Bowel and Bladder Management

Question 1

What is “neurogenic” bowel and bladder function?

Answer 1

describes a number of dysfunctions caused secondary to CNS damage which interrupts cerebral cortex mediation of bladder and/or bowel

Question 2

What is the goal of neurogenic bladder management?

Answer 2

to establish a method of adequate bladder filling and emptying to avoid stasis of urine and prevent bladder overdistention, while preserving the function of the upper urinary tract (ureters and kidneys)

Question 3

What is normal bladder capacity?

Answer 3

400-500cc (16 oz)

Question 4

What is a reflex neurogenic bladder?

Answer 4

automatic, spastic or UMN
secondary to UMN damage
cerebral control of voiding is absent
S2-S4 reflex arc is intact
uncontrolled, spontaneous voiding occurs
potentially spastic bladder sphincter which prevents expulsion of urine and may lead to overdistention of the bladder
above T12-L1

Question 5

What is an autonomous neurogenic bladder?

Answer 5

flaccid, LMN
secondary to LMN damage
S2-S4 reflex are is absent 
bladder is flaccid
overdistention of the bladder
urinary leakage can happen
at or below T12-L1

Question 6

What are methods are bladder management?

Answer 6

indwelling catheters (beginning and usually quads)
intermittent catheterization
external catheters
manual trigger techniques
padding
medications
surgical procedures

Question 7

What are the different types of intermittent catheterization?

Answer 7

sterile and clean
clean technique reused catheters
MDCR and insurance pays for one time use sterile catheters
“no touch” catheters- 2 documents UTIs
uses straight catheter (no junction or bulb to hold in place)

Question 8

Who can use external catheters?

Answer 8

males only

must be able to void bladder

Question 9

What are the manual trigger techniques for bladder management?

Answer 9

crede maneuver (massaging suprapubic area
valsalva maneuver (added with crede)

Question 10

What surgical procedures are used for bladder management?

Answer 10

transuretheral resection (TUR)

Question 11

How is fluid intake monitored for bladder management?

Answer 11

limited with intermittent catheterization

unlimited with indwelling catheters

Question 12

What are the implications for PT with bladder management?

Answer 12

bed mobility skills in hospital bed with rails vs regular bed
static vs dynamic sitting balance (dynamic is needed for toilet)
transfer skills in WC determine where patient can do bowel/bladder care (bed, padded WC with cutout, padded transfer bench over toilet)
ability of WC to go into bathroom
hand function (pinch, grasp, ROM, str)

Question 13

What are the diagnostic tests for bladder management?

Answer 13

urinalysis/urine culture and sensitivity (infections)
intravenous pyelogram (IVP) kidney stones
urodynamic studies

Question 14

What is the goal of neurogenic bowel management?

Answer 14

to establish a bowel training program which is a planned, predictable time to stimulate bowel evacuation and reduce evacuation problems/gastrointestinal complaints. Replaces normal urge to defecate when felt the need. Several weeks to month may be needed. Older the injury occurred hard bowel training is

Question 15

What is reflex neurogenic bowel?

Answer 15

automatic, spastic or UMN
secondary to UMN damage
cerebral control of defecation is absent
voluntary control of anal sphincter is absent, however, spastic contraction of the sphincter discourages leakage of stool
S2-S4 intact, therefore, it is possible to develop a stimulus-response bowel program using mass reflex
above T12-L1

Question 16

What is autonomous neurogenic bowel?

Answer 16

flaccid, LMN
secondary to LMN
final pathway for sensory and motor signals are interrupted, therefore the ability to appreciate the urge to defecate absent
voluntary control of the external anal sphincter absent. daily evacuation necessary to minimize leakage of stool with exertion
at or below T12-L1

Question 17

What are the methods of bowel evacuation?

Answer 17

manual removal of stool from rectal vault (terminal end)
digital stimulation of sphincters
valsalva technique
rectal suppositories or mini-liquid medication

Question 18

What can help with bowel evacuation?

Answer 18

oral medications (stool softners)
high fiber diet
timing of evacuations (after meals)
positioning (l-sidelying or seated)
activity/exercise
(UMN normal care, LMN more a daily emptying, can do pushups to increase abdominal pressure)

Question 19

What are the 8 steps in bowel care?

Answer 19

position
wash hands
examine rectum (remove stool)
apply stimulant (needs complete contact with rectal lining)
wait for stimulant to work (5-15 mins)
digital stimulation for faster and more complete evacuation (circular motion)
know when bowel movement is done (no stool after 2 digital stimulation)
clean up when done