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 ≤ 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 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