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urinary incontinence risk: chronic neurological diseases

by Diane K. Newman, DNP, FAAN, BCB-PMD

Diseases that affect the communication between the nerve pathways and the lower urinary tract and pelvic muscles are called neurologic diseases. Urinary incontinence may be the result of neurological diseases such as Alzheimer's, dementia, stroke, diabetes, rheumatoid arthritis, Parkinson's and multiple sclerosis.

Alzheimer's disease and dementia

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Alzheimer's disease and dementia are characterized by mental deterioration occurring while a person has a clear sense of consciousness. Dementia involves progressive lapses in memory, language, perception, learning, praxis (performance of daily activities), problem-solving, abstract thinking, and judgment. Alzheimer's disease is a neurologic disorder in which certain memory, speech, intellectual, and muscular functions deteriorate, including those of the bladder, but its main characteristic is dementia. Urinary incontinence occurs in the later stage of Alzheimer's disease because of changes in the part of the brain that affects urinary control. Due to memory loss, individuals with Alzheimer's disease may not be aware of the need to urinate and may urinate in wastebaskets, closets, and flowerpots as they cannot remember the appropriate place or the location of the bathroom. Posting the word “toilet” with a picture of the toilet at eye level is a great help. Avoid interfering with the person when toileting, as any distraction is a barrier to urination. Traveling is a significant problem for a person with memory loss because a new toilet location can be an overwhelming obstacle. 

Stroke and Urinary Incontinence

Stroke is a leading cause of severe disabilities. A stroke occurs when a blood vessel that feeds the brain becomes clogged or it bursts. The affected part of the brain can’t work, and neither can the part of the body it controls. Stroke frequency increases with advancing age. Men are more likely to have strokes than women and African- Americans are more likely to have strokes than Caucasians.

Urinary incontinence and other bladder dysfunction can occur after a stroke, usually within the first few days. Many individuals experience a loss of sensory awareness of the need to void or they lose the ability to control emptying of their bladder. Depending on the severity of the stroke and its effect on speech, many stroke victims are unable to communicate their toileting needs or may not be able to make it to the bathroom in time due to impaired mobility. Common bladder symptoms include frequency and urgency and urinary retention may also occur, which causes overflow incontinence. A stoke can result in the person’s inability to assist with being lifted, making his body heavier with what is known as “dead weight.” If an older woman is the caregiver, lifting of a person who’s had a stroke can cause them injury.

Diabetes

Classic symptoms of diabetes—excessive thirst, blurred vision, extreme hunger, dramatic weight loss, drowsiness, irritability and mood swings—include two urinary symptoms—frequent urination and frequent urinary tract infections. As the diabetes progresses, nerve damage may develop. Sometimes, nerve damage interferes with bladder function and prevents complete emptying. Additionally, people with with nerve damage due to diabetes experience reduced sensations to void.

Rheumatoid Arthritis

This is a general term referring to sore or swollen joints. Warning signs include swelling, redness and pain at joints, joint stiffness, especially in the morning, and restricted movement. Individuals with arthritis have mobility and dexterity problems that affect the ability to get to the toilet safely and on time.

Parkinson's Disease

Parkinson's disease is a degeneration of the nervous system characterized by tremor, rigidity, and bladder problems. Muscle rigidity contributes to the inability to ambulate to the toilet and to self-toilet. Muscle weakness affects the sphincter muscles, particularly the rectal sphincter, and causes both fecal and urinary incontinence.

Multiple sclerosis (MS)

Multiple sclerosis is a chronic disease of the nervous system characterized by fluctuating loss of muscular coordination and strength, as well as bladder problems. Urinary dysfunction occurs in about eighty percent of people with multiple sclerosis. The loss of bladder control may be temporary and may improve as the symptoms of the disease improve. However, most multiple sclerosis patients live with persistent urinary incontinence.

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A common cause of urinary incontinence in persons with multiple sclerosis is a bladder infection. In people with multiple sclerosis, a change somewhere in the central nervous system has interfered with the nerve signals from the spinal cord and the Bladder Control Center in the brain and causes what is known as a “neurogenic” bladder. One of the most significant bladder problems associated with multiple sclerosis is urinary retention -- incomplete bladder emptying. In this case, the sphincter does not open properly when the bladder contracts and the urine is not released. The person may not be aware that the bladder has not emptied completely and, as a result, may experience urgency, frequency, nocturia, and/or urinary incontinence.

Another reason for urinary incontinence is involuntary bladder contractions, which cause urination without control. Sometimes the sphincter relaxes while the bladder contracts, which allows the patient to urinate normally but without control. Initial treatments for urine loss due to multiple sclerosis include such behavioral treatments as diet modification, bladder retraining, Kegel exercises, and medications.

Newman, D. K. (1999). 2nd Edition  The Urinary Incontinence Sourcebook, Lowell House, California.

Posted January 2002
Last Updated July 2009

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