Neurogenic Bladder

Neurogenic Bowel

LE Weakness

Neurogenic Bladder: Spinal Cord Lesions

• Urge incontinence• Bladder empties too quickly and too frequently• External sphincter may have paradoxical

contractions • Detrusor-sphincter dyssynergia

– Both the bladder and external sphincter become spastic at the same time

– Even though the bladder is trying to force out urine, the external sphincter is tightening to prevent urine from leaving.

Neurogenic Bladder

• Intermittent catheterization is the factor most responsible for the nearly normal life span of patients with spinal cord injuries. – In this group, urinary tract infection is no

longer the leading cause of death.

Intermittent Catheterization Program

• Balanced bladder– Volume of residual urine ≤ 1/3 x volume of

voided urine

• Initiated if the residual volume is greater than 100 mL or if the voided volume exceeds 400 mL

• Every 4 hours initially and then every 6 hours for 24 hours

Intermittent Catheterization Program

• Ideally, the amount drained each time ≤ 400-500 mL– If catheterization is performed every 6 hours

and the amount drained is 700 mL, increase the frequency of catheterization to every 4 hours to maintain the volume drained at 400-500 mL.

Intermittent Catheterization Program

• Potential advantages: patient autonomy, freedom from indwelling catheter and bags, unimpeded sexual relations

• Potential complications: bladder infection, urethral trauma, urethral inflammation, stricture

• Long-term use of intermittent catheterization appears to be preferable to indwelling catheterization

Bladder Training

• Relearning how to urinate

• Urge incontinence and sensory urge symptoms (though the bladder is not full, it is signaling that it is time to void)

• Self-education, scheduled voiding with conscious delay of voiding, and positive reinforcement

Bladder Training

• Requires the patient to resist or inhibit the sensation of urgency and postpone voiding.

• Patients urinate according to a scheduled timetable rather than the symptoms of urge.

• Useful in young women but is difficult to implement in cognitively impaired persons

Others

• Crede method– applying external pressure on the bladder to

induce emptying

• Valsalva maneuver– forcibly exhaling against the closed glottis

Neurogenic Bowel

• Spastic / Reflexic / UMN bowel– Impulses are interrupted when a SCI is at the

cervical or thoracic level. – SC can still guide bowel reflexes.– Even though you do not feel the need to have

a BM, your body's reflexes can do it automatically.

– When the bowel becomes full, a BM occurs but in between BMs your anal sphincter stays tight.

Neurogenic Bowel

• Flaccid / areflexic / LMN bowel– Happens when the injury is at the lumbar or

sacral area • Injury decreases the peristalsis and the reflex

control of your anal sphincter.

– You cannot feel that you need to have a BM and your anal sphincter may not be able to hold BM in.

– The sphincter does not close tightly enough, so BM leaks out.

Neurogenic Bowel

• Improvement in mobility and activity levels in affected individuals improves the potential of lessening constipation and fecal impaction.

• Improve toileting and transfer techniques goal of improving independence potentially lessening fecal incontinence

Neurogenic Bowel

• Regular emptying

• Fixed schedule for bowel training– Every other day in most cases

LE Weakness

• Clothes modification– Dresses or skirts > pants or shorts– Flip flops to sandals

• Home modification– Grab bars in a shower– Transfer bedroom to first floor