Brain injury - Bladder and bowel incontinence

  • Children who have had a brain injury can sometimes have problems with toileting. After a brain injury, children who were previously toilet trained can become incontinent (have no control over wee and/or poo) because the usual mechanisms in the brain for controlling the bladder and/or bowel may be damaged.

    Bladder or urinary incontinence

    Children often experience urinary problems such as:

    • incontinence - the accidental loss of urine
    • urinary frequency - the need to empty the bladder more than once every two hours
    • urinary retention - the inability to empty the bladder completely, which then becomes an infection risk
    • dysuria - when passing urine is painful
    • stranguary - problems with starting the urine stream
    • urinary urgency - the sudden need to empty the bladder

    What is the treatment bladder incontinence?

    In the early stages of recovery, a child may require a catheter (a tube into the bladder) to monitor how much urine they are making and how their kidneys are working. A toileting regimen can be started as the child becomes more aware of their surroundings. Some simple measures can be taken to help the child, such as toileting them at regular intervals and reducing their fluid intake in the evenings. Using a reward chart each time the child stays dry may also be useful. During retraining, the child may need to wear a nappy or incontinence pad.

    Bowel incontinence

    Children with a brain injury may also experience problems with their bowels. A combination of factors such as mobility, inactivity, diet, medications and impaired thought processes can contribute to this problem. If a child is very constipated then they can have overflow incontinence of faeces (poo coming out frequently when they don't expect it to).

    What is the treatment for bowel incontinence?

    To help prevent or treat constipation, the doctor may prescribe either oral medications or bowel preparations for the child. Choosing food that is high in fibre, bulk or roughage - such as fresh fruits, vegetables and wholegrain foods - will help keep your child regular. A toileting program to encourage more regular bowel habits may also be used.

    Key points to remember

    • Following a brain injury, children who were previously toilet trained can become incontinent, meaning wee or poo can come out when you don't want or expect it to.
    • Incontinence can occur when the usual mechanisms in the brain for controlling bladder and bowel functioning are impaired.

    For more information


    Developed by The Royal Children's Hospital Paediatric Rehabilitation Service based on information from the Brain Injury Service at Westmead Children’s Hospital. We acknowledge the input of RCH consumers and carers.

    Reviewed September 2020.

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