Bladder continence management in adult acquired brain injury

Abstract

Purpose: Persistence of urinary incontinence post acquired brain injury (ABI) carries important prognostic significance. We undertook to document the incidence of urinary incontinence, its management and complications in rehabilitation inpatients following ABI and to assess adherence to post ABI bladder management guidelines. Method: A retrospective chart survey of a convenience sample of consecutive admissions to two adult neurorehabilitation units Forster Green Hospital, Belfast, and the Scottish Brain Injury Rehabilitation Service, Edinburgh (SBIRSE). Bladder continence and management on transfer to and discharge from rehabilitation, trial removal of catheter, use of bladder drill, ultrasound investigation, anticholinergic medication and complications were recorded. Results: One hundred and forty six patients were identified. Seventy-seven (52.7%) were independent and continent of urine at rehabilitation admission and 109 (74.7%) on discharge. In all, 13 patients had urinary tract infection, 7 had urethral stricture and 1 developed haematuria whilst catheterised. Ultrasound of renal tracts was underused. Trial removal of catheter after transfer to rehabilitation occurred at a median of 10 days. Conclusions: Urinary continence was achieved in almost half of incontinent ABI patients during rehabilitation. There is potential for increased use of investigation of the renal tracts. Rehabilitation physicians should consider urethral stricture in the management of continence post ABI.

Implications for Rehabilitation

• Persisting urinary incontinence post ABI is associated with increased morbidity.

• Urethral stricture is an under-recognised complication after ABI and should be considered as a potential cause of incontinence in this patient group.

• Gains in urinary continence are seen in patients post ABI, managed with various interventions.

• Goal setting offers an opportunity to focus on bladder management rather than simply continence and may allow improvement in rate of appropriate investigation.

• Brain injury
• continence
• urinary tract infection

Acknowledgements

S/N Maud Harrison and S/N Anne Rafferty collected the Belfast data for which we are most thankful. The authors are grateful for the assistance of the Belfast Health and Social Care Trust audit department in facilitating data input for both units, to Dr Brian Pentland for access to SBIRSE data and to Dr F Colin Wilson for his comments on later drafts.

Declarations of interest

The authors report no conflicts of interest.

Author contributions

SB Caldwell designed the data collection form, collected the Edinburgh data, and wrote the first draft with JP McCann. JS Wilson, D Smith and IK Walsh revised drafts, and all authors contributed to the final paper.