Quiz - Bladder Management Flashcards
Bladder volume capacity
400-500 cc
Sympathetic nervous system
fight or flight response, originates from T11-L2, suppresses micturition reflex, inhibits detrusor, stimulates internal sphincter to stay closed
Parasympathetic nervous system
rest and digest response, originate from S2-S4, stimulates detrusor
Micturition reflex
spinal reflex that causes activation of the detrusor along with simultaneous relaxation of the urethra
Reflexive bladder physiology
Spinal reflex is intact which means when the detrusor is stretched, it sends a message to the spinal cord which responds with a reflex to open the bladder. Without signals from the brain, it may happen at an inappropriate time.
Reflexive bladder symptoms
Incontinence - large amounts of urine released at unexpected time.
Reflexive bladder management
Intermittent catheterization
May also trigger a reflex via pressing, straining, etc.
May wear briefs or condom catheter for protection.
If funding available, consider functional electrical stimulation.
Reflexive bladder complications
detrusor sphincter dyssynergia (only affects some people), pressure sores from incontinence, feelings of social isolation
Detrusor sphincter dyssynergia
external sphincter contraction occurs simultaneously with detrusor contraction (reflexive bladder only)
Reflexive bladder population (who is affected)
UMN SCI typically above T12
Areflexive bladder physiology
Spinal reflex is NOT intact which means the detrusor continues to fill and stretch until urine dribbles out.
Areflexive bladder symptoms
dribbling incontinence
Areflexive bladder management
Routine intermittent catheterization
Areflexive bladder complications
renal failure, UTI, impaired muscle tone, pressure sores from incontinence, feelings of social isolation
Areflexive bladder population (who is affected)
LMN SCI (typically below T12)
What determines whether the bowel/bladder is reflexive or areflexive?
integrity of the sacral arc
How does the bowel/bladder function typically immediately following injury?
SPINAL SHOCK - no reflex activity for about 6-12 weeks (variable)
GOALS FOR BLADDER MANAGEMENT
- Empty at appropriate times.
- Stay dry.
- Maintain low-pressure storage (don’t overstretch detrusor).
Foley catheter
Catheter inserted into bladder via urethra and maintained via balloon
Can stay in place up to 30 days
Suprapubic catheter
Catheter inserted through abdomen directed to the bladder.
Can be indwelling up to 30 days or more or used for intermittent catheterization.
Condom catheter
Catheter that has an attachment on the end that fits onto the penis. Also called an external or ‘‘Texas’’ catheter. Does not empty bladder.
Urinary leg bag
bag used for collecting urine from a Foley, suprapubic, or condom catheter
Functional e-stim (FES) for bladder
Allows emptying bladder via electrodes surgically implanted electrodes on S2-S4.
Option for complete injuries with reflexive bladder.
Image: Functional e-stim (FES) for bladder
Intermittent catheterization (IC)
Catheter inserted into bladder via urethra to release urine (does not stay in place like Foley)
