GF17: Neuro Flaccid and Spastic Bladders Flashcards
_____ controls urination s/m functions and detrusor muscle contraction
Pons
A spinal cord injury above T12 would typically result in a _____ bladder.
spastic (reflex)
A spinal cord injury below T12 would typically result in a _____ bladder
flaccid
What are the bladder s/s of a spinal injury ≥T12?
- Bladder is spastic and irritable
- Urinary sphincter is tight
- This combination results in difficulty storing and voluntarily releasing urine leading to “Leaky issues”
What are the bowel s/s of a spinal injury ≥T12?
- Decreased GI motility
- Rectum holds stool
- Anal sphincter tight and does not relax voluntarily
- This results in difficulty releasing stool
What are the bladder s/s of a spinal injury ≤T12?
- Bladder will not contract when it becomes full
- Urinary sphincter is weak and fails to hold urine well
- This relaxed bladder results in urinary retention
What are the bowel s/s of a spinal injury ≤T12?
- Rectum holds stool
- Anal sphincter fails to contract
- This results in difficulty holding stool
What are the two basic bladder problems that arise from a T12 level injury?
- Filling problems (incontinence)
- Emptying problems (retention)
How is the physiology of urination?
- Bladder fills, sends a sensory signal back to the sacral region that triggers a contraction response that causes the bladder to empty. This is an autonomic process
- We can voluntarily control this with a signal from the brain that inhibits the contraction response until the person desires to urinate.
- At the time of urination, a signal is sent from the brain to the bladder to left the inhibition, thus urination occurs
How does a ≥T12 (suprasacral) injury disrupt the urinary process?
- It blocks the inhibitory bladder contraction signal from the brain effectively allowing the automatic fill/drain response of the bladder to play out independently of control
- This results in difficulty storing urine
- The urinary sphincter can’t receive a relax signal
- This resulting in difficulty in voluntarily releasing urine - involuntary sudden incontinenc
How does a ≤T12 (sacral) injury disrupt the urinary process?
- It blocks the automatic sensation/contraction process of emptying the bladder
- The bladder can’t receive a signal to contract, nor do the sensory signals indicating a full bladder work
- The inhibitory signal from the brain makes the journey to the contraction nerve, but its already in a constant state of relaxation
- Result is a full bladder that doesn’t contract (retention)
- And a constantly relaxed urinary sphincter. This will cause leakage upon laughing, coughing or any action that increases abdominal pressure
- Periodic catheterization will be required to relieve bladder
In the period of spinal shock after a T12 injury, how is the urinary system affected?
- Inflammation causes temporary paralyisis to s/m functions
- Bladder will fill and distend until manually drained via catheter
- Normal function can return after inflammation is resolved
What is the complication of a chronic spastic bladder?
- The constant contraction and release of the bladder muscles causes them to thicken and become less pliable and the bladder to not hold as much urine.
- The urine continues to fill the urine and since the bladder does not release, internal bladder pressure can rise causing urine to reflux back toward the kidneys.
- This reflux can cause UTI and hydronephrosis
- Hydronephrosis can lead to kidney failure over time and result in death if not treated
The main problem with a spastic bladder is
Urine leakage
The main problem with a flaccid bladder is
Urine retention
