Urinary incontinence in neurological disease

This guideline outlines the urological problems commonly associated with neurological disease. Most of this is familiar stuff. I will highlight things that stick-out or are new.

Remember that urological problems can be associated with bowel problems and sexual problems too and that these can cause social problems (such as carer stress) as well as physical problems such as recurrent UTI and renal impairment.

UTI – if assessing for UTI in someone with a catheter – do not take a bag sample to test as they will frequently show colonisation without infection – get a sample direct from the catheter.

Recurrent UTI:

Do not use prophylactic antibiotics if someone has a catheter in place.

BP and UE – these must be checked regularly (at least every 3 yrs) in people with neurological impairment. Beware that UE can be normal, even when the kidneys are affected.

Renal imaging for hydronephrosis may be needed in high risk patients every 1 to 2 years:

  • Spinal Cord Injury
  • Spina Bifida
  • Adverse features on urodynamic eg impaired bladder compliance / detrusor dyssynergia / vesico-ureteric reflux

Treatment of Incontinence:

Mostly, this can be treated as in patients without neurological impairment:

  • Bladder retraining and pelvic floor exercises in capable patients.
  • Timed or Prompted Voiding
  • Antimuscarinincs for Overactive Bladder (OAB) – eg in spinal cord or brain disease. Beware that patients can go into retention, so you need to check for residuals.

Botulinum A injection – If patients have spinal cord disease AND OAB AND failed treatment with bladder retraining and antimuscarincs. Many patients will need catheterising after injection and all will need repeated injections.

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton.

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