Bladder incontinence

Brain injury can damage nerve pathways in the brain, causing reduced control over the bladder and intestines. It is also possible that control over bladder and bowels disappears completely.
It can cause incontinence and/or problems with urination, urination and bowel movements. Bladder control is an important way to prevent bladder infections. On this page we only discuss urinary incontinence.

The complaints can be divided into:

• sudden urge to urinate (urgency)
  
• not being able to control urine (urge incontinence)
  
• having to urinate often during the day
  
• nighttime urination (nocturia)
  
• not being able to empty the bladder
  
• bladder spasms with spontaneous urine leakage
  
• urinary tract infection / bladder infection

These complaints can cause shame, stress, decrease social life and even lead to depression.
The brain has a complex task during the filling of urine into the bladder, partly during the discharge of urine, but also the transition from one of these functions to another.
Pelvic floor training may be an option for some incontinence complaints in people who are cognitively able to follow a training course. People then learn:

• how the muscles around the bladder feel
  
• contract and relax the bladder muscles
  
• slowly building up to holding the urine
  
• "Thinking through" previously experienced situations involving accidents
  

Some bladder control can be achieved; however, this usually requires the multidisciplinary approach of a rehabilitation team or a
specialized pelvic floor physiotherapist. See for example here.

Incontinence can cause problems with the skin if the skin is exposed to urine too often.

The risk of urinary tract infections is high if someone has problems urinating or cannot empty the bladder completely. If the brain injury, for example a stroke, is a consequence of diabetes, the risk of urinary tract infections is even greater.
In case the patient cannot feel the urge to empty the bladder, there are other options:

• give a bladder catheter (indwelling catheter)
  
• Inserting and removing a catheter at regular intervals so that the bladder is emptied regularly
  
• plan bathroom breaks
  
• use of an external condom catheter for men
  
• use incontinence material if absolutely necessary.
  

There is a high risk of a urinary tract infection, especially with the use of catheters.