Urinary incontinence in neurological disease: assessment and management

Finding out what is wrong

If you have a neurological condition and have or develop urinary problems, a healthcare professional should do an initial assessment to find out the type of problem. An assessment should also be carried out if your symptoms change and periodically to ensure that you are receiving the best care.

Your healthcare professional should ask questions about your urinary symptoms, your neurological condition, any other health problems you have (such as bowel or sexual problems) and your use of any medications and therapies. You should have an examination that includes checking your blood pressure and examining your abdomen and genitals, and you may be offered a vaginal or rectal examination if your healthcare professional thinks it would be helpful. Your healthcare professional should also assess your neurological condition, which might involve testing your ability to walk or move around, the use of your hands, checking your spine and assessing your mental ability and memory.

A sample of your urine should be taken to perform a 'dipstick test'. This test can help to detect an infection or may suggest other possible problems that may contribute to your urinary problem. If the results suggest you may have an infection, your urine should be sent for further testing (a bacterial culture test and an antibiotic sensitivity test) to help decide what type of antibiotic treatment is most suitable for you.

You or a family member or carer should be asked to keep a 'bladder diary' to record how much fluid you drink, how often you urinate and how much urine you pass. You should keep the diary for at least 3 days.

If you are able to urinate, your healthcare professional may measure your 'urinary flow rate'. This involves you passing urine into a special urinal or toilet that measures the amount of urine released and how fast it comes out.

You should then be offered an ultrasound scan to measure how much urine is left in the bladder after you urinate. And you may be offered several further scans on different occasions to look at how your bladder empties at different times and in different circumstances.

People with some neurological conditions, such as spina bifida and spinal cord injury, are at particular risk of kidney problems. If you are considered at high risk of kidney problems you may also be offered an ultrasound scan of the kidneys. You should also be offered tests called video-urodynamic investigations (see box on urodynamic investigations, below).

If you are not at higher risk of kidney problems, you should not usually need urodynamic investigations. However, you should be offered them before undergoing any surgery for urinary problems.

You should be referred to a specialist (called a urologist) for urgent investigation if you have any of the following:

Urinary problems can sometimes cause unexplained changes to your neurological symptoms (such as worsening spasticity or confusion). Your healthcare professional may offer assessment and treatment for urinary disease if this is suspected.

You may also need to be referred to a neurology specialist if your healthcare professional suspects that your urinary problems are caused by new or worsening neurological disease needing specialist investigation.

Your healthcare professional should also assess the impact of your urinary problems on your family members and carers, and look into how this can be reduced.