A seizure is a sudden, uncontrolled electrical disturbance in the brain, causing temporary changes in movement, behavior, or consciousness. Urinary incontinence, or involuntary leakage, is a known symptom. This loss of bladder control is most commonly associated with generalized tonic-clonic seizures, which involve both sides of the brain from the onset. This physical manifestation results from the seizure’s impact on the central nervous system.
Why Seizures Cause Loss of Bladder Control
The brain normally maintains sophisticated control over the bladder and bowels through a complex network of nerves and muscles. Urination, or micturition, requires the coordination of the bladder muscle (detrusor) and the external sphincter muscle, which is regulated by the brain’s control centers. During a generalized tonic-clonic seizure, the overwhelming electrical activity temporarily overrides the brain’s ability to maintain this coordinated control.
The seizure progresses through a stiffening phase, known as the tonic phase, followed by a rhythmic jerking phase, the clonic phase. The intense and widespread muscle contractions during both phases place extreme pressure on the abdominal area and the bladder. This massive, involuntary tensing can force urine out of the bladder.
The loss of bladder control most frequently occurs toward the end of the clonic phase as the body begins to relax. The seizure activity causes the involuntary relaxation of the sphincter muscles, the muscular ring that normally keeps the urethra closed to retain urine.
The brain’s control over these muscles is momentarily lost, allowing the bladder to empty. Although less frequent, the same mechanism can sometimes lead to a loss of bowel control. Since the loss of consciousness accompanies this type of seizure, the person is entirely unaware of these changes during the event.
Other Involuntary Physical Symptoms
The widespread electrical discharge of a generalized seizure produces a range of other physical effects. The initial tonic phase is characterized by a sudden, intense stiffening of all muscles, which can cause the person to fall immediately. This rigid contraction of the chest muscles forces air past the vocal cords, often resulting in a loud cry or groan at the start of the seizure.
Following this, the clonic phase introduces rhythmic jerking movements of the limbs, where the arms and legs bend and relax rapidly. These muscle movements can sometimes cause a person to bite their tongue or the inside of their cheek, which may result in bloody saliva or foaming at the mouth.
Autonomic functions are also affected, leading to changes in breathing patterns and heart rate. Breathing may become shallow or momentarily stop during the tonic phase. This can cause the person’s skin, especially around the lips, to take on a dusky or bluish tint. As the seizure subsides, a deep sigh often signals the return to more normal breathing.
Safety and Recovery After a Seizure
If you are present when someone is having a tonic-clonic seizure, move any nearby hard or sharp objects away to clear the area. Never try to hold the person down or restrain their movements, as this can cause injury.
Once the jerking movements stop, gently roll the person onto their side into the recovery position. This action helps keep the airway clear and prevents them from inhaling any fluids, such as saliva. You should place something soft, like a folded jacket, under their head to provide cushioning.
The postictal state is the period of recovery immediately following the seizure, lasting from a few minutes to several hours. During this phase, the person is often confused, drowsy, and disoriented. They may not remember the seizure event and will need gentle reassurance until their awareness returns to baseline.
Emergency medical services should be called if the seizure lasts longer than five minutes or if the person has difficulty breathing after the movements stop. Calling for help is also necessary if the person is injured, has another seizure soon after the first one, or if it is their first-ever seizure.