUS NO INTERVENTION/USUAL CARE, Outcome 3 Urinary symptoms ‐ overall.
Analysis 1.4
Analysis 1.4
Comparison 1 INTERVENTION VERSUS NO INTERVENTION/USUAL CARE, Outcome 4 Urinary symptoms ‐ frequency (continuous variables).
Analysis 1.5
Analysis 1.5
Comparison 1 INTERVENTION VERSUS NO INTERVENTION/USUAL CARE, Outcome 5 Urinary symptoms ‐ frequency (dichotomous variables).
Analysis 1.6
Analysis 1.6
Comparison 1 INTERVENTION VERSUS NO INTERVENTION/USUAL CARE, Outcome 6 Urinary symptoms ‐ urgency.
Analysis 1.7
Analysis 1.7
Comparison 1 INTERVENTION VERSUS NO INTERVENTION/USUAL CARE, Outcome 7 Urinary symptoms ‐ nocturia (continuous variables).
Analysis 1.8
Analysis 1.8
Comparison 1 INTERVENTION VERSUS NO INTERVENTION/USUAL CARE, Outcome 8 Urinary symptoms ‐ nocturia (dichotomous variables).
Analysis 1.9
Analysis 1.9
Comparison 1 INTERVENTION VERSUS NO INTERVENTION/USUAL CARE, Outcome 9 Urological measures: mean function of the pelvic floor muscle.
Analysis 1.10
Analysis 1.10
Comparison 1 INTERVENTION VERSUS NO INTERVENTION/USUAL CARE, Outcome 10 Health status: mean total score SF36.
Analysis 1.11
Analysis 1.11
Comparison 1 INTERVENTION VERSUS NO INTERVENTION/USUAL CARE, Outcome 11 Quality of life.
Analysis 1.12
Analysis 1.12
Comparison 1 INTERVENTION VERSUS NO INTERVENTION/USUAL CARE, Outcome 12 Function: mean Barthel score (continuous variables).
Analysis 1.13
Analysis 1.13
Comparison 1 INTERVENTION VERSUS NO INTERVENTION/USUAL CARE, Outcome 13 Function: people independent in transfer from wheelchair to toilet (dichotomous variables).
Analysis 1.14
Analysis 1.14
Comparison 1 INTERVENTION VERSUS NO INTERVENTION/USUAL CARE, Outcome 14 Patient satisfaction.
Analysis 1.15
Analysis 1.15
Comparison 1 INTERVENTION VERSUS NO INTERVENTION/USUAL CARE, Outcome 15 Cost/service use.
Analysis 3.1
Analysis 3.1
Comparison 3 INTERVENTION VERSUS PLACEBO, Outcome 1 Severity of incontinence: mean number of incontinence episodes per week.
Analysis 5.1
Analysis 5.1
Comparison 5 COMBINED INTERVENTION VERSUS SINGLE INTERVENTION, Outcome 1 Number of people with incontinence after treatment.
Analysis 5.2
Analysis 5.2
Comparison 5 COMBINED INTERVENTION VERSUS SINGLE INTERVENTION, Outcome 2 Severity of incontinence: mean number of incontinence episodes.
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Update of

References

References to studies included in this review

    1. Brittain KR, Potter JF. The treatment of urinary incontinence in stroke survivors (MS9). Report for NHS R&D Programme on Cardiovascular Disease and Stroke Project, Division of Medicine for the Elderly, Dept of Medicine, University of Leicester, in collaboration with the MRC Incontinence Study2000. - PubMed
    1. Chu M, Feng J. Discussion on treating frequent urine due to multiple cerebral embolism with scalp acupuncture (Translation from Chinese). Information on Traditional Chinese Medicine 1997;5:42.
    1. Gelber DA, Swords L. Treatment of post‐stroke urinary incontinence (Abstract). Journal of Neurologic Rehabilitation 1997;11(2):131.
    1. Gelber DA, Swords L. Treatment of post‐stroke urinary incontinence (Abstract). Journal of Neurologic Rehabilitation 1997;11:131.
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References to studies excluded from this review

    1. Cook D, Huboky E, Hasskarl J, Hochrien S, Reding M. Effect of voiding position on urinary retention post stroke. Journal of Stroke and Cerebrovascular Diseases 1998;7:382.
    1. Gross J C. Bladder dysfunction after a stroke: it's not always inevitable. Journal of Gerontological Nursing 1990;16:20‐5,41‐2. - PubMed
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References to studies awaiting assessment

    1. Engberg S, Sereika SM, McDowell J, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. Journal of Wound, Ostomy and Continence Nursing 2002;29(5):252‐265. - PubMed
    1. McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, Engberg R. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. Journal of the American Geriatrics Society 1999;47:309‐318. - PubMed

Additional references

    1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the standardisation subcommittee of the International Continence Society. Neurourology and Urodynamics 2002;21:167‐68. - PubMed
    1. Arunabh MB, Badlani GH. Urologic problems in cerebrovascular accidents. Probl Urol 1993;7:41.
    1. Barer DH. Continence after stroke: useful predictor or goal of therapy?. Age & Ageing 1989;18(3):183‐91. - PubMed
    1. Barrett JA. Bladder and bowel problems after a stroke. Reviews in Clinical Gerontology 2001;12:253‐67.
    1. Brittain KR. Urinary symptoms and depression in stroke survivors. Age & Ageing 1998;27(Suppl 1):116‐7.