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
What medications are used for a spastic bladder?
Anti-cholinergic urinary antispasmodics to relax bladder muscle, inhibit bladder contraction:
- oxybutynin chloride (Ditropan)
- tolterodine tartrate (Detrol)
- solifenacin succinate (Vesicare)
What medications are used for a flaccid bladder?
Alpha-1 adrenergic blockers (relax prostate smooth muscle to promote urination)
- terazosin hydrochloride (Hytrin)
- tamsulosin hydrochloride (Flomax)
Cholinergic urinary antispasmodic
- Bethanechol chloride (Urecholine)
Besides catheterization, what other method can be used to help those with a flaccid bladder to empty the bladder?
Crede Maneuver
Using both hands, lean forward and press down firmly on the lower abdomen between the belly button and the pubic bone
If medications and crede maneuver are ineffective in preventing/managing urinary retention, what surgical option may need to be employed for flaccid bladder?
Urinary diversions
