Diaphragm Function and Urinary Incontinence in Stroke

N/ANot Yet RecruitingNCT07048210

Istinye University50 enrolled

Overview

Stroke affects respiratory functions by causing structural and strength impairments in both inspiratory and expiratory respiratory muscles. Weakening of the diaphragm leads to a decrease in maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), which may result in respiratory insufficiency, postural instability, and urinary incontinence (UI). Additionally, post-stroke reduction in diaphragmatic mobility and decreased activity of the diaphragm and abdominal muscles on the paretic side may disrupt the piston mechanism between the diaphragm and pelvic floor muscles. These mechanical changes may trigger the development of urinary incontinence. This study aims to investigate the relationship between diaphragm muscle strength and endurance and urinary incontinence in 50 stroke patients. In addition, diaphragmatic function and posture-related respiratory changes will be evaluated using functional tests based on the Dynamic Neuromuscular Stabilization (DNS) approach. The relationship between respiratory muscle strength (MIP, MEP) and endurance and the scores of the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) will be analyzed. Furthermore, individuals with and without urinary incontinence symptoms will be evaluated in terms of diaphragmatic function and contribution to respiration.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Stroke

Eligibility

Sex: ALLMin age: 40 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Aged between 40 and 75 years, * Diagnosed with hemorrhagic or ischemic stroke confirmed by computed tomography (CT) or magnetic resonance imaging (MRI) conducted by a specialist physician, * Presence of urinary incontinence, * No other orthopedic, rheumatologic, or neurological diagnoses apart from stroke, * Ability to understand the investigator's instructions and a score of ≥24 on the Mini-Mental State Examination (MMSE), * Voluntary participation in the study, * Ability to speak and understand Turkish. Exclusion Criteria: * Presence of serious diseases affecting vital organs such as the heart, lungs, liver, or kidneys, * Presence of a genitourinary infection, * Pelvic organ prolapse at stage 3 or higher, * Uncontrolled cardiopulmonary or unstable chronic diseases, * Presence of one or more neurological disorders that may cause balance impairments, * Severe cognitive, speech, or visual impairments, * History of urogynecological surgery within the past 6 months, * History of abdominal surgery within the past 6 months.

Outcomes

Primary Outcomes

Diaphragm Muscle Function

Diaphragm muscle function will be assessed using the Dynamic Neuromuscular Stabilization (DNS) approach. The evaluation consists of three components: (1) the diaphragm's contribution to respiration, (2) its role in postural stabilization, and (3) active respiration during postural stabilization. Each component will be rated separately using a 4-point scale: none (3), mild (2), moderate (1), and severe (0). Higher total scores reflect greater impairment in diaphragm-related respiratory function.