Neurological Incontinence: Causes, Symptoms and Management

16 January 2018

Neurological incontinence is the involuntary leaking of urine or faeces as result of a problem with the nervous system (brain, spinal cord or nerves). Damage to the nervous system can be through trauma or an underlying disease.

Neurological disorders and incontinence are not necessarily linked. This means that just because someone has incontinence, doesn’t mean they have a neurological problem and also if someone has a neurological problem they will not neccesarily have or develop incontinence.

That said, neurological conditions can increase the chances of developing incontinence related problems.

What Happens When There is Neurological Damage?

Normally there are a collection of nerves around the bladder that control the muscles of the urinary tract and sphincter. These nerves allow communication between the brain and bladder, which lets you control where and when you go to the toilet

Any disruption in this communication can result in a lack of bladder control. Some of the common problems could include spastic involuntary contractions of the bladder or a more flaccid, overextended bladder that does not empty properly and results in dribbling and leaking.

In addition, you may also be at risk of more serious complications such as recurrent infections.

Causes of Neurological Incontinence

There are a combination of diseases and injuries that can lead to neurological incontinence.

These include:

  • Parkinson’s Disease
  • Multiple Sclerosis
  • Dementia
  • Stroke
  • Spinal Cord Injuries
  • Central Nervous System Tumours
  • Diabetes
  • Long-Term Alcoholism

These conditions can lead to an interruption in the signals to and from the brain. Although bladder function is automatic, it is the brain that decides when and where it is emptied.

If the nerves surrounding the bladder are damaged, it is unable to communicate with the brain to control urination. This can result in urge incontinence and the involuntary leaking of urine.

In addition, the bladder can become either overactive or under-active depending on the nerves involved.

Symptoms

Varying symptoms can develop as a result of neurological incontinence depending on the nature and extent of the damage to the nervous system;

Overflow Incontinence

If there is damage to the communication channels between the brain and bladder, the need to urinate may be decreased. This results in the bladder filling up without the usual urge to urinate. This could therefore lead to urine overflow.

Frequency

Damage to the nerves that surround the bladder can interrupt the normal signal. This can lead to a feeling of bladder fullness when there is none. This means you need to go to the toilet more frequently.

female incontinenceUrgency and Urge Incontinence

Retention is the inability to empty the bladder because of surrounding nerve damage. It can cause severe discomfort and pain, and can lead to overflow leakage as well as urinary tract infections.

Weak Urine Stream and / or Dribbling

It is usually a flaccid or weak bladder that causes dribbling. Surrounding nerve damage stops the bladder muscle contracting as it should, which in turn causes urine to flow freely down the urethra without any control.

Painful Urination Due to Urinary Tract Infections

Any kind of incontinence can put you at high risk of infection. Urinary tract infections are most common in these scenarios and are usually treated with antibiotics. Cleanliness is an important part of preventing infections.

Skin Rashes and Irritation

If urine or faeces is exposed to the skin for extended periods, it can lead to irritation and inflammation of the skin. Secure pads or pull-up pants can be an effective solution to keeping the skin dry.

Treatment

Treating incontinence is most often focused on the type of incontinence presented.

Surgery can be a more permanent way of treating certain long-term causes of incontinence, or where there has been significant neurological damage. An operation to widen the sphincter can help decrease resistance in the bladder outlet, which can then maximise bladder emptying. In other cases, the sphincter or pelvic muscles can be surgically tightened to improve bladder control.

Pelvic Floor Exercises

A more behavioral approach such as bladder training or pelvic floor exercises can be effective in treating urge incontinence, but can be useful in many other types of incontinence as well. Medication can be prescribed in a variety of settings for different types of incontinence.

These can help improve bladder muscle control and prevent involuntary muscle contractions. Muscle relaxants, antispasmodics and anticholinergic drugs (which block the neurotransmitter acetylcholine) can be helpful in many cases.

Severe cases of overflow incontinence are best treated with a catheter to help empty the bladder fully. These can be long or short-term placements. Some patients can get instruction on how to insert their own catheters when needed.

Certain kinds of incontinence require treating underlying causes such as urinary tract infections or managing other symptoms of neurological damage.

To control symptoms, absorbent products can be extremely effective. Although they are helpful in controlling leaks and odours, they should not be used as a cure for incontinence.

It is important to speak to a doctor to determine the best course of treatment.

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