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4.4 CoNTINENCE PRoBlEMS
4 • Physical rehabilitation and management
Urinary and faecal incontinence are frequently reported following neurological illness or injury and specifically
following a brain injury. 77 Up to 62% of patients will have urinary incontinence issues at admission, reducing
to 18% at six months post injury. 78 The frequency of faecal incontinence can be correlated to increase in
severity of a brain injury. 79 Urinary disturbances are also associated with a poor overall function following
TBI, including impaired cognitive function. 80,81
A Cochrane review of management of incontinence and constipation in adults with neurological diseases
reported that there was insufficient evidence to make any recommendation on the management of
neurogenic bowel function. 82 The review noted that, in the absence of a robust evidence base, bowel
management protocols will continue to be developed empirically using an individualised and patientcentred
approach.
One very small non-comparative study (n=3) reported that voiding dysfunction can be a significant problem
following brain injury, but that it carried a good prognosis and resolves spontaneously. Treatment with
anticholinergics may be required in the acute phase. 83
A prospective study of 20 patients with moderate or severe TBI reported that motor difficulties are more
frequent in patients with urodynamic abnormalities. The study noted that while only two patients reported
lower tract symptoms when screened using a questionnaire, urodynamic evaluation revealed abnormalities
in 55% of the patients. Subtle dysfunction may not be clinically evident but can be picked up on urodynamic
evaluation and may have short and long term implications. 80
Further advice on the care and treatment of people with a neurological condition and urinary incontinence
can be found in NICE clinical guideline 148: urinary incontinence in neurological disease. 84
It is not possible based on the evidence reviewed to make a specific recommendation for treatment of
incontinence in patients with brain injuries. However, the suggestion in studies of the influence of cognitive
impairment and incontinence would suggest that an individualised approach including behavioural
management strategies could influence a positive outcome.
Full assessment of bladder and bowel function should be undertaken over a period of days following
admission. The physical, cognitive and emotional function of the patient should be considered and
the multidisciplinary team should be involved to plan an individualised approach.
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