*3.1.3 Pathophysiology of post-stroke urinary incontinence*

Damage to the midbrain that responsible for micturition can result in an inability to coordinate bladder contractions with urethral sphincter relaxation. After a stroke, the brain may enter a transient phase of acute brain shock. During this time, the bladder will be in retention – detrusor areflexia. After the brain shock phase subsides, the bladder exhibits detrusor hyperreflexia (overactivity of the bladder detrusor) with coordinated urethral sphincter activity. This occurs because the pontine micturition center (PMC) is responsible for suppressing the periaqueductal


## **Table 1.**

*Types of post-stroke urinary incontinence and their causes.*

gray (PAG) which is located in the midbrain and directs the urethral sphincter and bladder wall muscle activity to maintain bladder control, cause the weakening of these processes [12]. When the pontine is damaged by a stroke, hyperreflexia of the detrusor muscle can occur, causing symptoms of "frequency" and "urge" to urinate [13]. Sensation of urinary urgency is characterized by more frequent micturition throughout the day and night [14].
