Bowel, Bladder and Sexual Dysfunction After SCI

Question 1

The lower portion of the spinal cord contains the sacral micturition center at what levels?

Answer 1

S2-S4

Question 2

What level would you see a “spastic” or “reflexive” bladder?

Answer 2

T12 injury and above

Question 3

What is the bladder presentation with a T12 and above injury?

Answer 3

The bladder might try to squeeze, but the external sphincter muscle may tighten at the same time, causing inability to urinate and high-pressure build-up in the bladder. This is called incontinence

Question 4

What level would you see a “flaccid” or “areflexive” bladder?

Answer 4

Usually L1 or below

Question 5

What is the bladder presentation with an L1 or below injury?

Answer 5

Reflexes are sluggish or absent below the sacral micturition center. The patient will not feel when his/her bladder is full, nor be able to squeeze the bladder causing over-distention of the bladder, bladder overflow, and inability to release urine.

Question 6

What is a bladder program?

Answer 6

Ongoing set of treatments and practices that maintains the health of the patient’s bladder and kidneys.

Question 7

What are the most common methods using for a bladder program?

Answer 7

Intermittent catheterization, indwelling catheter, indwelling suprapubic catheter, and external condom catheter for men.

Question 8

How often should you perform the intermittent catheterization?

Answer 8

Perform every 4-6 hours, 4-6 times a day.

Question 9

What volumes should you maintain in the bladder to prevent distension?

Answer 9

Less than 500 mL

Question 10

Patients should be able to independently verbally direct their bladder program to a caregiver if they had what level of injury?

Answer 10

C4-C6

Question 11

Patients may be able to assist with clothing management and catheterization with assistive devices if they had what level of injury?

Answer 11

C7-C8

Question 12

A male should be able to learn and complete bladder management from wheelchair level at what levels of injury?

Answer 12

T1-L5

Question 13

A female should be able to initiate from bed level using mirror and positioning strategies then progress to over toilet using mirror or touch technique to locate anatomy at what levels of injury?

Answer 13

T1-L5

Question 14

What is considered a normal bowel?

Answer 14

When the rectum becomes full of stool, the person detects the pressure against the rectum and recognizes the need to go to the bathroom.

The person is able to control the sphincter muscles around the anus to open and empty the bowel when the time is appropriate to do so (on the toilet)

Question 15

A reflexic bowel happens at what level of injury?

Answer 15

T12 and above

Question 16

What happens to the anal sphincter muscles when there is a reflexic bowel?

Answer 16

The voluntary control of the anal sphincter muscles may be absent and the muscles remain tight

Question 17

An areflexic bowel happens at what level of injury?

Answer 17

Usually below T12

Question 18

What happens to the anal sphincter muscles when there is an areflexic bowel?

Answer 18

The muscles of the anal sphincter remains relaxed

Question 19

True or false: it is recommended to give patients with areflexive bowels digital stimulation and/or suppositories to assist with their bowel movement.

Answer 19

False: patients would not be able to respond to that type of injury

Question 20

How long does a successful bowel program take?

Answer 20

30-60 minutes (but may take several hours at first)

Question 21

What are you looking for when you perform a neurologic exam and determining the type of bowel program for the patient?

Answer 21

Assess sacral reflexes: anocutaneous reflex and bulbocavernosus reflex

Perform rectal exam for sensation and voluntary strength of external anal sphincter and puborectalis muscle

Question 22

What is an anocutaneous reflex?

Answer 22

Contraction of external sphincter when touched or provided with pin prick to perianal skin

Question 23

What is a bulbocavernosus reflex?

Answer 23

Performed by pinching dorsal glans penis or pressing clitoris while assessing for bulbocavernosus reflex and external anal sphincter contraction in anal canal

Question 24

If a reflex is present the patient would:

Answer 24

Present with an UMN injury and proceed with reflexic/UMN bowel program

Question 25

If a reflex is absent, the patient would:

Answer 25

Patient presents with a LMN injury and proceed with areflexic/ LMN bowel program

Question 26

What are medical complications with a reflexic bowel program?

Answer 26

Orthostatic hypotension

Autonomic dysreflexia

Question 27

What is mandatory that your patient should be doing during the bowel program?

Answer 27

Sitting upright, performing pressure relief using a padded commode chair.

This includes tilting of commode, forward lean, lateral lean, or press up.

Question 28

A patient should be able to independently verbally direct their bowel program to a caregiver and requires a mechanical lift transfer to a commode chair at what level of SCI?

Answer 28

C4-C6

Question 29

A patient should be able to use a padded tilting shower commode chair with chest strap at what level of SCI?

Answer 29

C7-C8

Question 30

A patient should be independent with clothing management either in or out of bed, use of transfer board or sit pivot transfer technique and be independent with all portions of the bowel program at what level of SCI?

Answer 30

T1-L5

Question 31

True or false: You are more likely to see UMN lesions with a T7-T9 SCI than a L1-L3 SCI.

Answer 31

True

Question 32

True or False: You are more likely to see LMN lesions with a T10-T12 SCI than an L1-L3 SCI`

Answer 32

False; L1-L3 is 95.5% LMN lesion compared to T10-T12

Question 33

Which of the follow groups of SCI have the most mixed signs of MN lesions?

T7-T9
T10-T12
L1-L3

Answer 33

T10-T12

Question 34

True or false: Women can still get pregnant after SCI.

Answer 34

True

Question 35

True or false: Men may not able to get partner pregnant after SCI because of poor sperm motility.

Answer 35

True

Question 36

After SCI, the pathway for UMN is considered to be a:

Answer 36

Reflexive pathway

Question 37

After SCI, the pathway for LMN is considered to be a:

Answer 37

Psychogenic pathway