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Incontinence denotes the involuntary loss of bladder and/or bowel control. It is a usual secondary effect of brain injury that can affect one’s independence and quality of life. Incontinence after brain injury results from a disrupted communication between the brain, bladder, and bowel muscles. This can challenge one’s functional independence as leakage or discomfort may occur. Fortunately, incontinence following brain injury can often be improved with the right management interventions.

Urinary Incontinence After Brain Injury- Reasons

Incontinence after brain injury primarily occurs because the association between the bladder and the brain is disturbed.

The brain and the bladder continuously communicate to ensure that we only urinate when appropriate. When the bladder is filled, it sends signals through the spinal cord into the brain stem that it’s time to empty it.

In a healthy individual, the bladder won’t empty until the pontine micturition center, located in the brain stem, sends signals to the muscles of the bladder. But that will not happen until the frontal cortex - the area involved in conscious thought permits it to.

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

Let’s discuss the differences between various types of urinary incontinence that may occur after brain injury.

Types of Urinary Incontinence That Occurs After Brain Injury

Depending on the site of the brain injury, several aspects of bladder and bowel control can be affected. As a result, affected individuals may experience altered sorts of incontinence.

The four chief types of urinary incontinence that occurs after a brain injury include:

• Stress incontinence describes leakage that happens when you cough, laugh or sneeze. Weakened pelvic floor muscles cause it.
• Overflow incontinence occurs when you can’t completely empty the bladder due to damaged nerves or weakened muscles, leading to unexpected leaks. Leaks can also take place when the bladder is too full, although you don’t feel the urge to void.
• 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 soon afterward, making them rush to the bathroom to avoid leaks.

Reflex incontinence occurs with no warning or urges to use the bathroom. Rather, the bladder automatically empties itself when full. This is the most severe form of incontinence.

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

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.

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

Complications Associated with Incontinence after Brain Injury

Women after brain injury, experience stomach pain with incontinence. It’s essential to properly manage incontinence after brain injury to prevent further complications from developing.

Complications 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, a 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.