Lower Urinary Tract Symptoms in Stroke Patients

Abstract: The overall aims of this thesis were to investigate the prevalence, severity and bother of Lower Urinary Tract Symptoms (LUTS) in a clinical sample of stroke patients and to evaluate the effect of pelvic floor muscle training (PFMT) in women with urinary incontinence after ischemic stroke. The thesis consisted of 6 articles based on 4 studies and a review. In the first study (Paper I), the Danish Prostatic Symptom Score (DAN-PSS -1) questionnaire was tested in 71 stroke patients by a prospective questionnaire-based survey and demonstrated acceptable test-retest reliability and that this system was useful in stroke patients of both genders. Secondly the prevalence, severity and bother of LUTS were investigated in a cross-sectional, clinical survey of 482 stroke patients (Paper II). The response rate was 84 %. The period prevalence of at least one symptom of LUTS was 94 % and the most frequent symptom was nocturia (76 %). The most severe symptom was urgency and among respondents who had at least one symptom the prevalence of bother was 78 %. The extent of self-reported activity limitations were also assessed in this clinical sample of 482 stroke patients in order to identify whether activity limitations related to prevalence, severity and impact on daily life of LUTS (Paper III). The extent of self-reported activity limitations varied from 17 % to 34 % depending on the measurements and the mobility velocity was highly significantly correlated to severity of LUTS. In the next study the effect of 12 weeks Pelvic Floor Muscle Training (PFMT) in 26 women with urinary incontinence after ischemic stroke was evaluated in a prospective, randomized and single-blinded study design (Paper IV-V). Twenty-four subjects completed the study and a significant improvement in frequency of voiding in daytime (p=0.018), 24-hours pad test (p=0.013) and dynamic endurance of pelvic floor muscle (p=0.028) was demonstrated in the Treatment Group compared to the Control Group. The long-lasting effect of PFMT was evaluated by a 6-month follow-up study and measured by quality of life parameters (Paper VI). The sample consisted of 24 women, who had completed the initial study. In the Treatment Group a trend to long-lasting effect compared to the Control Group was found. In conclusion, the prevalence of LUTS and its bother was very high in stroke patients and the most severe symptom was urgency. PFMT had a significant effect in women with urinary incontinence after stroke and increased focus on LUTS and the possibilities of training can highly be recommended.