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Urinary incontinence in neurological disease
This pathway covers the management of lower urinary tract dysfunction resulting from neurological disease and injury in adults and children (from birth). The recommendations on assessment apply to people who have a neurological condition. If the assessment shows the incontinence to be non-neurogenic, please refer to Lower urinary tract symptoms (NICE clinical guideline 97) and Urinary incontinence (NICE clinical guideline 40).
Assessment applies to new patients, those with changing symptoms and those requiring periodic reassessment of their urinary tract management. The interval between routine assessments will be dictated by the person's particular circumstances (for example, their age, diagnosis and type of management) but should not exceed 3 years.
Urinary symptoms resulting from neurological disease can occur because of damage to the brain, the suprasacral spinal cord, the sacral spinal cord (the conus medullaris) or the peripheral nervous system. Damage within each of these areas tends to produce characteristic patterns of bladder and sphincter dysfunction.
Symptoms of neurological lower urinary tract dysfunction may be related to impaired urine storage (such as increased frequency of urination and urinary incontinence) and/or bladder emptying difficulties. Incontinence can arise as a result of an overactive bladder, dysfunction of the urethral sphincters or a combination of the two.
Secondary effects can also arise as a result of neurological lower urinary tract dysfunction. For example, there is an increased risk of urinary tract infection in people with neurological lower urinary tract dysfunction, and kidney function can be lost as a result of abnormally high pressures within the bladder, from the effects of urinary tract infection and as a result of kidney stones.
Urinary symptoms have a significant impact on quality of life, causing embarrassment, leading to social isolation and impairing activities of daily living. Medical interventions often do not restore normal urinary function, and quality of life may be affected by the medical management of neurological lower urinary tract dysfunction. The economic cost of managing neurological lower urinary tract dysfunction is considerable.
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Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent, the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards. In Wales, healthcare professionals should follow advice on consent from the Welsh Government.
If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children. If a young person is moving between paediatric and adult services their care should be planned and managed according to the best practice guidance described in the Department of Health's Transition: getting it right for young people.
Updates to this pathway
8 March 2013 Minor maintenance updates.
Offer urodynamic investigations before performing surgical treatments for neurogenic lower urinary tract dysfunction.
Person with urinary incontinence related to neurological disease
AssessmentView the 'Assessment of urinary incontinence in people with neurological disease' path
Management of urinary incontinenceView the 'Management of urinary incontinence in people with neurological disease' path
Possible complicationsView the 'Possible complications of urinary incontinence in people with neurological disease' path
Monitoring and surveillance
Monitoring and surveillance
Monitoring and surveillance
Monitoring renal function
Do not rely on serum creatinine and estimated glomerular filtration rate in isolation for monitoring renal function in people with neurogenic lower urinary tract dysfunction.
Consider using isotopic glomerular filtration rate when an accurate measurement of glomerular filtration rate is required (for example, if imaging of the kidneys suggests that renal function might be compromised).
For more information on the measurement of kidney function, see the chronic kidney disease pathway.
Offer lifelong ultrasound surveillance of the kidneys to people who are judged to be at high risk of renal complications (for example, consider surveillance ultrasound scanning at annual or 2 yearly intervals). Those at high risk include people with spinal cord injury or spina bifida and those with adverse features on urodynamic investigations such as impaired bladder compliance, detrusor-sphincter dyssynergia or vesico-ureteric reflux.
Consider the need for continuing upper urinary tract surveillance in people who have impaired bladder storage (for example, due to reduced bladder compliance).
Consider urodynamic investigations as part of a surveillance regimen for people at high risk of urinary tract complications (for example, people with spina bifida, spinal cord injury or anorectal abnormalities).
Do not use plain abdominal radiography for routine surveillance in people with neurogenic lower urinary tract dysfunction.
Do not use cystoscopy for routine surveillance in people with neurogenic lower urinary tract dysfunction.
Do not use renal scintigraphy for routine surveillance in people with neurogenic lower urinary tract dysfunction.
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Paths in this pathway
- Assessment of urinary incontinence in people with neurological disease
- Management of urinary incontinence in people with neurological disease
- Treatment to improve bladder storage in people with neurological disease
- Treatment for stress incontinence in people with neurological disease
- Possible complications of urinary incontinence in people with neurological disease
Pathway created: August 2012 Last updated: March 2013
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