Bladder Flashcards
what is the process of bladder fx?
micturition
what muscle controls micturition?
detrusor muscle
what are structure of micturition?
Kidneys
Ureters
Bladder
Urethra
what does normal bladder fx depend on?
neurological control of the detrusor (smooth), External sphincter (striated), and Periurethral (striated) pelvic floor muscles
what types of innervation does the bladder have?
autonomic and somatic innervation
where are motor neurons for detrusor muscle located?
sacral spine- S2- S4 segments
what happens once the bladder is full?
sensation of fullness is transmitted to the spinal cord and then to the cerebral cortex- conscious inhibition of the micturition reflex
what does overfilling of the bladder cause?
urine reflux (back up into kidneys)
what occurs during urination?
detrusor muscle contracts and the internal and external sphincter muscles open to allow urine to pass
how does bladder control work for children?
micturition is reflexive and as children learn bladder control, it becomes a voluntary function
what occurs during urine retention?
kidneys function normally, but bladder retains
Potential for bladder infection
can be dangerous
what is Urethral Obstruction?
stricture or closing/blocking of urethra can lead to bladder retention
who is urethral obstruction common for?
elderly people
what can cause urethral obstruction?
prostate enlargement, tumor, congenital narrowing, scar tissue from injury or infection, also constipation and fecal impaction
what is stress incontinence?
involuntary loss of urine with local stress/pressure
what can cause stress incontinence?
hyper mobility and displacement of urethra during exertion
Weakness pelvic floor mm
During laughing or sneezing changing internal pressure within body
what is urge incontinence?
involuntary loss of urine associated with strong desire to void
Often involuntary and hyper reflexive detrusor
who does urge incontinence happen to?
people with neurological bladder dysfx, can also occur in ppl with no neurological dysfx
how do you tx urge incontinence?
bedside commode
what is overflow incontinence?
involuntary loss of urine when intra vesicular pressure exceeds maximal urethral pressure, absence of detrusor activity
can occur with retention- small amounts or urine are passed
wha does overflow incontinence cause?
bladder distension with absence of detrusor mm activity
what does overflow incontinence often occur with?
obstruction of bladder neck
what causes Neurogenic Bladder Disorder?
if innervation of the bladder is interrupted
can occur from interruption at any level of lesion
i.e. Brain injury, stroke, spinal cord injury, PNI
what does neurogenic bladder disorder result in?
Problem with brain telling sphincter what to do and sphincter not being able to follow
resulting in flaccid bladder
or spastic bladder
what causes Flaccid Bladder aka areflexia?
lesion at level of sacral micturition reflexes or peripheral innervation of the bladder
accompany detrusor muscle dysfx
external sphincter tone and perineal mm tone diminished
what does flaccid bladder result in?
voluntary urination doesn’t occur but achieved through supra pubic pressure
Urine leaks b/c sphincter isnt squeezing tight enough
how does spastic bladder occur?
occurs with lesion above the level of sacral control of micturition (S2-4)
what does Detrusor Sphincter Dyssynergy affect?
Coordinated activity between the detrusor mm. and the external sphincter
what causes Detrusor Sphincter Dyssynergy?
Lesions that affect the micturition center in the brain stem or impair communication
what does Detrusor Sphincter Dyssynergy result in?
Instead of relaxing during micturition, the external sphincter becomes more constricted. can lead to increasing pressure and back up into kidney
how does bladder dysfx occur?
During the period of spinal shock, all reflexes are depressed, including micturition.
Bladder is atonic and cannot contract
how long does bladder dysfx last?
1-2 months and then spinal reflexes return and become hyperactive
what is still intact during bladder dysfx?
Sacral reflex arc
what does bladder dysfx result in?
Stimuli generated by bladder stretch receptors produce freq contractions of detrusor mm.
Sacral Sparing retains bladder/bowel fx
what are Peripheral NN disorders that can lead to bladder dysfx?
Neuropathies that involve pelvic, pudendal and hypogastric nerves
Diabetes mellitus = most common cause: urination becomes less freq
what are TXs for Bladder Dysfunction?
Catheterization
Bladder Training
Pharmacology
Surgery
what is a Texas Catheter?
external condom catheter
what is an indwelling catheter?
cant pass own urine. Stays in place and gets changed every few days.
Threaded through urethra to base of bladder to sphincter.
Pressure from catheter relaxes sphincter. Work out slowly to get urine from base of bladder
what is an intermittent catheter?
not there all the time. Only put in when need to be relieved
what are methods for bladder training?
body positions that facilitate micturition
monitoring fluid intake
Trigger voiding methods
biofeedback
what are trigger voiding methods?
Tapping over the suprapubic area, pulling of pubic hairs, rubbing the thigh
Crede’s method- person sitting, apply pressure to supra pubic area to increase intra vesicular pressure
Valsalva’s maneuver- bearing down by exhaling against a closed glottis. increases intra abdominal pressure
what are pharmacology methods of bladder control?
anticholinergics to decrease detrusor mm tone and increase bladder capacity with spastic bladder dysfx
parasympathometic drugs to inc bladder tone in mild flaccid Neurogenic bladder
mm.
relaxants to decrease tone of ext sphincter
what are surgery options for bladder control?
Sphincterectomy
TURP- trans urethral resection prostrate
Suprapubic Catheter Placement
what is an implication for suprapubic catheter?
Catheter placed in bladder
Must be cleaned more often
what occurs for Bowel Function Following Spinal Cord Injury?
S2-S4 controls the reflex to relax the external anal sphincter. Spastic control similar to bladder sphincter
may lead to flaccid control
How does the bowel empty?
Reflex control with cortical input (brain allows expelling)
when rectum is full: fullness sensation is transmitted to spinal cord via sacral nerves and then to cerebral cortex
what is examined in a bladder assessment?
bowel routine prior to injury routine since injury dietary habits GI problems or abnormalities current medications rectal sensation rectal tone
what are Goals of bowel management following SCI?
est. complete bowel evacuation
minimize incontinence
minimize complications
afford dignity and independence
what are methods for a pt’s bladder to expel normally?
dietary management- high fiber, high fluid Medication consistent timing of evacuation privacy and positioning techniques to relax sphincter
how does Sex after SCI happen?
complex reflexes combine during sexual expression
stimuli can be mental- erotic material, situations, and thoughts
touch- applied to genitalia or other parts of the body
what part of the spinal cord controls genitals?
penile erection and vaginal lubrication S2-4 and T11-12- L1
Reflexive erection can occur
how does Erection before spinal cord injury occur?
Stimuli from the genitalia are carried to the sacral center by the pudendal nerve reflex activity is controlled higher centers in the brains (inhibition)
how does Erection after spinal cord injury occur?
brain is disconnected and no longer has the inhibitory fx, erection becomes reflexive
what to know when addressing sex with SCI pts?
Sexual behaviors can still occur
Women can still become pregnant
Couple/individual will need to explore techniques and details of the act
what are problems to address with SCI pts?
accidental bowel/bladder during sex logistics of clothing management positioning alternative techniques worries about victimization
