Bladder Management After Spinal Cord Injury - PowerPoint Presentation

Slide1

Bladder Management After Spinal Cord Injury

Frazier Rehab

Institute

Spinal Cord Medicine Program

Slide2

Urinary SystemConsists

of the kidneys, ureters, bladder, sphincters and urethra

Major

functions:

Regulates

your body’s electrolytes

Removes

waste products and excess water (urine)

Slide3

How Do You Pee?

Your

kidneys filter blood to remove waste products & produce urine

Your

urine travels through the ureters to the bladder

Your

nerves send messages up the spinal cord to the brain when bladder is ready to empty

Your

brain then sends a message down the spinal cord to the bladder telling it to empty

Your

sphincter muscles relax, your bladder muscles tighten to push urine from the bladder and the urine leaves the body through the

urethra

Slide4

Urination After Spinal Cord Injury

Messages/signals

from the bladder to the brain and vice versa become disrupted or lost completely due to the SCI

Bladder

becomes dysfunctional (neurogenic)

The

level of your spinal cord injury will affect how urination will occur

Slide5

Neurogenic Bladder

ReflexicBladder

AKA

Spastic bladder

SCI

above Lumbar 1-2

Reflexes

are triggered to urinate but you may not be aware

AreflexicBladder

AKA

Floppy bladder

SCI

below Lumbar 1

There

are no reflexes triggering urination

Bladder

will become too full, urine may leak and/or back up to kidneys

Slide6

Bladder Management GoalsMaintain

good function of your bladder and kidneys

Develop

a realistic management

Prevent

complications

Slide7

Bladder Management Programs

Options may include:

Intermittent

catheterization (IC or CIC)

Indwelling

or

Suprapubiccatheter

External

(condom) catheter

Manual

techniques to trigger voiding

Behavioral

strategies

Medications/Surgeries

Slide8

Intermittent Catheterization (IC or CIC)

AKA

“in & out” catheterization

Preferred

method

Catheter

is inserted into the bladder, drains the urine then the catheter is removed

Performed

every 4-6 hours

Timing

varies depending on fluid intake

Each

IC should be less than 500cc

Slide9

CathetersMany

different kinds of catheters available

Options

dependent on insurance

Briefs

can be purchased at local stores or off the Internet

Not

covered under insurance

Slide10

Straight Catheters

Slide11

Closed System Catheters

Slide12

Male Coude’ Caths

Slide13

Indwelling Catheter

Foley

Catheter

Inserted

through the urethra and remains in the

bladder, continuously

empties urine into a drainage bag

Suprapublic

Catheter

Surgically

inserted in the bladder through the

stomach, continuously

empties urine into a drainage bag

Management

Clean at

least twice a day

Change

catheter at least

monthly

Slide14

External Catheters - Males

AKA

Texas or condom catheters

Beneficial

for males who experience spontaneous voiding

No

external options for females due to anatomy

F

its

over the penis and connects to drainage bag to keep you dry

Adhesive

on the condom catheter holds it in place

Must

be careful when removing to avoid skin breakdown

Slide15

Other Techniques

Manual

Technique

Triggers

sphincter relaxation = involuntary bladder contraction to cause voiding

Suprapubic

tapping

Thigh

scratching

Anal/Rectal

manipulation

Increase

abdominal pressure = causes voiding

Valsalva

Crede

’

Risks

AD

Recurrent

UTI

Kidney

or bladder stones

Deterioration

of bladder or kidney

functions

Behavioral

Strategies

Timed voiding

Pelvic muscle exercises

Kegel

Slide16

Surgical Procedures

Mitrofanoff

Surgical

procedure to construct a new passageway for urine using the appendix

Allows

a catheter to be passed through the abdomen and directly into bladder

Bladder

Augmentation

Surgical

enlargement of bladder

Reduces

need for frequent catheterization

Slide17

Medications for Bladder Management

Help

prevent bladder spasms to promote storage

Oxybutinin

Trospium

Myrbetriq

Botuliunumtoxin

(Botox)

Helps

promote emptying

Flomax

Bethanechol

Slide18

Urinary Tract Infection (UTI)

Bacteria

that multiplies in the urinary tract and can cause an infection

Slide19

Signs & Symptoms of UTI

Cloudy

and/or foul smelling urine

Increase

in mucous or sediment

Increase

in bladder or

general spasms

Pain

or burning with urination

Increase

in frequency or incontinence

Low

back or flank pain

Blood

in urine

Elevated

temp/fever or chills

Nausea/vomiting

Just

not feeling well

Slide20

UTI

Asymptomatic

Not

a true infection

Colonization

Presence

of odor or cloudiness alone not an indicator

Symptomatic

Increased

spasms

Incontinence

Fever

Feeling

poorly

AD

Slide21

Detection & Treatment of UTI

Call

MD if you suspect UTI

May

need urine specimen (UA C&S) to determine if true infection

Treatment

may include use of

antibiotics

Slide22

Ways to Prevent UTI

Proper

fluid intake

2L

daily

Routine

bladder emptying

Be

consistent with bladder management

Keep

volumes below 500cc

Good

hygiene

Proper

positioning and draining of collection device (leg bag/bedside drainage bags)

Daily

cleaning of drainage devices and proper

cleaning

of catheters

Medications

Follow

up with Urology

Slide23

Conclusion

It

may take time and effort, but proper bladder management can be achieved in those with a spinal cord injury

Try

to keep a healthy urinary system by staying educated, sticking to a regimen and using preventative measures

Follow

the recommendations of your healthcare providers

Slide24

References

Paralyzed

Veterans of America. (2019, February).

Retrieved

from Bladder Management Following

Spinal

Cord Injury: What You Should Know:

https

://www.pva.org

Urologic Management and Renal Disease in Spinal Cord

Injury

. (2018). In S.

Kirshblum

, & V. W. Lin, Spinal

Cord

Medicine (pp. 332-386). Demos Medical; 3

edition

.