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Bladder and Bowel Control Following Brain Injury

Routine use of the toilet is an activity we take for granted, yet patients with brain injuries may be unable to achieve control of their bladder and/or bowel. The brain doesn't receive the signal, or the patient is unaware of the need to go to the bathroom. The rehabilitation team's goal is to help patients learn to manage their toileting in an acceptable manner. Sometimes it may be a while before toilet use is relearned. In some cases it may never occur.

When this happens, alternative methods are used to maintain proper urine drainage. These methods include:

  • Intermittent Catheter: A catheter temporarily inserted in the urethra to drain the bladder and then removed
  • Condom Catheter(males only): A condom-like appliance is placed over the penis and urine is collected in a bag at the bedside
  • Attends: Diaper-like briefs keep the patient dry and are worn under loose fitting clothing

Bladder Training

When the patient starts to be aware of bladder fullness or the urge to urinate, a bladder-training program is started. This is usually started during the day when the patient is most alert and oriented. The patient is placed on the toilet every two hours and asked to urinate. Gradually, the time between one urination and the next is increased to a pattern similar to the way it was before the brain injury. The patient is taught and encouraged to use the call light to signal the nurse when he or she needs to urinate. Finally, depending on the safety of the transfer and ambulation skills, the patient is encouraged to use the toilet independently.

Fluids are encouraged during the training process. They help prevent infections, kidney stone formation, and dilute the urine, which minimizes strong urine odor. Water is the best fluid. Juices are also acceptable. If needed, fluids are restricted after 7:00 p.m. or 8:00 p.m. to allow the patient to get through the night without an accident.

Sometimes medications are used to help restore bladder function. They are usually antibiotics to prevent or fight infections. Signs of infections are dark, cloudy, and foul smelling urine; sediment, mucus or blood in urine; fever; chills, painful, and frequent urination; fatigue and general discomfort. In some cases, drugs are used to help the bladder contract or to relax longer, to help the sphincters open and close properly.

Bowel Control

Normal bowel elimination may be a problem. This normal process can be interrupted as a result of:

  • Decreased food intake (especially roughage)
  • Immobility from long confinement in bed
  • A confused mental state
  • Narcotic pain medications

Our goal is to help the patient establish a routine bowel pattern and prevent complications such as diarrhea and constipation.

Bowel Training

The first thing the rehabilitation nurse will do to help the patient regain normal function is to establish a regular pattern of elimination at the same time every day or every other day. After meals, and when a patient has time to relax is the best time for the bowel program.

Bowel training is done to prevent constipation, diarrhea, and incontinence. Impaction is the term used to describe persistent constipation that causes the rectum to become plugged with stool. Usually the nurse will use an enema or suppository to break up the stool and remove the mass. Then softeners, fluids, exercise, or bulk agents are used to keep the bowels moving.

Diarrhea occurs when waste moves through the intestines too quickly. Little water is absorbed into the intestines and the stool is watery. Medications, tube feeding formulas, certain foods, and even stress can cause diarrhea. A change in the bowel pattern will usually control it.

Aids to Bowel Control

If the patient’s anal sphincter doesn't open because the brain isn't sending a strong signal, a nurse may try anal stimulation. A lubricated finger is inserted into the anal sphincter to cause dilation. The patient may eventually be taught to do this. (Most common in spinal cord problems.)

Good nutrition helps bowel elimination function normally. Water keeps the stool from getting too hard. If the patient isn't able to drink water, the nurse will supplement the tube feeding with extra water. Bulk provided by foods high in fiber helps push waste through the intestinal system. Fresh fruits and vegetables or bran cereals and muffins are good sources of fiber. Some tube feeding formulas contain a fiber supplement along with other nutrients. Activity, in general, helps the bowels move. Patients are encouraged to be up and doing as many things for themselves as possible.

Quite often the medical team will use various medications and supplements to help achieve normal bowel function such as stool softeners, laxatives, bulk-providing agents, suppositories, and enemas.

Time and adjustment is important. Total  success may not be achievable during early rehabilitation, and in some cases, bowel incontinence remains an around the clock nursing care need.

© 2015 Mary Free Bed Rehabilitation Hospital., Grand Rapids, MI | 1.855.MFB.REHAB
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