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Incontinence After Brain Injury: Why It Occurs and How to Manage It

nurse helping woman with brain injury manage bladder and bowel incontinence

Incontinence refers to the involuntary loss of bladder and/or bowel control. It is a common secondary effect of brain injury that can affect one’s independence and quality of life. Fortunately, with the right management interventions, incontinence after brain injury can often be improved. 

To help you understand incontinence after brain injury, this article will discuss:

Causes of Urinary Incontinence After Brain Injury

Incontinence after a brain injury primarily occurs because the connection between the bladder and the brain is disrupted.

The brain and the bladder are constantly communicating to ensure that we only urinate when it is appropriate. When the bladder fills up, it sends signals up through the spinal cord into the brain stem that it’s time to void (i.e., empty the bladder).  

In a healthy individual, the bladder will not void until the pontine micturition center, located in the brain stem, sends signals to the muscles of the bladder. But that, in turn, will not happen unless the frontal cortex (the area involved in conscious thought) allows it.

After a brain injury, this process can get disrupted. In some cases, the bladder and brain can no longer send messages to each other and, as a result, individuals lose the ability to control their bladder and bowel functions.

In the following section, we’ll discuss the differences between various types of urinary incontinence that may occur after brain injury.

Types of Urinary Incontinence That May Occur After Brain Injury

Depending on the location of the brain injury, various aspects of bladder and bowel control can be affected. As a result, individuals may experience different types of incontinence.

The four main types of urinary incontinence that may occur following a brain injury include:

  1. Stress incontinence describes leakage that occurs when you cough, laugh or sneeze. It is caused by weakened pelvic floor muscles.
  2. Overflow incontinence occurs when you cannot completely empty the bladder due to weakened muscles or damaged nerves. This leads to unexpected leaks. Leaks can also occur when the bladder is overly full, although you do not feel the urge to void.
  3. Urge incontinence (overactive bladder) describes when the bladder contracts and spasms, even if it is not full, causing leakage. People with this condition may feel like they have to use the restroom constantly. When they feel the urge to go, the bladder will typically spasm very soon afterward, making them have to rush to the bathroom to avoid leaks.
  4. Reflex incontinence occurs with no warning or urge to use the restroom. Rather, the bladder automatically empties itself when full. This is the most severe form of incontinence.

Besides these four, another form of incontinence a person can experience after brain injury is functional incontinence.

With this type, the connection between the brain and the bladder remains intact. However, the person’s physical or cognitive impairments impede them from being able to get to a toilet in time. For example, an individual with severe mobility impairments (weakness, arthritis, etc.) may have trouble getting to the toilet and lowering their pants before having an accident. Or, an individual with severe attention deficits may not notice that they have the urge to go until it is too late.

On the cognitive side, functional incontinence is mostly found in individuals with dementia, but can also occur in severe brain injury survivors, especially at the beginning of their recovery, when they might have post-traumatic amnesia.

Now that you understand the different types of incontinence that may occur after a brain injury, let’s discuss the importance of proper management.

Complications Associated with Incontinence after Brain Injury

woman with incontinence after brain injury experiencing stomach pain

It’s essential to properly manage incontinence after brain injury to prevent further complications from developing.

Complications[1],[2] associated with urinary and fecal incontinence after brain injury include:

  • Skin irritation
  • Pressure ulcers
  • Skin infections
  • Leaking
  • Urinary tract infections
  • Formation of bladder stones
  • Kidney failure

Moreover, lack of bladder and/or bowel control can significantly affect one’s functional independence and social life. Individuals may develop avoidant behaviors due to anxiety about bladder- and bowel-related accidents.

Fortunately, incontinence after brain injury can often be successfully managed, enabling individuals to live their best quality of life.

How to Manage Incontinence After Brain Injury

Overcoming incontinence after brain injury requires patience and dedication, but it is possible for many.

The following are some of the best methods for managing incontinence after brain injury.

Bladder/Bowel Retraining

Bladder/bowel retraining exercises help retrain your brain to hold back the urge to release waste. It works by activating your brain’s adaptive healing mechanism, neuroplasticity.

Plenty of task-specific repetition is essential for promoting neuroplasticity, which means you will need to practice bladder and bowel retraining consistently to see results.

First, schedule bathroom visits at least every hour. Then, while on the toilet, try to hold back for ten seconds before letting yourself go. Gradually increase the amount of time between bathroom breaks (but try not to wait more than a few hours) and how long you hold.

Additionally, it helps to keep a “bladder diary” to record when you last visited the restroom and when any accidents occur. If you notice that incontinence tends to occur at a certain time, schedule your bathroom breaks about 30 minutes before that.

Dietary Changes

Adjusting your diet will help keep the bladder and bowel healthy and reduce accidents. Some advice for a good diet includes:

  • Eat foods with plenty of fiber. This will prevent constipation and other digestion problems.
  • Stay hydrated. While it may sound counterproductive, be sure to drink lots of water. Even though that will make you produce more urine, it will also reduce the risk of bladder infections and teach your bladder to hold more fluid at once.
  • Avoid caffeine and alcohol. Do not consume drinks containing caffeine or alcohol, as they may irritate the bladder and make incontinence worse.

Pelvic Floor Muscle Exercises

Pelvic floor exercises will strengthen the pelvic floor muscles, the muscles that control the release of urine and feces. Kegels are some of the most common exercises used for both men and women to increase control over the pelvic floor. To complete Kegel exercises, simply squeeze the muscles you use to stop urinating.

There are two different types of Kegel exercises you can practice: slow contractions and quick contractions.

Slow contractions will increase your pelvic floor muscles’ stamina, which will allow you to hold your bladder for longer periods. Here’s how to do them:

  • Slowly tighten the pelvic floor muscles and squeeze them for as long as possible. Try to avoid squeezing your thighs and/or abdominal muscles, and don’t hold your breath.
  • Relax for 10-20 seconds, then repeat.
  • Increase the number of seconds you hold until you can do ten slow contractions for ten seconds each.
  • Do these exercises three times each day.

Quick contractions, on the other hand, will increase the strength of the pelvic floor muscles. They will also help prevent leaking when you are coughing, laughing, or exercising. To perform quick contractions, follow these steps:

  • Quickly squeeze the muscles
  • Hold for just one second
  • Relax for three seconds, then repeat
  • Do ten squeezes, three times each day

The more you do these exercises, the stronger the pelvic floor muscles will become. Eventually, you should regain more control of your bladder.

For more specialized treatment, consider asking your doctor to refer you to a physical or occupational therapist with specific training in pelvic floor therapy. There, they may give you different pelvic floor exercises to work on and can use methods such as electrical stimulation and biofeedback to help improve the connection between the brain and the pelvic floor.

Catheterization

In severe cases of incontinence after brain injury, doctors may recommend using a catheter.

Most of the time they will give you an indwelling catheter, which can be removed easilyIf you require a more permanent solution, doctors might install a suprapubic catheter, which is surgically implanted into the bladder.

Individuals who use a catheter should also make sure to regularly check that there are no bends or clogs in the tube to prevent the development of further complications.

Generally, it’s recommended to avoid prolonged catheterization and encourage individuals to start a bladder/bowel retraining program and/or pelvic floor therapy as soon as possible. This helps individuals develop the skills necessary to recover bladder and bowel control. As previously mentioned, the key to recovering skills affected by TBI is to continuously practice them to promote adaptive changes in the brain.

Medications

Depending on what type of bladder and/or bowel problems an individual experiences after brain injury, a doctor may recommend various types of medications.

For example, Botox injections or anticholinergics can help relax the bladder muscles. When the bladder muscles are too tight, individuals often feel the urge to urinate, even when the bladder is not full.

Likewise, individuals who struggle with bowel control after brain injury may benefit from bulking agents, laxatives, or stool softeners.

However, medications can have adverse side effects and may not be safe for all individuals following brain injury. Speak to your doctor to determine what medications may help your specific type of bladder or bowel problem.

Up next, we’ll discuss tips for living with incontinence after brain injury.

Tips for Living with Incontinence After Brain Injury

person holding up absorbent underwear to manage loss of bladder control after brain injury

Even though it is possible to overcome incontinence after a head injury, it will not be a quick or easy fix.

In the meantime, here are some helpful tips for dealing with the effects of incontinence after brain injury:

  • Use incontinence pads and pants to keep fluid away from your skin.
  • Keep an extra set of clothes in your car.
  • Wear pants without zippers or buttons so they can be removed quickly.
  • Keep hand sanitizer and wipes with you wherever you go.
  • Set alarms on your phone to remind you when to visit the restroom.
  • Check your skin using a mirror regularly to ensure that you are not having any skin breakdown, which could lead to a pressure ulcer.

These tips should help you manage the worst aspects of incontinence while you work on retraining your bladder.

Remember, the more you practice controlling your bladder and bowel movements, the better you will get at it. As your brain continues to heal, you should start to see your incontinence fade.

Incontinence After Brain Injury: Key Points

Incontinence after brain injury is the result of disrupted communication between the brain, bladder, and bowel muscles. This can present challenges to one’s functional independence as leakage or discomfort may occur.

Luckily, many individuals learn to effectively improve their incontinence and consequently boost their quality of life.

We hope this article helps you understand why incontinence occurs after brain injury and how to manage it. Good luck!

featured images: iStock/halfpoint/dragana991/FotoDuets

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