Incontinence is a common secondary effect after brain injury that can often be improved with the right approach.
In today’s article, we’ll discuss how the brain controls bladder and bowel function, and what you can do to minimize accidental leaking.
Causes of Incontinence After Brain Injury
Incontinence is the involuntary loss of control over the bladder or bowels, or both. It occurs when the connection between the bladder and the brain is disrupted, among other reasons.
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 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, you are not in charge of deciding when to empty anymore.
Types of Incontinence After Brain Injury
It might seem at first that all incontinence is the same. But depending on where the brain damage occurred, it could affect different aspects of the voiding process.
The four main types of incontinence are:
- Stress incontinence. Leakage occurs when you cough, laugh or sneeze. It is caused by weakened pelvic floor muscles.
- Overflow incontinence. This occurs when you cannot empty the bladder completely 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.
- Urge incontinence (overactive bladder). With this type, 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 afterwards making them have to rush to the bathroom in order to avoid leaks.
- Reflex incontinence. With reflex incontinence, there is no warning or urge to use the restroom, the bladder just automatically empties itself when full. This is the most severe form of incontinence.
Besides these four, another form of incontinence a person can develop is functional incontinence.
With this type, the connection between the brain and the bladder remains. But 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 dementia patients, but can also occur in severe brain injury survivors. Especially at the beginning of their recovery, when they might have post-traumatic amnesia.
Managing Incontinence After Brain Injury
Overcoming incontinence will take patience and dedication, but it is possible.
The following are some of the best methods for managing incontinence after brain injury.
These exercises help retrain your brain to hold back the urge to release the bladder. It works by activating your brain’s natural healing mechanism, neuroplasticity.
To trigger neuroplasticity, you must use lots of repetition. This means you will need to practice bladder and bowel retraining consistently if you want to see results.
First, schedule bathroom visits at least every hour. Then, when 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.
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.
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 will only inflame the bladder and make incontinence worse.
Pelvic Floor Muscle Exercises
These exercises will strengthen the pelvic floor muscles, the muscles that control your bladder.
To do them, simply squeeze the muscles you use to stop urinating.
There are two different 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 stretches of time. 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.
Catheters and Medications
In severe cases, where you have no control or sensation of your bladder at all, doctors may recommend using a catheter.
Most of the time they will give you an indwelling catheter, which can be removed easily. If you require a more permanent solution, doctors might install a suprapubic catheter, which is surgically implanted into the bladder.
There are also medications that can reduce urination frequency. These meds are not safe for everyone however, so talk to your doctor before trying them.
Tips for Living with Incontinence After Brain Injury
Even though it is possible to overcome incontinence, 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 zips or buttons so they can be removed quickly.
- Keep hand sanitizers and wipes with you wherever you go.
- Set alarms on your phone to remind you when to visit the restroom.
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. And as your brain continues to heal, you should start to see your incontinence fade.
We hope this article helps you find ways to manage your incontinence after brain injury with the dignity you deserve.
Featured Image: ©iStock/AaronAmat