What kind of problems occur with urinating (peeing)?

The bladder holds urine in the body. Individuals with DoC may experience urinary incontinence or urinary retention. Your medical team will evaluate the cause of the incontinence or retention.

  • Incontinence: Incontinence is the inability to hold the urine until you get to the bathroom. Incontinence is frequently referred to as having “accidents.” Some people have incontinence as they are unable to communicate that they need to go to the bathroom or cannot get to the bathroom in time. Other people may be incontinent because they have an overactive bladder due to brain injury.
  • Retention: Retention is the inability to void or release the urine from the bladder. Sometimes people with urinary retention will appear to be voiding due to “overflow voiding.” Overflow voiding refers to incontinent episodes that happen because the bladder is too full to hold any more urine. Patients with urinary retention are at risk for urinary tract infections (UTIs) and kidney damage if it is not treated.

How do they manage problems with urinating (peeing)?

  • “Timed voids” refers to scheduling times for the patient to go to the bathroom. Timed voids can help people with urinary incontinence get on a regular bathroom schedule.
  • Briefs and condom catheters (for men) can be used for people who are incontinent even with timed voiding.
  • Intermittent catheterization refers to the insertion of a tube (catheter) into the bladder to remove the urine. This is typically completed every four-to-six4 to 6 hours based on how much urine is removed from the bladder. The goal is to have catheter volumes of 300-400 cc (mlL) urine each time.
  • Foley catheters can be placed in the bladder to drain the urine. These are catheters that are placed in the urethra (tube in the body that takes the urine from the bladder).  These are not good for long-term management because they can cause you can have skin breakdown.
  • Suprapubic catheters are chronic catheters that can be placed in the lower abdomen to drain the bladder. These are typically reserved for cases of urinary retention where the patient does not have a caregiver who that is able to catheterize the patient regularly.

What kind of bowel problems can occur?

Bowel movement refers to passing stool from the rectum. Problems are common after brain injury because the brain may have trouble understanding the messages from the bowel and spinal cord. Possible issues include:

  • Constipation: Inability to release the bowel. You can use over-the-counter stool softeners or suppositories for treatment.
  • Incontinence: Bowel accidents. Bowel programs designed to "retrain the bowel" by having a consistent toilet schedule should be started early in the recovery process and continue while at home.

The Shepherd Center offers information and how-to guides on bowel and bladder problems associated with disorders of consciousness:

Bladder Function (PDF)
From My Shepherd Center

Bowel Function (PDF)
From My Shepherd Center

Bodily Function Information for People with Disorders of Consciousness
From My Shepherd Center