Test 1: Bowel, Bladder, and Sexual Function Flashcards
types of bladder management strategies
depends if LMN or UMN
indwelling cath
intermittent cath
condom drainage
suprapubic cystostomy
reflex voiding
bladder augmentation
bladder management: LMN vs UMN
UMN (above T12) = reflex operated;
- micturition reflex: bladder fills because of stretch, when stretched the detrusor mm contracts which opens the internal sphincter and inhibits the external sphincter
LMN = areflexive; will leak and requires a leg bag
bladder complications
urinary retention
bladder overdistension
urinary reflux into ureter
UTI
kidney and bladder stones
when to use an indwelling foley and how to manage/ what are the risk
indicated if pt is unable to self cath (no hand function) and with LMN injuries
risk = high rate of UTIs
management = need to change monthly and needs to be kept clean
why is it important to consider post spinal shock when working with bladder management
recommend urodynamic testing with urologist around 3 months to see what works
sacral sparing (UMN) = presence of bulbocavernous reflex/anal wink
flaccidity/gravity = LMN
when is intermittent catheterization recommended and what are the risks/management requirements
indications = aesthetics and lower infection rates
risks = infection; in clean IC there is reuse of catheters; need to make sure everything is clean
managemetn = need hand function or tenodesis at least with adaptive equipment; must do it every 4-6 hours; positioning is important
positioning for intermittent cath in females
must assume reclined position to access urethra
good justification for letters of medical necessity for power seating functions
indications, risks, and management of condom cath
indications = males only; LMN or UMN; may be used as “just in case” with SCI pts and still intermittent cath
risks = infection (less than indwelling, urinary retention), can get pulled with transfers/clothing management
management = would need to use valsalva or suprapubic management to void
indications, risks, and management of suprapubic cath
indications = easier access/management for higher level injuries who have difficulty with self cath
risk = infection
management = change every 4-6 weeks, must keep clean, and can do free drainage or have catheter valve (on/off system)
sympathetic bladder reflex
filling/storage
fight/fligh = less likely to have an accident
detrusor mm relaxes, internal AND external urethral sphincter contract
parasympathetic bladder reflex
micturition
rest/digest = can use bathroom/be intimate
detrusor mm contracts
internal AND external urethral sphincter relax `
what is the guarding reflex
IUS and EUS activation
what is bladder augmentation and why might it be done; risks, management?
surgical expansion of bladder mm in setting of mm atrophy
used with atrophy or UMN injuries (to stimulate reflex)
risks = infection due to sx procedure
management = check volumes in addition to other bladder management strategies
stats of UTI in pts who need bladder management
frequently occur in hospitals
one of the leading causes of bloodstream infections in SCI
least likely to occur with IC
incidence of pts who need bowel care/its impact
98% SCI pts have bowel program
34% require assistance
one of largest impacts on QOL
sphincters controlled by pudendal nn
risks of improper bowel management
constipation
abdominal pain
small bowel obstruction
bowel incontinence
bowel rupture/infection/sepsis
AD in pts T6 and up
UMN bowel program vs LMN
UMN
- mediated via pudendal n
- pts may discover bulbocavernosus reflex to help determine how to address bowel plan
- defecation reflex
LMN
-based on timing and diet
how does an UMN bowel program work
indicated if injury above cauda equine BCR reflex present
- use suppositoty to get stool moving
- digital stimilation to stimulate BCR reflex
- genital/anal stim sends reflex loop to SC to open sphincter
- circular motion to elicit a void
usually done 1x/day in AM or PM
takes up to an hour
best to keep timing consistent so body adjusts
how does LMN bowel program work
indicated with cauda equina injuries and LMN presentations
no reflex activity so cannot use BCR
sphincter is flaccid so stool will flow with gravity or increased abdominal pressure
30-40 min after major meals
diet = need fiber and fluid balance to create optimal stool firmness
evacuation = valsalva or manual evacuation
when is a colostomy indicated and how does management of this work
indicated to save time, QOL, or if pt has difficulty with hand function for bowel program
risks = infection/aesthetics
management
- last resort
- studies suggest increased QOL due to decreased time for bowel program and decreased hospitalizations for bowel problems
2016- 2.4% SCI pts had colostomies
equipment needed for bowel programs
suppositories (LMN)
lubricant
gloves
orthotic stimulation device/U cuff (UMN)
ways to increase abdominal pressure
pads
usually done in bed/padded commode with cut out
bowel program impact on daily life
takes up to an hour
LMN - high risk for accidents throughout day, especially if eating upright
LMN programs often BID
UMN may be morning or night
LMN is after eating so may impact desire to eat in public
how does erectile capacity differ between UMN vs LMN and complete vs incomplete injury in males
greater capacity in UMN and incomplete
how does ejaculation capacity differ between LMN vs UMN and complete vs incomplete injury in males
LMN = 15%, UMN = 5%
incomplete more likely than complete
