Some of you may be thinking, this does not apply to me, but other neurology issues come together with issues that need to be addressed. What one area of healthcare discovers is often applicable to other disciplines.
From a healthcare point of view, any issues with neurogenic bowel care depend on the entirety of the gut, but the bladder function is very different. Some thoughts and tips may make things run a bit more smoothly.
The lower urinary tract is your bladder and urethra. The bladder is a storage organ. It holds urine until an appropriate time to release it. The bladder is a muscle that expands as urine collects and contracts as urine is emptied from it. The urethra is a sphincter that opens to drain urine and closes to let more urine collect.
A neurogenic bladder occurs when there is a neurological issue that affects how the nerves that control the function of the bladder. This chart contains an overview of neurogenic bladder issues and how they affect bladder function. This is a brief overview. Your individual neurogenic bladder issue may not match the chart exactly.
Or any combination of above
-Difficulty in perceiving bladder filling
-Frequency with low volume output
-Short wait time for toileting
-Difficult to control urine output
Spinal Cord Injury from disease or trauma
Cervical or Thoracic level of injury
Pontine center of the brain is unable to send or receive messages
-Unable to tell when the bladder needs to be emptied
-Hyperactive bladder with frequent contractions
-Incomplete emptying with urinary incontinence
-Overactive external sphincter tone with sphincter incoordination (detrusor overactivity with detrusor sphincter dyssynergia, DSD)
-High voiding pressure, high residual urine volumes
-Higher incidence of autonomic dysreflexia
Spinal Cord Injury from disease or trauma
Lumbar or Sacral level of injury
-Unable to tell when the bladder needs to be emptied or sensation of a full bladder is altered
-Bladder is without tone, fills but does not empty
-Loss of sensation that bladder is full
Each of these bladder concerns will have treatments, medications, and therapies that will improve your bladder situation. Neurogenic bladder programs are devised to maintain the health of your urinary system. This can include timed toileting to reduce urinary incontinence for individuals with urgency, urine collection systems for incontinence, specialized voiding techniques such as Valsalva or rectal stretching for individuals with lower motor neuron bladders, and intermittent catheterization for individuals to control and contain urinary output. Some individuals with high bladder pressures will have a sphincterotomy where a small incision is made in the sphincter to allow urine to flow out continuously. Others may have a suprapubic catheter placed through a surgical opening in the abdomen above the bladder to keep the pressure low. There are options to increase your bladder size (bladder augmentation). Some individuals who have difficulty reaching the urethra for intermittent catheterization will have a Mitrofanoff surgical procedure which uses the appendix or a part of the bowel to make a tract from the belly button to the bladder. Catheterization then occurs through the belly button.
Medications may be used to contract the bladder, relax the bladder, contract the sphincter, relax the sphincter, or coordinate the contraction of the bladder with the opening of the sphincters to reduce pressure in the bladder. Botox injections into the bladder are helpful in controlling the hyperactivity of the bladder or sphincters.
There are some global actions you can take to make sure your neurogenic bladder program is working well:
Have a urodynamic test to assess your bladder. Your healthcare professional will guide you as to improvements or treatments to keep your urinary system healthy. It is essential to lifelong care to maintain your urinary system.
With children, it is important that you use catheterization equipment that is appropriate for your child’s size. It will need to be adjusted as they grow.
The developmental needs of children should be considered with their neurogenic bladder program. Even though babies wear diapers, they still need catheterization with neurogenic bladder diagnoses. As you catheterize, tell your child what you are doing so they learn the steps. Eventually, as they develop, you can have them gather supplies, wash their hands (even if you are performing the catheterization to start a good habit), learn about fluid intake, and eventually complete the entire catheterization process.
As parents want to do the most for their child, it can be easy to just do the catheterization for them but remember, when your child goes to school, they should be able to catheterize on their own if they have the developmental skills to do so. This is their normal. Make it yours as well. Independence is what all parents are trying to achieve for their children.
Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.
The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.
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