Continence after stroke: useful predictor or goal of therapy?

Natural-history data from 362 conscious stroke victims, taking part in an acute intervention trial, were used to explore the prevalence and time course of recovery of urinary incontinence, associations with other variables and the relationship between bladder control and neurological, functional and overall outcome. More than half the patients were incontinent when first seen, at a mean of 24 h after onset, but this proportion fell to 29% by 1 month and was halved again by 6 months. Outcome was so much better in those who remained or became dry that it seems possible that recovery of continence may promote morale and self-esteem which could actually hasten overall recovery. A controlled trial of a rehabilitation programme, concentrating on restoration of bladder control in the early stages of stroke, is now needed to test this possibility.