Incidence of and Risk Factors for New-Onset Urinary and Fecal Incontinence After Acute Stroke

ABSTRACT Background and Purpose Understanding the risk factors for incontinence after acute stroke allows for early identification and treatment of patients who are likely to experience this complication. This study estimates incidence of urinary and fecal incontinence (UI and FI) after stroke in adults and examines the association of risk factors. Methods Screening data of a prospective study were analyzed. Included were 652 consecutive patients admitted to an acute stroke unit over a 15-month period beginning May 2021. Those with pre-existing UI or FI were excluded from the analysis. Bivariate analyses examined unadjusted relationships between both UI and FI and age, sex, stroke severity, premorbid disability, stroke type, and stroke anatomical site. Regression analyses were performed to build iterative models. Results A total of 418 patients had an acute stroke without pre-existing incontinence. The median age of stroke survivors was 76 years ( IQR 66-84), 58% were men, and 76% had an ischemic stroke. Within the first 7 days after stroke, 128 (29%) had UI and 115 (26%) had FI. Increasing age, premorbid disability, and stroke severity increased the risk of both new-onset UI and FI after stroke. Those with intraventricular hemorrhage were 2.9 times more likely to develop UI. Women were 1.7 times more likely to have UI after stroke than men. Intraventricular hemorrhage increased the risk of new-onset FI after stroke by 2.9 times, while lobar hemorrhage increased the risk by 2.2 times. Conclusions Urinary and fecal incontinence continue to be relatively common after acute stroke, although incidence rates are lower than 20th century estimates. Patients are more likely to require incontinence assessment, monitoring and care if they are older, had higher premorbid disability, and have experienced more severe stroke or intraventricular hemorrhage. Provision of continence care and rehabilitation remain essential components of stroke services.