P
Priority
F
Fundamental

New
Level of evidence
A
B
C
T 2.1
P
C
The rehabilitation plan for urinary incontinence following traumatic brain injury should include:
A regular monitoring program
Strategies for alerting the caregivers to the person’s need to pass urine where there are communication problems
A toileting regimen based on reinforcement in cases of cognitive impairment
Bladder re-education
(Adapted from NZGG 2006, 6.1.3, p. 93)
T 2.2
P
C
Individuals with traumatic brain injury with continence problems should not be discharged home until continence aids and services have been arranged at home and caregivers have been adequately prepared.
(Adapted from NZGG 2006, 6.1.3, p. 93)
T 2.3
C
Anticholinergic medication for continence problems for individuals with traumatic brain injury should only be prescribed after demonstration of an overactive bladder. Use of urodynamic assessment is considered optimal.
(Adapted from NZGG 2006, 6.1.3, p. 93)
Note: Anticholinergic medications are associated with complications including memory and cognitive impairments.
T 2.4
C
Intermittent catheterisation should be considered for use in individuals with traumatic brain injury who are shown to have an elevated post-micturition residual volume.
(Adapted from NZGG 2006, 6.1.3, p. 93)
T 2.5
C
Long-term catheters can be considered as part of a planned catheter management program for individuals with traumatic brain injury. Supra-pubic catheters should, however, be considered as a preferred alternative to long-term urethral catheters.
(Adapted from NZGG 2006, 6.1.3, p. 93)
T 2.6
C
In the case of constipation following traumatic brain injury, an active bowel management regimen should be instituted as soon as possible, which includes:
Ensuring sufficient fluid intake
The use of natural laxatives, stimulants, or simple bulk laxatives
Exercise and standing, where possible
Avoiding medications which slow gut motility
Maximum privacy and comfort during defecation
Supported sitting up for defecation at the earliest safe opportunity, and at a regular time each day
Where the rectum is full but no spontaneous evacuation occurs, rectal stimulation may be used
(Adapted from NZGG 2006, 6.1.3, p. 93)
T 2.7
C
Bladder and bowel management plans for individuals with traumatic brain injury should be developed with the full knowledge and support of the person’s primary caregiver.
(Adapted from NZGG 2006, 6.1.3, p. 94)
T 2.8
C
Asymptomatic bacteriuria should only be treated with antibiotic therapy in exceptional circumstances following traumatic brain injury (i.e., pregnancy, pending urologic procedure, worsening cognitive status).
(INESSS-ONF, 2015)
REFERENCES:
- Lin and Fajardo (2008)
- Colgan et al. (2006)