Neurogenic bladder By Cindy Mendez

ETIOLOGY  Loss of voluntary voiding control –Manifested by retention or incontinence  Caused by a lesion to the nervous system –Congenital, –Traumatic, –disease  Interrupting the conduction

ETIOLOGY  Two types of neurogenic bladder –spastic  Caused by a lesion above, at the voiding reflex.  resulting in loss of sensation to void and loss of motor control –Bladder may also atrophies, decreasing bladder capacity

ETIOLOGY –Flaccid  Lesion on the lower motor neuron  Bladder Continues to fill and extend fill and extend  Pooling of urine and incomplete emptying –Causing urine stasis, and possible infection

Clinical manifestations  Infection –From urinary stasis –And catherization  Retention –May lead to back up of urine  Distention –Of any of the structures in the urinary track causing discomfort

Assessment  Diaphoresis, flushing and nausea prior to reflex incontinenc.  Infrequent voiding  Urinary incontinence  Assess for: –congenital abnormalities –neurological disease –Or spinal cord injury

Diagnostics  To asses the type and extent of damage to the bladder and any other urinary system structures –BUN –Creatinine levels –And radiograph studies to check for structural changes that have occurred

Medical management  Parasympathomimetic ( urecholine) –Increase bladder contractility  Catherization –To relieve distention  Sacral modulation and stimulation –To reduce urinary urge incontinence  The Interstim device –To reduce overactive bladder or stimulate an under-active bladder

Pelvic floor muscles affected by neurogenic bladder

Nursing interventions patient teaching  Establish urinary elimination  Bladder training ( with or with out self stimulation) every 2 hrs  Having patient recognize signs of distention  Supportive sensitive environment to have patient discuss feelings and self image adaptation