Bowel & Bladder

Question 1

Neurogenic Bladder

Answer 1

When damage has occurred to the CNS, bowel function is initiated and regulated without regulation by the cerebral cortex.

• Transit time doubles
• Constipation/Impaction more prevalent
• Decrease in functional ability to perform program
• Increase risk for skin compromise

Question 2

Neurogenic Bowels- 3 systems involved

Answer 2

• Somatic (sphincter)
• Sympathetic/ parasympathetic (colon- )
• Enteric (colon- specifically secretions, blood flow and partial peristalsis)

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Question 3

Neurogenic System

Answer 3

• 3 Systems involved
• Spinal shock
• Upper Motor Neuron vs. Lower Motor Neuron
• Complete vs. Incomplete

Question 4

Complications of Neurogenic Bowel

Answer 4

• Bowel dysfunction
• 41% of individuals with SCI will report significant health problems related to bowel management
• Rectal prolapse
• Hemorrhoids
• Abdominal pain and bloating

Question 5

The 2nd most common cause of autonomic dysreflexia

Answer 5

Bowel dysfunction

Question 6

How is Bowel Status determined?

Answer 6

• Presence of Bulbocavernosus reflex (BCR)
• Sensation (completeness of injury)

Question 7

Signs of UMN ? Reflex Bowel

Answer 7

• • Bulbocavernosus reflex (BCR)
• Usually injuries higher than T10-12
• Good sphincter tone
• Sensation may or may not be present

Question 8

2 Options of Reflex Bowel Programs

Answer 8

• Digital stimulation
• Suppository or Theravac

Question 9

S&S Lower Motor Neuron/ Flaccid Bowel
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Answer 9

• • Bulbocavernosus reflex (BCR)
• Usually injuries T10-12 and below
• Lacks internal and external sphincter tone
• Sensation may or may not be present

Question 10

Components of Flaccid Bowel Program

Answer 10

• Timing- when did patient have BMs prior to injury?

 -Common strategy is RC after each meal

•  Fiber and fluids - Fiber recommendation is 18 g/ day& Warm liquids prior to bowel program may promote movement
• Manual evacuation (rectal clear)