After a stroke, your entire life can change. Difficulties speaking, getting out of bed, and dressing can feel overwhelming. Stroke survivors can go through months or even years of physical, speech, and occupational therapy to assist in recovery. However, these are only the visible hardships of a stroke. A stroke can also impact the parts of our bodies that we don’t always see or talk about, including our pelvic health, which includes bladder, bowel, and sexual function. Anything that impacts this part of our body can be more difficult, or even embarrassing, to speak about. But these functions are essential to address to maximize the quality of life after a stroke.
Treatments are available for changes in bowel, bladder, or sexual function after stroke, including interventions such as medications or surgery. Just as therapy can help you return to walking, reading, or bathing yourself, specialized pelvic health therapy exists to address changes in bowel, bladder, or sexual function. Pelvic health therapy is provided by either a physical or occupational therapist. Let’s talk about pelvic health after a stroke and how pelvic health therapy can help.
After a stroke, you may find it difficult to urinate or no longer get the urge to go to the bathroom. This might mean you need to use a catheter to empty your bladder. Over time, you may have a strong desire to go to the bathroom and have trouble making it there in time. You might leak urine whenever you cough, laugh, sneeze, or bend to pick something up. These types of bladder symptoms are common after stroke.
It is reported that 50% of people experience urinary incontinence one month after their stroke, and 17% of stroke survivors still experience incontinence years later. Treatment for urinary incontinence may include medications, nerve stimulation, or surgery.
Pelvic health therapy is also an intervention that can improve bladder health. This may include talking to your pelvic health therapist about timing, amount, and type of fluid intake and whether you are going to the bathroom too much. It may also include instruction in stretches or exercises to improve your overall mobility, the ability to get to the bathroom, or exercises specifically for your pelvic floor muscles. Sometimes manual therapy can help maximize your muscle and nerve function and improve your bladder health.
Just as bladder problems are common after a stroke, so are bowel problems. Some people may experience accidental leakage of solid or liquid stool. This is especially common in early recovery and is reported in 10% - 40% of people. In the longer term, this rate drops to 5%; however, this is still four times higher than the general population.
Over time, it can be more common to experience constipation, which is present in 48% of stroke survivors. Constipation is having a bowel movement less than three times a week and/or having difficulty emptying your bowels, including straining, pushing, or having frequent incomplete bowel movements.
Many people know the medications used to treat constipation, such as stool softeners and laxatives. However, because your pelvic floor and abdominal muscles are also essential to emptying your bowels, they may also need re-training after a stroke. A pelvic health therapist can help you retrain these muscles for more effective bowel movements. They may also teach you about other factors that may improve your bowel movements, including eating habits, exercise, toilet posture, and abdominal massage. They also provide manual treatments to maximize abdominal and pelvic floor function.
Sexual function is complex. It involves an interplay of physical, sensory, psychological, cognitive, behavioral, and relationship factors and societal and cultural influences. A stroke can impact many of these factors. No wonder 50% or more of stroke survivors report experiencing sexual decline after a stroke.
Direct causes of sexual decline can involve a decrease in libido and ability to orgasm, a decrease in vaginal lubrication, and difficulty with erection and ejaculation. Indirect causes include the influence of related medical issues and new medications prescribed after a stroke, such as those used for heart disease and blood pressure. Also, the ability to sense or feel touch in erogenous zones may impact sexual arousal, and the onset of depression or anxiety after having a stroke may affect desire. Finally, your relationship with your significant other may change due to changes in daily demands and stressors.
There are many medications on the market for sexual functioning, including the well-known medications available for erectile dysfunction and the use of hormone supplements such as testosterone or estrogen. There are mechanical devices such as vacuum pumps and penile implants to assist with erections. Lubricants can help with vaginal dryness, which, left untreated, can contribute to painful sex. Relationship, individual, or sex counseling is also available to address psychological factors impacting sexual health.
Many people do not think of physical or occupational therapy when it comes to sexual function, but pelvic health therapists also have training in this area. Pelvic health therapists can provide positioning recommendations based on your body’s impairments, discuss intimacy tools or adaptations, and provide pelvic floor muscle training to assist with sexual function. If sex has become painful, pelvic health therapists are also specially trained to address the nerves and muscles of the pelvic floor, which may be contributing to pain.
When To Talk To A Medical Provider
If you are experiencing issues related to your pelvic health because of your stroke, even if some of the problems were present before your stroke, speak with your medical provider because help is available. The realm of pelvic health therapy has grown beyond treating pregnant and postpartum people and teaching “Kegels.” We have a wide range of training to assist anyone with a pelvis and pelvic floor with the above mentioned issues. Even if you find it challenging to use your pelvic floor muscles, pelvic health therapists can provide many tools, tricks, and tips to address the factors “outside the pelvis” that may be impacting your pelvic health.
The pelvic health therapists at the Spaulding Outpatient Center for Pelvic Health at Care New England have advanced training to evaluate your needs and develop an individualized treatment plan.
Contact us today to get on the road to better pelvic health!
Disclaimer: The content in this blog is for informational and educational purposes only and should not serve as medical advice, consultation, or diagnosis. If you have a medical concern, please consult your healthcare provider, or seek immediate medical treatment.
1 Thomas, L.H., Coupe, J., Cross, L.D., Tan, A.L, and Watkins, C. (2019). Treatment of urinary incontinence after stroke in adults (Review). Cochrane Database of Systematic Reviews, Issue 2. Art. No: CD004462.
1 Kampen, M.V, and Geraerts, I. Evidence for pelvic floor physical therapy for neurological diseases. (2015). In: K. Bo, B. Berghmans, Morkved, S., and Kampen, M.V. (Eds.), Evidence-Based Physical Therapy for the Pelvic Floor: Bridging Science and Clinical Practice, Second Edition (387-388).
1 Lucente, G., Corral, J., Rodríguez-Esparragoza, L., Castañer, S., Ortiz, H., Piqueras, A., Broto, J., Hernández-Pérez, M., Domenech, S., Martinez-Piñeiro, A., Serra, J., Almendrote, M., Parés, D., & Millán, M. (2021). Current incidence and risk factors of fecal incontinence after acute stroke affecting functionally independent people. Frontiers in Neurology, 12. https://doi.org/10.3389/fneur.2021.755432
1 Li, J., Yuan, M., Liu, Y., Zhao, Y., Wang, J., & Guo, W. (2017). Incidence of constipation in stroke patients. Medicine, 96(25). https://doi.org/10.1097/md.0000000000007225
1 Stratton, H., Sansom, J., Brown-Major, A., Anderson, P, and Ng, L. (2020). Interventions for sexual dysfunction following stroke (Review). Cochrane Database of Systematic Reviews, Issue 5. Art. No.: CD011189.