Brain-imaging studies are giving researchers a better understanding of the cause of incontinence after a stroke that could lead to therapies for restoring bladder control in these patients, according to a report published on Thursday.
Urinary incontinence affects up to 79% of patients in the immediate aftermath of a stroke and persists in nearly 40% of survivors one year later, the researchers wrote in the journal Stroke.
"The brain plays a crucial role in regulating the bladder, allowing people to sense bladder fullness and giving them the ability to delay urination until it is socially appropriate or initiate it at will," study leader Dr. Evgeniy Kreydin of the Keck School of Medicine at USC said in a statement.
"Stroke survivors often struggle to suppress unwanted bladder contractions and may even lose bladder sensation and awareness entirely. Since a stroke impacts the brain, it disrupts the normal (nerve) pathways that govern bladder control," he explained.
His team recruited stroke patients with incontinence and healthy volunteers and obtained MRI scans of their brain functions during repeated bladder filling and voiding.
When participants consciously decided when to empty their bladder, both healthy individuals and stroke survivors showed significant activation in brain regions associated with sensorimotor control and executive decision-making.
In contrast, during involuntary or incontinent bladder emptying in stroke survivors, researchers saw minimal cortical activation, suggesting a failure to engage key brain networks necessary for urinary control.
This finding open doors for potential therapeutic interventions, the researchers said.
These might include non-invasive brain stimulation techniques, such as transcranial magnetic stimulation or direct current stimulation, to target the necessary network, or the development of medications that enhance activation in critical continence control regions in the brain.
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