CVA and Urinary Incontinence

CVA, also referred to cerebrovascular accident and a stroke, occurs when a significant reduction or complete interruption to the brain’s blood supply occurs. This results in the brain tissues being deprived of nutrients and oxygen. Within just a few minutes, brain cell death begins. Twenty percent of are hemorrhagic and eighty percent of strokes are ischemic. CVA and urinary incontinence is a concern of many stroke patients.

Signs and Symptoms of a Stroke

The signs and symptoms depend on the location of the stroke. CVA and urinary incontinence occurs when the location of the stroke is the anterior cerebral artery. A stroke in this location of the brain is uncommon. In addition to urinary incontinence, patients can experience contralateral hemiparesis, apathy, poor judgment, grasp reflex, confusion, mutism, and gait apraxia.

General stroke symptoms also occur. These include difficulty walking, numbness or paralysis affecting one side of the body, headache (sudden and severe), difficulty speaking, and difficulty seeing.

Diagnosing a CVA

A cerebrovascular accident is a medical emergency and patients who think they may be having a stroke must seek immediate medical attention. Once a patient arrives at the hospital they will first be stabilized. Then the doctor will perform testing to determine what type a stroke the patient is experiencing. Such testing may include a carotid ultrasound, computerized tomography, echocardiography, arteriography, magnetic resonance imaging, and a physical examination. During the physical examination the doctor will use a stethoscope to try and hear a whooshing sound over the arteries. If this whooshing sound is present, it may indicate atherosclerosis, a risk factor for CVA.

Treating a CVA

During a stroke aspirin and a tissue plasminogen activator may be administered. Aspirin is a blood thinner that can be beneficial to patients having an ischemic CVA. However, aspirin should not be given to patients having a hemorrhagic stroke because it can worsen the bleeding. Because of this patients should not take aspirin on their own at home when they are, or think they are, having a stroke. A tissue plasminogen activator injection may benefit some patients during a stroke. It is a very potent drug that can break up clots in those who have had a stroke to help ensure a fuller recovery. However, this drug can only be administered to patients within three hours of them having a stroke, and it can only be given if the doctor is absolutely sure that it will not lead to more bleeding. Because of this a tissue plasminogen activator injection cannot be given to patients having a hemorrhagic stroke.

Other procedures and surgeries may be done to help treat stroke patients. Stents and angioplasty may be done to prevent strokes in the future, or for patients who are unable to have surgery. Carotid endarterectomy involves removing any plaques that are blocking the carotid arteries. Hemorrhagic strokes may be treated with aneurysm embolization (coiling), aneurysm clipping, or surgical AVM removal.

CVA and urinary incontinence is something that can occur. The treatment method used will depend on the severity and type. Behavioral techniques may be beneficial for some urinary incontinence patients. These techniques include scheduled toilet trips, bladder training, and diet and fluid management. Physical therapy techniques, such as pelvic floor muscle exercises, may help to strengthen the pelvic floor muscles and urinary sphincter to help the patient better control their urination. Medications, such as topical estrogen, anticholinergics, and imipramine, may help to lesson incontinence episodes when combined with either physical therapy, behavioral therapy, or both.

Resources

Merck Manuals Online Medical Library. (2010). Cerebrovascular Accident. Retrieved on February 28, 2010 from Merck Manuals: https://merck.com/mmpe/sec16/ch211/ch211a.html

Mayo Clinic. (2008). Stroke. Retrieved on February 28, 2010 from the Mayo Clinic: https://www.mayoclinic.com/health/stroke/DS00150

Mayo Clinic. (2009). Urinary Incontinence. Retrieved on February 28, 2010 from the Mayo Clinic: https://www.mayoclinic.com/health/urinary-incontinence/DS00404

Image Credits

Pills and Syringe: forwardcom – Wikimedia Commons