What are the possible GI and genitourinary (GU) complications of traumatic brain injury (TBI)?

Updated: Feb 01, 2018
  • Author: Percival H Pangilinan, Jr, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Answer

GI and GU complications remain among the most common sequelae in patients with TBI. Some of the most frequent GI complications are stress ulcers, dysphagia, bowel incontinence, and elevated levels on liver function tests. Underlying constipation and/or impaired communication and mobility are often the causes of bowel incontinence. The use of oral stool softeners, laxatives, and rectal suppositories may facilitate full bowel evacuation and improve incontinence.

GU complications include urethral strictures, urinary tract infections, and urinary incontinence. An appropriate workup to evaluate GU symptoms and rule out infection is indicated. When the causes of urinary incontinence are impaired communication and mobility, a trial of a timed voiding is indicated to manage overflow incontinence. Patients are taken to the bathroom and given the opportunity to void without instrumentation every 2 hours during the day and every 4 hours overnight.

If the patient is unable to void or cannot evacuate the urinary bladder to completion, intermittent straight catheterization may be necessary in the acute recovery period. Although not preferred, diapers and condom catheters may be needed if urinary incontinence does not improve.

Voiding dysfunction and upper urinary tract status were studied in 57 survivors of coma resulting from TBI. Direct statistical links were found between urge incontinence, detrusor overactivity, and poor neurologic functional outcome, as well as between detrusor overactivity and right hemisphere injuries, and between impaired detrusor contractility and left hemisphere damages. [37]


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