Bladder and bowel dysfunction in cerebral palsy

People with cerebral palsy (CP) may experience bladder and bowel dysfunction. Symptoms are variable but may include urgency, incontinence, frequency, sensation of incomplete bladder emptying, urinary tract infections, hesitancy, slow flow, constipation or a combination of these.

Bladder and bowel problems can have a negative impact on quality of life but they are often under-reported and under-treated by people with CP. They are caused by multiple factors including the brain injury, abnormal development of muscles, ageing, reduced mobility and side effects of medications.

You can find some general advice here but, if you experience any bladder or bowel problems, please speak to a nurse or doctor for an assessment and individualised advice.

General management strategies

There are a lot of simple things you can do to help:

• It is important to drink enough, fluid intake should be about six to eight glasses of fluids/day. 
• Try to avoid drinks that could make your symptoms worse:
  • Drinks that can irritate the bladder:
    • Caffeinated tea and coffee. 
    • Green tea. 
    • Hot chocolate. 
    • Fizzy drinks.
    • Caffeinated energy drinks.
    • Fresh acidic drinks such as orange juice.
  • Drinks that don’t irritate the bladder:
    • Water.
    • Decaffeinated tea and coffee.
    • All types of diluted fruit juices: non-acidic fresh drinks.
    • Herbal tea: red bush tea. 
• Try to eat a healthy diet with enough fibre: such as fruit, vegetables and cereals. 
• Stay active and do exercise. 
• Apply for the RADAR National Key Scheme: offers independent access to 
accessible toilets with a RADAR lock. 

Other treatment options and investigations

• Your doctor or nurse might arrange a urine test to rule out infection and a bladder scan to see if the bladder is emptying after urination.
• You might be asked to complete a bladder diary for three days, to check fluid intake and visits to the toilet.
• Bladder and bowel retraining and pelvic floor physiotherapy might be helpful for some types of bladder and bowel symptoms – your nurse or doctor can advise whether these would be helpful for you. 
• Your doctor will be able to advise regarding :
  • Pharmacological treatments (medications).
  • Non-pharmacological treatments (percutaneous/ transcutaneous tibial nerve stimulation) that can be explored to improve some bladder and bowel symptoms and a referral to a specialist department will be discussed, if appropriate.
• Your nurse and doctor will be able to advice regarding continence products (e.g. pads, catheters, conveen sheaths).

If you have any questions, please do not hesitate to contact the CP team (Direct line: 0203 448 3439 or uclh.cpteam@nhs.net) or talk to your local medical centre.