Bowel, Bladder and Sexual Dysfunction After SCI Flashcards
The lower portion of the spinal cord contains the sacral micturition center at what levels?
S2-S4
What level would you see a “spastic” or “reflexive” bladder?
T12 injury and above
What is the bladder presentation with a T12 and above injury?
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
What level would you see a “flaccid” or “areflexive” bladder?
Usually L1 or below
What is the bladder presentation with an L1 or below injury?
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.
What is a bladder program?
Ongoing set of treatments and practices that maintains the health of the patient’s bladder and kidneys.
What are the most common methods using for a bladder program?
Intermittent catheterization, indwelling catheter, indwelling suprapubic catheter, and external condom catheter for men.
How often should you perform the intermittent catheterization?
Perform every 4-6 hours, 4-6 times a day.
What volumes should you maintain in the bladder to prevent distension?
Less than 500 mL
Patients should be able to independently verbally direct their bladder program to a caregiver if they had what level of injury?
C4-C6
Patients may be able to assist with clothing management and catheterization with assistive devices if they had what level of injury?
C7-C8
A male should be able to learn and complete bladder management from wheelchair level at what levels of injury?
T1-L5
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?
T1-L5
What is considered a normal bowel?
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)
A reflexic bowel happens at what level of injury?
T12 and above
What happens to the anal sphincter muscles when there is a reflexic bowel?
The voluntary control of the anal sphincter muscles may be absent and the muscles remain tight
An areflexic bowel happens at what level of injury?
Usually below T12
What happens to the anal sphincter muscles when there is an areflexic bowel?
The muscles of the anal sphincter remains relaxed
True or false: it is recommended to give patients with areflexive bowels digital stimulation and/or suppositories to assist with their bowel movement.
False: patients would not be able to respond to that type of injury
How long does a successful bowel program take?
30-60 minutes (but may take several hours at first)
What are you looking for when you perform a neurologic exam and determining the type of bowel program for the patient?
Assess sacral reflexes: anocutaneous reflex and bulbocavernosus reflex
Perform rectal exam for sensation and voluntary strength of external anal sphincter and puborectalis muscle
What is an anocutaneous reflex?
Contraction of external sphincter when touched or provided with pin prick to perianal skin
What is a bulbocavernosus reflex?
Performed by pinching dorsal glans penis or pressing clitoris while assessing for bulbocavernosus reflex and external anal sphincter contraction in anal canal
If a reflex is present the patient would:
Present with an UMN injury and proceed with reflexic/UMN bowel program
