Continence and bladder and bowel health in adulthood
Bladder and bowel continence problems are common for adults with cerebral palsy (CP). Continence means being able to control wee and poo.
Continence difficulties can affect comfort, confidence, relationships, work, study, community participation and quality of life. Some people may feel embarrassed talking about bladder or bowel concerns, but support is available. If your continence changes, or if you are finding it harder to manage, it is important to speak with your healthcare team.
Adults with CP may have continence issues for many reasons. These may include bladder function, bowel function, muscle tone, movement, mobility, pain, fatigue, constipation, medications, communication needs, ageing, or difficulty getting to and using the toilet.
Urinary incontinence means having trouble controlling wee. It may come and go, or it may happen more often. Some adults may notice changes as they get older, including needing to wee more often or having less time to get to the toilet.
You may have issues with urinary continence due to:
-
overactive bladder or urge incontinence, where you feel a sudden or frequent need to wee and may leak before getting to the toilet
-
stress incontinence, when leaking happens with coughing, sneezing, laughing, exercising or lifting
-
overflow incontinence, when the bladder does not empty fully and leaking occurs
-
functional incontinence, when it is difficult to get to or use the toilet because of mobility, clothing, transfers, communication or access barriers
-
urinary tract infections or constipation, which can make bladder symptoms worse.
Bowel problems can include constipation, soiling, loose stool leakage or difficulty doing a poo. Constipation is common in adults with CP. It can be linked to reduced mobility, tight or weak muscles, gut movement, diet, fluid intake, some medicines, pain when doing a poo, or difficulty sitting comfortably and safely on the toilet.
Constipation can cause:
-
pain or discomfort
-
bloating or tummy pain
-
poor appetite
-
nausea or vomiting
-
soiling or leakage
-
urinary tract infections
-
more problems with bladder control
-
difficulty with some medicines being absorbed properly.
It is helpful to keep track of your bladder and bowel patterns. This may include how often you wee or poo, whether accidents happen, whether poo is hard or painful to pass, whether you have tummy pain, and whether you avoid using the toilet.
A GP, urologist, continence nurse or other health professional can assess your bladder and bowel concerns and help you create a continence plan. Depending on your needs, your team may also include an occupational therapist, physiotherapist, dietitian, psychologist or support worker.
A continence plan may include:
-
a regular toileting routine
-
bladder and bowel diaries
-
constipation management
-
support with drinking enough fluid and eating enough fibre
-
toilet seating and positioning
-
equipment, clothing, communication or transfer supports
-
pelvic floor exercises, if appropriate
-
medication, if needed
-
biofeedback training, if appropriate
-
surgery or other specialised treatments in some cases.
The right plan will depend on your symptoms, goals, lifestyle and support needs. Getting help early can improve comfort, dignity, independence and participation.
Want to learn more? Watch our webinar Bladder and bowel health for people with cerebral palsy, which covers practical continence information for people with cerebral palsy.