COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is primarily a respiratory illness but affects multiple organ systems. While common symptoms include fever, cough, and fatigue, medical literature documents an association between the infection and problems with continence. Incontinence, the loss of bladder or bowel control, is not a standard primary symptom. However, evidence suggests the virus and the systemic stress it causes can trigger new or worsened urinary and fecal symptoms in some patients.
Clarifying the Link During Active Infection
Incontinence rarely appears as the first symptom of COVID-19, but it can arise as a complication, especially in severe illness. Acute infection often causes profound general muscle weakness (sarcopenia) due to prolonged bed rest and the body’s inflammatory response. This generalized weakness directly affects the pelvic floor muscles, which support the bladder and control the urethral and anal sphincters.
Severe coughing, a prominent respiratory symptom, dramatically increases intra-abdominal pressure. This forceful coughing places sudden strain on the pelvic floor, potentially leading to stress urinary incontinence, where urine leaks with physical exertion. For hospitalized patients, factors like delirium and sedation side effects can temporarily impair cognitive function and the ability to reach a restroom, resulting in functional incontinence.
The systemic inflammation may also directly impact the urinary tract itself. The SARS-CoV-2 virus uses the ACE2 receptor to enter cells, and these receptors are expressed in the urothelium, the bladder lining. Inflammation in the bladder lining can cause COVID-19-associated cystitis. This leads to lower urinary tract symptoms, such as urgency, increased frequency, and excessive nighttime urination (nocturia). These acute complications are often transient and tend to resolve as the patient recovers from the active phase of the illness.
Autonomic and Neurological Causes
The mechanisms linking SARS-CoV-2 to continence issues often involve the nervous system, which controls both bladder and bowel function. Continence is regulated by a complex interplay between the central nervous system (CNS) and the autonomic nervous system (ANS), which manages involuntary functions. The virus can disrupt this system through direct neuro-inflammation or post-infectious immune responses.
The body’s immune reaction, sometimes referred to as a “cytokine storm,” can trigger inflammation in the nervous system (neuro-inflammation). This inflammation may damage the protective myelin sheath surrounding nerves, a process known as demyelination. In rare but documented cases, this can affect peripheral nerves, such as the pudendal nerve, which innervates the urethral and anal sphincters. Damage to this specific nerve directly impairs the muscular control necessary for both urinary and fecal continence.
A more common neurological link is dysautonomia, a dysfunction of the autonomic nervous system frequently observed after a COVID-19 infection. Dysautonomia compromises nerve signaling and can manifest as postural orthostatic tachycardia syndrome (POTS). Since the ANS controls involuntary muscle contractions of the bladder and bowel, its dysfunction leads to a loss of coordinated control. This can result in symptoms ranging from urinary retention to overactive bladder and urgency incontinence.
Incontinence as a Manifestation of Long COVID
When symptoms persist for weeks or months after the acute infection, the condition is referred to as Post-Acute Sequelae of COVID-19 (PASC), commonly known as Long COVID. Incontinence and related lower urinary tract symptoms have been identified as a manifestation of this chronic phase. Studies show that many patients report new or worsened symptoms of overactive bladder (OAB) long after the virus has cleared.
The persistent inflammation and ongoing dysautonomia established during the acute phase can continue to affect the bladder and bowel long-term. The prolonged nerve signaling issues associated with dysautonomia mean the bladder may remain hypersensitive or the sphincter muscles may not function optimally. This neurological fallout can result in chronic urgency and frequency issues that resemble overactive bladder syndrome.
The generalized fatigue and muscle weakness reported by Long COVID patients translate to chronic pelvic floor dysfunction. When the muscles that support the pelvic organs remain weakened, stress incontinence may persist long after respiratory symptoms have resolved. This enduring physical and neurological impact highlights the multisystem nature of PASC, where continence issues are a symptom of the underlying chronic inflammation and nervous system dysregulation.
Next Steps and Medical Consultation
If you experience new or significantly worsening issues with bladder or bowel control following a COVID-19 infection, seeking medical consultation is necessary. Incontinence requires proper investigation to identify the cause. Consulting a primary care provider, urologist, gastroenterologist, or neurologist is advisable, depending on the specific symptoms.
A medical professional will rule out other common causes, such as urinary tract infections, pre-existing conditions, or neurological emergencies. Patients should document the timeline of symptoms, noting when the incontinence began, its severity, and its chronological relation to the COVID-19 diagnosis. Providing this detailed history assists in determining if the issue is a complication of the infection or an unrelated health concern.