What no one told you about marriage after stroke

Maintaining a happy marriage can be challenging for any couple, but when one partner is recovering from stroke, new marital problems may arise. 

Although every stroke is different and each recovery is unique, emotional changes and physical disabilities are likely to change a survivor’s marriage. While some people may recover quickly, others may need long-term support to regain their independence.

Relationship problems after stroke are not uncommon. The work of realigning the husband and wife role-identities is complex, as couples have to rethink the meaning of their relationship in the new context of care.

According to the UK Stroke Association, strokes could disrupt the basal ganglia part of the neuronal system that is linked to emotions, leading to behavioural and emotional problems that put a strain on romantic relationships.

Physical changes, such as muscle weakness, fatigue, continence problems, hormone imbalances and other medical conditions, are also likely to impact a stroke survivor’s marriage and sex life as well as their mood, confidence and self-esteem.

“Strokes can be life changing and can put relationships under a lot of stress,” says Dr Terrence Quinn, from the School of Cardiovascular and Metabolic Health of the University of Glasgow and member of the British and Irish Association of Stroke Physicians (BIASP).

“Although we see various physical changes, the real problem is with what we sometimes call ‘the hidden effects of stroke’.

“If someone has a stroke and they’re left with visible effects like a weak arm or a weak leg, people try their best to make adjustments and understand what that person is going through. However, the less visible effects, such as low mood or memory problems, are much more difficult to understand and loved ones often shy away from them.”

Researchers from the University of Alberta have found that in a third of marriages they analysed, both survivors and their spouses were dissatisfied with their love lives.

Nick Clarke, a stroke survivor and founder of the StrokeInformation charity, says that as survivors come to terms with what happened to them, relationship disconnect is almost inevitable.

“A lot of survivors don’t carry on with their relationship, because their partners struggle to understand what they’ve been through. The survivors did not change. What changed is the way they had to adapt to their new life after stroke.”

Experts say that communication is key in making sure that both partners feel valued and suggest finding a balance between discussing openly and protecting each other’s self-esteem.

“Speaking about these feelings and listening to each other is incredibly important,” says Dr Quinn.

“Although the damage and disruption that’s been caused by Covid is something that we’re only beginning to realise, we know that many stroke survivors really benefit from having these conversations with their loved ones or with support groups through organisations such as the Stroke Association or Chest Heart and Stroke Scotland.”

Some American studies have suggested that having an active, healthy lifestyle can also help improve stroke patients’ health, as well as their sexual and emotional wellbeing.

However, many of these preventative measures get overlooked, says Clarke, adding that the lack of education remains an issue.

“We are not educating people enough and I think the lack of knowledge is one of the reasons why people fail to understand their partners after stroke.”

Kate Allatt, sexuality and disability clinical trainer and SR Times columnist, agrees. “Very few stroke survivors are able to go from lovers to carers back to lovers again.

“Occupational therapists often lack the skills, confidence and knowledge to start difficult conversations about sexuality and are inhibited by their own judgements.

“While education, signposting and creating safe spaces for service users to talk about sex and intimacy can help, we need to do much more to improve support and training for occupational therapists to start these difficult, but vital conversations.”

For emotional support stroke patients can contact the Stroke Helpline.

For more information about Kate Allatt’s online interactive training, visit kateallatt.com.