Mar 18, 2019

Constipation for Stroke and Other TBIs: Well, SOMEBODY Had to Write About It and It Might As Well Be Me

I had constipation after the stroke. It wasn't unusual for me to defecate once every 5 or 6 days. A few doctors told me that the muscles in the bowel weren't working correctly. That was the easy answer. And I believed it because nothing was working correctly. I believed it until I did research on constipation. And the doctors may have been wrong

According to researcher
s at the University of Michigan, "Stroke by itself does not cause constipation. But constipation often occurs after a stroke because you 1) are not drinking enough liquids, 2) are in bed most of the time, or 3) are taking certain medicines as part of your treatment. If your constipation is severe, stool can become lodged (impacted) in the bowel."

That was me, all right. All of it. 

In another article in the Annals of Rehabilitation Medicine, the researchers took 55 brain-injured patients. They divided the patients into constipation (number=29) and non-constipation (number=26) groups, achieving 7.32± (plus or minus) 3.63 and 5.04± (plus or minus) 2.46, respectively. 
The constipation group had significantly elevated constipation scores, with prolonged CTT (Colon Transit Time, the colon responsible for producing the bowel) of total right and left colon, and it depended on these factors in a table entitled, "The General Characteristics of Patients with Brain Injury:" 
Total Number of subjects                                   55
Mean age in years                                               61 +- 14.1
Sex (male/female)                                               37/18
Brain injury in months                                       11.1 +- 17.5
Type of brain injury (infarction, bleed, other)  33/20/2
(Press your doctor for where in the brain your injury occurred)
Site of brain injury 
Frontal/Parietal          5
Temporal/Occipital    7
Basal ganglia           24
Thalamus                   6
Multiple                      3
Other                        10

But the article didn't say how much liquid they drank, how much bed rest, or what kind of medicines they took. In my opinion, University of Michigan hit the mark: ie, too little liquids, too much bed rest, and/or medications.

My solution to constipation was when a doctor recommended a stool softener. I was afraid at first because I thought it would give too strong an urge to make it to the bathroom. 

After 5 years of constipation, the stool softener improved my quality of life because I "go" once a day or so without any urgency. And I eat everything that's supposed to be in a healthy diet with no restrictions (except keep a consistent diet of Vitamin K because I'm on Coumadin). See a doctor first because something else may be afoot, but if the doctor says to try stool softeners for constipation, permit the bowel to go forth. I buy the cheap kind from Walmart. 

I'll end with this cartoon that says it all, to both pee (https://stroketales.blogspot.com/2019/03/incontinence-for-stroke-and-other-tbis.html) and poop:




Mar 14, 2019

Incontinence for Stroke and Other TBIs: Well, SOMEBODY Had to Write About It and It Might As Well Be Me

Once upon a time, before I had the stroke, I used to sit for long, agonizing hours at my office desk, and didn't urinate for 12 hours while drinking boatloads of coffee and water. I didn't want to leave my desk for fear the boss wanted something earth-shattering, silly office things, like telling us who passed gas in front of the Director or who got canned because he watched Westerns on his office computer. He always wanted us available for things. Things that could wait

As a result, I got used to not peeing. I developed a remarkably humongous bladder (5 doctors at 5 offices in 3 different states said so after I had CT scans) and I had, I might add, constant UTIs (urinary tract infections). You're supposed to "pee" after drinking massive amounts of fluid.


Anyway, despite my inordinately large bladder, I developed incontinence after I had my stroke. I was constantly leaking. So I took to Poise to help with the embarrassment, larger and thicker pads until I was at #6, the Ultimate. Ultimate absorbency, the ominous sign above a grocery shelf said. Ultimate absorbency. I had reached the limit. 


Why was this happening? Soon, in about a week's time of research, I had my answers. And we're off!


No matter how you explain it, everything comes from the brain. And The American Urological Association (AUA) has a simple answer. 


It's called a neurogenic bladder, or bladder dysfunction. 


"The bladder and kidneys are part of the urinary system," the AUA says. "These are the organs that make, store, and pass urine. When the urinary system is working well, the kidneys make urine and move it into the bladder. The bladder is a balloon-shaped organ that serves as a storage unit for urine. It is held in place by pelvic muscles in the lower part of your belly."


The AUA goes on to say that the nerve signals in your brain let you realize that your bladder has to empty itself. Then the  brain tells the bladder muscles to contract, allowing urine out through your urethra, the tube that carries urine out of your body. Your urethra muscles are called sphincters that keeps the urethra shut until you're ready to "pee." 


If these nerves are damaged by illness or injury, the muscles may not be able to relax or tighten at the correct time. As a result, bladder muscles may be overactive and squeeze more often than normal before the bladder is full, or sometimes the muscles are too relaxed and let urine come out before you're ready, or sometimes the sphincter muscles around the urethra remain tight when you are trying to empty, and sometimes people have both overactive and underactive bladder at different times. Don't bother with the distinctions. If you're leaking or gushing, you're wet to some degree. 
Maybe you're a visual learner, so how about this? Remember. Start at the top with the brain.



If you have neurogenic bladder, or incontinence, see your doctor. It can't be cured, but it can be managed. 

I came across 2 interesting therapies, the one involving surgery, the other a needle:


Sacral Neuromodulation: When drugs or lifestyle changes don't help, there's sacral neuromodulation. The sacral nerves carry signals between your spinal cord and the bladder, allowing the surgeon to place a narrow wire in proximity to the sacral nerves. A wire is connected to a small, battery- operated device that is placed under your skin. The harmless electrical impulses to the bladder stop the signals that can cause the bladder to leak.


Percutaneous Tibial Nerve Stimulation: This type of  neuromodulation involves a needle that's inserted into a tibial nerve in your leg, most likely the ankle. The needle, connected to a device that emits electrical impulses, travel to the tibial nerve, and then to the sacral nerve. This procedure is done in your doctor'ss office, and patients ordinarily receive 12 treatments for top results. 


The AUA says that certain drinks, foods, and medications may act as diuretics, stimulating your bladder to "go" more often. They include:

  • Alcohol
  • Caffeine
  • Chocolate
  • Carbonated drinks and sparkling water
  • Heart and blood pressure medications, sedatives, and muscle relaxants
  • Large doses of vitamin C


Persistent urinary incontinence may be caused by underlying changes, including:
  • Neurological disorders, like stroke or other TBIs 
  • Pregnancy
  • Childbirth
  • Age changes
  • Menopause
  • Hysterectomy
  • Enlarged prostate
  • Prostate cancer
  • Obstruction, such as a tumor or urinary stones
  • Hysterical laughing or annoying coughing


Risk factors that increase your risk of developing urinary incontinence include: 
  • Gender
  • Age that weakens the muscles involved with urination
  • Being overweight
  • Brain injury
  • Smoking
  • Family history (lousy genes will get you every time)
  • Other neurological diseases 
  • Diabetes

As I said before, urinary incontinence may not be preventable, but you have to maintain a healthy lifestyle, including: 
  • Maintain a gender-specific correct weight
  • Practice pelvic floor exercises 
  • Avoid bladder bothers listed above 
  • Don't smoke, the perennial favorite
  • Avoid constipation by eating more fiber, constipation being one of the causes of urinary incontinence
Easier said than done? Maybe. But as the quote-worthy Mark Twain once said, "The only way to keep your health is to eat what you don't want, drink what you don't like, and do what you'd rather not." 

I think Mark Twain nailed it.