Urinary and Bowel Symptoms in Idiopathic Normal Pressure Hydrocephalus

Background Idiopathic normal pressure hydrocephalus (iNPH) patients have gait and balance disturbance, cognitive impairment and urinary urgency/incontinence. Gait and balance symptoms have been examined carefully. There is presently a lack of evidence‐based criteria to make recommendations regarding the characteristics and evaluation of urinary incontinence. Additionally, patients with urinary incontinence may also have faecal incontinence. The aims of this prospective single‐centre study with a pre–post design and a control group were to characterise the urinary symptoms, to investigate possible bowel symptoms and to evaluate possible reversibility after shunt surgery. Patients and Methods Fifty‐seven iNPH patients (27 females, median age 77 years) answered the questionnaires preoperatively, and 42 patients postoperatively. Meanwhile, 42 healthy individuals (HIs) (25 females, median age 71 years) were included. Before and 3 months after the shunt surgery, patients and HIs were asked to answer three questionnaires: the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ‐UI), Wexner’s Faecal Incontinence Score in the Swedish language (Wexner’s FI) and a bowel function questionnaire. The HIs followed the study protocol only once. Results The mean duration of iNPH‐related symptoms was 24 months (range 6–120). Urinary incontinence appeared in 84.6% of the patients. Urinary leakage was always present in 13.5% vs. none of the HIs, with an improvement in some patients after the shunt operation. Bowel disturbances (more frequent bowel movements, a longer defecation time, incomplete evacuation feeling, abdominal pain and bloating, involuntary gas leakage and soiling) were reported by 67.5% of patients. The patients’ bowel function influenced their daily life as compared to the HIs. Postoperatively, bowel symptoms were improved with fewer bowel function‐dependent limitations in social life. The total ICIQ‐UI score was significantly different between the patients and HIs ( p < 0.001) and improved significantly postoperatively ( p < 0.001). Conclusion Urinary and bowel incontinence symptoms were notable features in this cohort of iNPH patients, causing limitations in their social life. Postoperatively, both symptoms improved to some extent. Trial Registration NCT04808076.