Urinary incontinence in neurological disease: assessment and management

Training programmes

If your urinary symptoms are caused by problems with storing urine in the bladder, you may be offered a training programme after a specialist assessment to check if your condition is suitable for this treatment. Training programmes include different methods aimed at changing the pattern of urinating, for example by urinating at set times rather than when your bladder feels full, gradually increasing the time between urinating or delaying urination, or identifying your pattern of urination and using it to predict and avoid incontinence (habit retraining). You and/or your family or carer should also be given information to help understand the training and how the bladder and urethra work.

Medications

You should be offered a type of drug called an 'antimuscarinic drug' (which work by relaxing the bladder muscle) if you have spinal cord disease (such as spinal cord injury or multiple sclerosis) and symptoms of an 'overactive bladder' such as needing to urinate more frequently, an urgent and sudden need to urinate, or incontinence. Your healthcare professional should take into account the possible side effects (such as a dry mouth, blurred vision, impaired thinking and constipation) and increased risk of urinary tract infection associated with these drugs.

You may also be offered an antimuscarinic drug if your neurological condition affects your brain (such as cerebral palsy, head injury or stroke) and you have symptoms of an overactive bladder, or if you have had urodynamic investigations that show you have problems with storing urine in your bladder.

If you are taking an antimuscarinic drug and are not using a catheter, the amount of urine left in your bladder after urination should be monitored because you may be at increased risk of infection or need a catheter to help with draining urine.

Bladder injections

Adults with spinal cord disease should be offered an injection into the bladder wall with a drug called 'botulinum toxin type A' (which works by relaxing the bladder muscle) if antimuscarinic drug treatment is not successful.

Bladder injections are also an option for children and young people with spinal cord disease in whom antimuscarinic drug treatment is not successful.

Before offering you bladder injections, your healthcare professional should explain to you and/or your family and carers that after the injections you may not be able to pass urine normally and you may need to start using a catheter to empty your bladder. They should discuss with you whether you are able and willing to use a catheter if needed.

If you are having treatment with bladder injections and do not use a catheter, the amount of urine left in your bladder after urination should be monitored. If your doctor thinks that you might be at risk of kidney problems your kidneys should be monitored.

If bladder injection is successful, and you have been offered continuing treatment, repeat injections should be available promptly when your urinary symptoms return.

Surgery

If you have a neurological condition that is not going to get worse (non-progressive) and problems with storing urine in your bladder that cause problems such as incontinence or hydronephrosis (enlargement of the kidney caused by urine build-up) and other treatments have failed, you may be offered surgery called 'bladder augmentation'. This involves removing a segment from your intestine and using it to enlarge the wall of your bladder. This procedure should only be offered after a thorough assessment and discussion with you and/or your family and carers about possible problems, risks and alternative treatments.

After bladder augmentation, you should be offered ongoing checks for any problems, some of which may develop gradually over time.